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Extrapolated Worlds

Home of science fiction author Doug Franklin

Category: Life as we know it

Prostate Cancer – Part 2

In which my misadventures with prostate cancer lead to medical tourism in Germany…

A couple years after my initial diagnosis and adoption of a “watchful waiting” approach, my PSA test scores started to creep up, and I started looking for treatments that didn’t involve willful destruction of my basic plumbing. There were all sorts of semi-experimental procedures that attempted to do the job, like high-intensity focused ultrasound (HIFU) and cryotherapy where they stick needles in and freeze the tumor, but at least at the time none were much better than a good old-fashioned prostatectomy. I was really hoping for the male equivalent of a lumpectomy.

Somewhere along the way I stumbled on hyperthermia, which involves jacking up the temperature of the rotty bits just enough to kill the cancer cells whilst leaving the healthy stuff intact. It seemed plausible, so next thing you know I was on a plane to Germany with my wife. Our destination was Klinik Marinus am Stein, there to submit myself to the tender ministrations of Dr. Axel Weber. 

The big idea was – essentially – to microwave my prostate, which is an organ roughly the size of a walnut, without cooking anything else. So the way Dr. Weber did this was with a machine of his own invention. The process involved placing a balloon inside my bladder that anchored a microwave emitter a fixed distance downstream, as it were, hopefully in the middle of said walnut. 

Now, there’s really only one way into a person’s bladder that doesn’t involve a sharp knife, which is through the urethra. Which in guys, exits the body through – you knew this was coming – the penis. So there I was, feet in the stirrups, with Dr. Weber leaning over me with a well-lubed microwave emitter roughly the size of a mechanical pencil, saying in a heavy German accent, “Look into my eyes!” while my wife looked on. It is a moment burned into my memory. 

Yeah. Good times. 

As a palate cleanser, I went off and trekked in the Himalaya for three weeks, which was a truly amazing experience. And also speaks to the degree to which the procedure was not destructive. But was it effective? Hard to say. My numbers went back down and stayed down for half-a-dozen years, so I thought it was a good spend at ~$8K all up (none covered by insurance, of course, because America). 

But nothing lasts forever, and about the time the COVID-19 pandemic got rolling, my PSA scores reached the inflection point of the “hockey stick” curve and threatened to go vertical. Not a good sign.

More to come in part 3!

Prostate Cancer – Part 1

Back in 2012 my employer was eager to get ahead of healthcare costs, so they launched an annual biometrics program where employees got screened for all sorts of things. The theory was that early detection would reduce the need for expensive treatment later. Oh, and of course, lead to better health outcomes for the employees, though it’s unclear to me whether that was a key driver of their decision making process.

In my case, there were two red flags, which are interesting case studies of what went well and what did not. Good news first: I had moderately high blood pressure. Not the kind of eyeball-popping blood pressure that puts you in the ER, but the kind that takes years off your life in the long run. Something like 150/110.

I am very interested in living a long time (with certain caveats, like being healthy and able to engage with the world more or less on my own terms). So taking years off my life was definitely not okay. After a few pharmaceutical experiments, I settled on a cheap medication that knocks off 20-30 points without noticeably affecting my quality of life. Note that experiments were necessary; the first couple drugs had side effects that made me question whether those nominal extra years of life were worth it. (If you find yourself in a similar situation, I advocate not sticking with the first shitty hand your doctor deals you.) So, good news, right? Problem found, problem solved.

Now the second red flag: a high Prostate Specific Antigen (aka PSA) score. A high PSA score indicates a man might have prostate cancer, or as I fondly think of it, root rot. There followed many very expensive, painful, and in one unfortunate case, life-threatening diagnostics. That last was a doozy. Everything was pointing to, “It is very likely you have cancer Mr. Franklin, but the only way we’ll know for sure is by taking a biopsy.” So the way they take a biopsy of a guy’s prostate is by sticking something kind of like a mini nail gun up the ol’ poop chute and punching a needle through the wall of your rectum, through various other layers, and on into your prostate. Twelve times.

I’m a standard-issue cis guy, so I didn’t have a lot of a priori experience about how sensitive prostates are, but lo all these years later I’ve had many things inserted into me and can tell you, as my gay brothers already know, that it is quite sensitive. Getting core-sampled with a nail gun through your poop chute twelve times produces an altered state I hope to avoid in the future. It also has the side effect of ramming whatever shit soup is still coating your gut deep into your tender bits. (This after drinking 80 ounces of yummy Moviprep strands you on the toilet overnight waiting for your big date with a nail gun.) The docs anticipate this problem and give you a huge oral antibiotic right before getting busy with their nail gun. I’m told it works for 99% of the folks involved. If you happen to be part of the unlucky 1% like me, you get sepsis, go down the proverbial drain, and get to be on a first-name basis with the staff of your local ER. 

But really this is all a long aside, because after all that fun, it turned out that my specific kind of prostate cancer was likely to grow very slowly, and could probably be safely ignored for years to come. Take note: they can actually do genetic tests on cancer these days, but you have to ask for it specifically, in advance. Even though my particular flavor of root rot was just barely on the evil side of benign, the docs were very keen on taking my prostate out as soon as fucking possible to eliminate any risk. Or to pay for their fancy robotic surgery suite, because capitalism. 

There followed a period of intense research on my part, because it seemed unreasonable, if my risk of dying of prostate cancer anytime soon was quite low, to have a procedure that would likely have life-long consequences ranging from incontinence, to not being able to have an erection without some kind of pharmaceutical or mechanical assistance, to not being able to have one at all. My read at the time was that 1/3 of men who get their prostates removed need diapers, and 2/3 were not going to have a normal sex life after treatment. That’s like putting two to four rounds in in my trusty Smith & Wesson .357 revolver and playing Russian Roulette with my junk. 

Now… I know, sex isn’t everything. And sure, I’ll give it up before I give up life itself. But if I don’t have to? If giving it up is OPTIONAL? I have friends who were in the same boat and now swear by Cialis. It was driving them crazy, sitting on a ticking time bomb whose fuse was lit, but the length of which was only sort of statistically knowable. I get it. But the saying goes that most men die WITH prostate cancer, instead OF prostate cancer. Root rot comes for all men in the fullness of time. And sex is one of my very favorite things in life.

So I said no thanks, I’ll just wait this out. Which drove the docs nuts. They could cure me! “You, with the intact prostate! Get on the table right fucking now!” But no.  It must be frustrating to know you can fix some guy’s problem for good, and have him refuse. As it turned out, I was on the forefront of a wave of refuseniks, so much so that these days a guy with my numbers wouldn’t have even had a biopsy. They’d probably wait until the PSA was much higher, or there was some kind of detectable growth or readily noticeable problem like you can’t pee. (Detectable with a finger – which is delightfully and misleadingly called a digital exam.) 

But the problem remained that I had cancer. I knew it. It was in there. So I couldn’t just completely ignore it. 

Stand by for part 2, wherein I have medical adventures in Germany…