Survivor guilt (?)

While screening can sometimes catch the very aggressive kind in time, I've read that it can often develop and metastasise in the year between annual screenings. It's almost a different disease: my oncologist told me it represents about 1 in 20 prostate cancer cases, and most typically appears in people of African or Caribbean ancestry (which I'm not).

In my case, there was was nothing visible in my prostate. They were trying to figure out where the metastasis on my spine had come from, and CT and MRI showed a perfectly-normal prostate with no signs of tumours and normal volume. After the tumour biopsy showed prostatic origin, they gave me a DRE, and the urologist thought -- just, maybe, not sure -- he *might* have felt a tiny nodule, but he didn't sound too confident.

In my case, that sucker just escaped the prostate almost as soon as it was born and made a beeline for my spine. That's what I mean by two different diseases ­— with the really aggressive kind, you might not have the luxury of years, or even months, to catch it early. And just coincidentally, for a week I was sharing a hospital room with an army vet (also not of African or Caribbean ancestry) who'd had the same experience: he was getting annual PSA screenings, and his prostate cancer just appeared out of nowhere and almost instantly metastasised.

True, although I would refuse to believe in a god who doles out special favours like surviving cancer only to those who beg and plead through prayer and denies those favours to others, or who has a cruel, complicated divine plan that involves killing millions of innocent people in wars, for example.

As pantheist, I prefer to believe in a caring deity who doesn't interfere in the physical world — it's up to humans to make the best of it or mess it up, as the case may be — but who is there to provide comfort and solace if we reach out and ask for it.

That, unfortunately, takes me back to "dumb luck" for my good response to cancer treatment so far. 🙂 YMMV

I'm with you on that deity view. Sometimes I refer to myself as a Zen-Methodist. Mostly pantheist.
Thanks

Thanks for initiating and adding too this string of posts. Yes, survivors' guilt comes in many forms. My dear wife of 53 years had multiple sclerosis (MS) for the last 20 years of it and I was caregiver. In Jan of 2022 we both contracted Covid. Mine was like a bad cold, her's started that way but the autoimmune disease modifying therapy (DMT's that suppress the immune system) sent her on a fast track to lung failure.
Could I have done more? Made her more comfortable over the years of quadriplegia? Challenged her more to retain function? And worst of all, could I have been somehow glad to be relieved the stress and strain of her cursed MS???
Don't know. And in spite of super support from our 2 grown and very wonderful sons - it still haunts me.
But life does go on. And I try, sometimes too hard, to make the most of every day. Fun and service to friends, family, and God (choose your concept) are great distractions.
(PC is now only an unwelcome distraction at this point of zero PSA's for the last 3+ years)
Blessing to all you guys and prayers you can enjoy some of all of your 'bonus years' after diagnosis.

Fortunately, the cases where “… it can often develop and metastasize in the year between annual screenings…” are so rare that it wouldn’t even make the evening news.

That’s also the reason why when PSA is being tested, both the % Free PSA and the PSA Doubling Time should also be tracked. Those additional datapoints may give an indication that something more serious might be lurking unseen that the PSA test might be missing. Also, these days there’s a PSE test that can be used that is more sensitive than the standard PSA test.

As for the DRE, these days many centers are moving away from that. The data show that if an irregular prostate is felt, that 50% of the time it’s benign; and of the 50% that were cancerous, 95% of the time an MRI would’ve picked that up anyway. (So, the value of DREs is being questioned these days, especially since many men are skipping PSA tests just to avoid getting a DRE.) If an elevated PSA is found, and other possibilities are ruled out, then go straight to the mpMRI,

How old were you when you were initially diagnosed with prostate cancer?

Fortunately, the cases where “… it can often develop and metastasize in the year between annual screenings…” are so rare that it wouldn’t even make the evening news.

That’s also the reason why when PSA is being tested, both the % Free PSA and the PSA Doubling Time should also be tracked. Those additional datapoints may give an indication that something more serious might be lurking unseen that the PSA test might be missing. Also, these days there’s a PSE test that can be used that is more sensitive than the standard PSA test.

As for the DRE, these days many centers are moving away from that. The data show that if an irregular prostate is felt, that 50% of the time it’s benign; and of the 50% that were cancerous, 95% of the time an MRI would’ve picked that up anyway. (So, the value of DREs is being questioned these days, especially since many men are skipping PSA tests just to avoid getting a DRE.) If an elevated PSA is found, and other possibilities are ruled out, then go straight to the mpMRI,

How old were you when you were initially diagnosed with prostate cancer?

"How old were you when you were initially diagnosed with prostate cancer?"

I was 56 with a de-novo metastatic prostate cancer diagnosis, which is right in the middle of the typical age range for that type. The common, more-mild type typically manifests itself later in life. Some more-famous examples of the early-onset, aggressive type of prostate cancer:

- Musician Johnny Ramone (died age 55)
- Canadian politician Jack Layton (died age 61, just 2 years after initial diagnosis)
- Music and composer Frank Zappa (died age 52)
- Actor James Michael Tyler ("Gunther" on Friends, died age 59)
- Actor Gary Cooper (died age 60)
- Musician Dan Fogelberg (died age 56)
- Actor Bill Bixby (the Incredible Hulk, died age 59)
- Brazilian soccer star Marinho (died age 59)

Until very recently, this type of prostate cancer was considered unstoppable, and expected survival time was often short. It's just 5–10 years ago that that started to change, and now we suddenly have the hope of a longer life that was denied to those men (and the many thousands of non-famous ones in the same situation).