When my doctor told me I might have cancer.

During the last few weeks I’ve had some urinary problems. Nothing too bad, not worth going into detail over, but I decided to make an appointment with my doctor to see if something could be done.

When I went in to speak with the doctor I told him my symptoms and he began to ask me some questions. The second question he asked was if anyone in my family had a history of prostate cancer.

In fact, every single male member of my family on both sides and has either had prostate cancer or enlarged prostate. My dad had his prostate removed when he was in his early 50s, which is quite young. My grandfather had cancer, but this didn’t develop until he was in his late 90s and he died, not from the cancer but basically from old-age. My other grandfather did have prostate cancer, but instead of having it removed they treated it with radiation. He died of a heart attack, completely unrelated to the cancer as he had been in remission for more than a decade. My uncle has an enlarged prostate, and as far as I’m aware it is not turned into cancer but it does give him some problems.

When the doctor asked this I told him everything, and I told him that, given my family history, I was pretty sure I was going to get prostate cancer eventually. “Not too young I hope,” he said to me right before he asked if he could check my prostate.

I’m 31 years old, and although I’ve resigned myself to the fact that if I’m going to catch cancer, prostate cancer is going to be the one I’ll get, I had assumed that it would happen in my 50s or possibly 60s. Not when I’m 31 years old, not when I’ve only just begun to start thinking of myself as an adult.

I’ll spare you the details of the exam, but my doctor was not happy with the results. He ordered several blood test, including a PSA which stands for prostate specific antigen. Somewhat hypocritically I agreed to have all of the tests done.

I say hypocritically because I’ve actually studied the statistics on cancer. I know for example that early screening is not really very effective. The false positive rate with such early screenings is rather high, and it can lead to individuals having unnecessary treatments more often than not. Of course the false positive rate is different from cancer to cancer, but with prostate cancer the evidence is fairly clear.

Setting aside the issue of false positives for a moment, and I will be getting back to that issue, ever since early screening for prostate cancer was enacted the mortality rate of that cancer has dropped significantly by about 20%, according to a recent study. However, the rate of overdiagnosis has also increased dramatically. ¹⁾Schröder, F. H., Hugosson, J., Roobol, M. J., Tammela, T. L. J., Ciatto, S., Nelen, V., … Auvinen, A. (2009). Screening and Prostate-Cancer Mortality in a Randomized European Study. New England Journal of Medicine, 360(13), 1320–1328. http://doi.org/10.1056/NEJMoa0810084

One of the problems with early screening (and there’s a little bit of debate in the medical community and since I’m not a doctor I’m not really giving medical advice here, just relaying the statistics) is the false positive rate. What that means is that there’s a chance that early screening could show evidence of a cancer existing when no cancer is present. Of course there’s also the chance of a false negative, which is a test failing to find evidence of cancer being present when there actually is cancer. When it comes to prostate cancer, the false negative rate is fairly low, but the false positive rate is a bit high. This leads to unnecessary treatment.

Because of this early detection, either with the digital exam or with the PSA test, and most of the time both are done, will be followed up by a biopsy. This is a minor procedure where a small piece of the prostate will be removed surgically and examined under a lab. This is a far more diagnostic test and there isn’t much of a risk from this.

But the real problem with early detection is that not all cancers are malignant. As the American Cancer Society puts it:

Another important issue is that even if screening detects a cancer, doctors often can’t tell if the cancer is truly dangerous. Finding and treating all prostate cancers early might seem as if it would always be a good thing, but some prostate cancers grow so slowly that they would probably never cause problems. Because of an elevated PSA level, some men may be diagnosed with a prostate cancer that they would have never even known about at all. It would never have led to their death, or even caused any symptoms.

There are two issues here. First, some cancers grow so slowly that they may never do a person any real harm. This was the case with my grandfather: he was in his early 90s when the cancer was detected and they were fairly certain that it was cancer, but since prostate cancer grows so slowly and he was already past the standard life expects for his generation there was no reason to put him through a surgery surgery which, at his age, may actually have killed him.

Second, and related to the first, because prostate cancer grows so slowly early screening may detect cancer that wouldn’t even have begun to show symptoms and an individual for another decade. Which leads to surgeries and radiation, which may not even be medically necessary. Unlike the appendix, the prostate is a necessary organ. You can survive without it but it does lead to some problems, like incontinence and impotence.

For myself, I’m in a bit of a limbo. Since I already am having physical symptoms, this isn’t exactly early detection but rather a screening to rule out a possible cause. It could be that I have an infection of the prostate, or an enlarged prostate, neither of which are cancerous nor deadly. But I am having symptoms and so the doctor was right to order the screening.

Another issue, and this is the issue that worries me slightly, is the fact that I’m so young. Prostate cancer in a 30-year-old is not unheard of, but it is a statistical abnormality. If I do have prostate cancer, and that’s a big if because I haven’t seen any test results and statistically speaking the odds are in favor of me not having any cancer at this age, it may eventually turn malignant. In a few decades. Unless of course I have some sort of very rare and very aggressive cancer. But the odds of that happening are very very low, and I’m not going to waste time worrying about that until I have test results back.

So should I have gotten the PSA? Yes, because I’m having symptoms that might be prostate cancer (but are almost certainly not). Again, given my family history, I’ll almost certainly be getting prostate cancer eventually.

The real question is, if I have cancer what should be done? Since prostate cancer grows very slowly it’s not likely to kill me anytime soon. It may be that it can be treated with radiation or chemotherapy. Or it may be that I can safely wait a few years before any treatment is necessary. Honestly I’m going to do what my doctors recommend because they are the experts.

The only thing I can do right now is wait. As I’ve said, I almost certainly don’t have cancer. But even if I do, will I change my diet, switch to non-GMO, Organic juice cleanses in an attempt to have my body cure heal itself? Certainly not, because those things don’t work. Medicine works and that’s what I’ll put my trust in.

Media Credit

The featured image for this article is Ilmicrofono Oggiono. It is available under a Creative Commons Attribution 2.0 license.