Column from the Marion Star

This is a portion of the column I published in The Marion Star today (Sunday 7/2).

I haven’t added to this blog in a long time because I have been stuck on the next step.

I want to continue to write about the prostate cancer – I still have a lot to report – but my life has been consumed by the rectal and renal cancer.

This sort of sums up my attitude right now. I promise to get back to this soon.

Column follows:

I had a job about ten miles out of town and no car. I didn’t have any money, so I borrowed a bicycle from a friend and started pedaling back and forth.

When I got a few bucks together I bought a blue Motobecane ten-speed from a local bike and ski shop.

I took that bike on some great rides. When I was the best man for a friend’s wedding, he and I rode 100 miles in one day to his bride’s hometown. I used to ride to the top of Dannemora Mountain to get a sip of spring water before barreling back into the Village of Dannemora with my nose about three inches from my front wheel. I rode my Motobecane through the desert in Arizona in August (not a smart idea).

I wrecked the bike while on my way to a job interview in Denver, Colo.I have owned a few bikes since then, but the Motobecane will always be my favorite.

I never raced, because I didn’t see the joy in the pain of bicycle racing. I like riding long distances at high speed, but I also like stopping when I see something interesting, like a “cold beer” sign.

All of this is an explanation of why I was so interested in the interviews Lance Armstrong was giving last week on television.

Armstrong and I have cycling and cancer in common. His cycling and cancer were a little more intense than mine, but I still feel a kinship.

Jon Stewart asked the obvious question. “How did you do it?” he asked. How did he go from a death sentence to the best cyclist in the history of the sport?

It’s all a matter of perspective, Armstrong said. You take things more seriously after recovering from a serious illness. Your job becomes more important, you look at things differently, you realize what’s important and what’s not, he said.

As I watched the interview, I was a few weeks past my chemotherapy and radiation treatments and a few weeks away from my eventual surgery for growths in my rectum and on my kidney.

All I could think of was, perspective or not, Armstrong has certainly set the bar high for cancer survivors.

I looked at my wife and laughed, “What am I supposed to do,” I said, “win seven Pulitzers?”

“No,” she said, “just one.”

She didn’t necessarily mean one Pulitzer. She meant one anything. Pick the thing I wanted to do and do it. Don’t let this incredible reminder of what’s important get away.

At least, I think that’s what she meant.

Lance Armstrong didn’t really set the bar high at all. Lance Armstrong won the Tour de France seven times because after he beat cancer he realized that the only thing that could stop him was himself.

It shouldn’t take cancer to remind us of this. We live in the greatest, most free country in the history of the world.

The Fourth of July should be enough to remind us that we all have the tools and the freedom to go and be and do whatever we want. In this great country we alone limit ourselves.

The beauty of television

I was in the hospital for four solid days following my prostate surgery. I kept the TV on the entire time.

I had a portable CD player with some Tragically Hip discs, but I didn't listen to them once. I bought the CD player specifically for the trip to the hospital.

Except for the few hours after coming out of the operating room, I can't recall sleeping a wink in the hospital. I know I must have, but it never felt like I did.

The TV helped me sleep. I was watching the first episodes of "24" and "The Best Damn Sports Show Period." I hated them both.

There were a lot of crazy old movies. On the last day, I remember sitting with Mary while we watched some crazy Tarzan knock off.

I have not been sleeping much in my current situation.

When my port was first installed, I was taking Vicodin to dull the pain and that seemed to help me sleep.

The docter later prescribed some Ambian and that helped for two nights. Now, the only thing that works is the TV.

With the TV on I can sleep a complete night. If I am in bed, I get up every hour to do something – pee — look out the window — look at Lucy — check the damn e-mail.

I hope I have a TV in my room this time. I am looking at 7 days or so.. I need my sleep. 

Why am I doing this?

Obviously I don't have the time for it. I have a more than full-time job that requires my attention  7-days a week (I would say 24-7, but I do sleep about six-hours per night and I have been spending a lot of fruitless time in the bathroom).

If you are my friend, some of this stuff you heard before in bits in pieces at parties or budget meetings at a newspaper.

While, I hope my friends care and that they are worried about my family and will jump in to help them if something horrible happens, I am not looking for sympathy.

I really do find all of this interesting.

When I first learned I had prostate cancer, I had a very difficult time finding any useful information.

It was either so technical that I couldn't understand it, or so dumbed down and lacking in detail that it was useless.

The other night I got a call from a friend telling me that her father-in-law was having a prostate screening and she needed to give her husband some words of encouragement.

For one thing, he heard, that the biopsy he was about to have was very painful.

"It's not," I said. "It certainly sounds painful. It's not fun. It's uncomfortable. It is not something a reasonable person would look forward to, but it is not something to dread."

I described the procedure in an earlier post but I will reiterate here.

A TRANSRECTAL NEEDLE BIOPSY OF THE PROSTATE GLAND, WHILE UNCOMFORTABLE AND DISTURBING, IS NOT PAINFUL.

You don't get up off the table and want to dance a jig. You have to stay off a riding lawnmower, bicycle or motorcycle for a while. You have blood in your urine and in your semen. But, I can guarantee you have had more pain on the dentist chair.

My current situation:

I'm on my last week of radiation therapy and my last week of chemotherapy for treatment of my rectal cancer.

The radiation fields are being reduced to two – they will be shooting the beam at either hip beginning today and skipping the shot at the middle of my back (butt). I will still get the same amount of radiation – just concentrated more.

The chemo therapy is being administered by a pump that is attached to the port in my chest. At this moment I have had 8.3 ml of 5FU administered since about 11 a.m. yesterday. The total amount I will receive is 55 ml. I should be done at 11 a.m. on Saturday, May 27.

Thursday is my 10th wedding anniversary. Last night we decided that we would do little to mark it. The preliminary plan is to wait until we get a bunch of stuff behind us this summer and have a Graser Family Thanksgiving (maybe in September). Then we can still celebrate Canadian Thanksgiving and American Thanksgiving.

I weigh about 240 pounds now, the most in my life (I played defensive line, noseguard, at good old PHS at 160 pounds and was a varsity wrestler in the 119 pound weight class (I was horrible). The weight now is good. The doctors want me to keep it on. Weight loss, I suppose, is a sign that the cancer is winning.

I was in the treatment room at the oncologist's office yesterday with two older women who were asking everybody who came in a ton of questions. It was their first treatment and they figured everybody else was a veteran. I know they had talked to the doctor and to the nurses before they got to this stage of their treatment, but now, they wanted real answers from real people. "They told us what is going to happen – but what happened to you?"

That's another reason for this blog.

I was a little hesitant to tell them. One of the ladies was getting 5FU but she was getting it in five sessions at the office rather than through a continuous pump – like me. She was also being treated for stomach cancer and had already had an operation. All very different from my situation.

I would hate to tell her that the 5FU as a piece of cake. It has been easy for me, but I have spoken with other people that had a horrible time with it.

"I have found through my treatments," I said. "That you can get used to just about anything."

They agreed.

One of the women was 84 and had some sort of bone cancer. She told me she wasn't interested in any treatment at first. She was going to leave it up to God. Her doctor convinced her that God might want her to have the treatment – without it she would surely die, with it she had a chance for many more years. You would never guess she was 84 – she looked to be in pretty good shape.

I don't want to be fighting cancer when I am 84, but if I have to, I will. Even at 47, there have been times when I thought that maybe it would have been so much easier to not say anything about my situation and let nature happen.

Then Lucy comes in the house all covered in mud and magic markers and I resolve to never give up.

Next time, I will write more about my recovery from prostate cancer. In the meantime, if you have any specific questions let me know. I can only tell you what I know from my experience and everybody's differs, but still, it's an answer you might not find anywhere else.

Check out An Inch an Hour for more day to day stuff with my current treatment.

Making decisions and removing your catheter

Any decision that anyone makes about cancer treatment is incredibly personal. Every situation is unique.

When I decided to have my prostate removed at the age of 42 I had to consider some definite consequences.

Number one would be that my natural reproductive life would be over. If Mary and I wanted to have another child we would have to use artificial insemination.

On the one hand, that is kind of devastating, but on the other it is kind of reassuring.

It does put your future reproductive life in the hands of technicians, but it also gives you a sense of immortality – as long as the storage company doesn't suffer a catastrophic power failure or you credit card gets turned down.

Also, the doctors warned me that it would be more than a year before I would be capable of an erection and much longer before that particular function would ever return to normal.

The unabashed truth is that it never returns to normal – More on that much later.

At the time that I made my decision, alternative treatments offered at best 12 to 15 years before a likely recurrence of the cancer.

If I were 70 my decision would have been much different – I think. The conventional wisdom at that age would be to take radiation treatment or freezing and hope that something else kills you before the cancer comes back.

I was, and am, planning on getting well past 67 – so surgery was kind of a no-brainer.

I have since read about and met several people who chose alternative treatments.

Some chose the alternatives simply because they were afraid of the surgery and the consequences.

Living with a catheter for three weeks or so, facing an extreme sex-life challenge, fear of incontinence and the pain and discomfort of major abdominal surgery are very real things to think about – but for me I believe it was worth it.

It also wasn't that bad. I have learned that you can adjust to just about anything.

I got pretty good at changing from my bedside catheter bag to the one that strapped to my thigh for traveling and visiting.

I went to Thanksgiving dinner at a friend’s house with about 15 other people with the bag strapped to my thigh and had no problems.

I went for walks in the neighborhood and horsed around with my one-year-old daughter.

I do have to admit that the removal of the catheter was something that I will remember always.

I was on a table in the urologist's office. There was an opening in the table between my legs.

The catheter, of course, is a thin tube threaded up your penis into your bladder, there it is held in place by a little balloon and some stitches that go up to a button on your belly (yes a real button – like you might have on a cardigan sweater.)

I am not sure if the button was unique to my guy – but I still have it somewhere.

"You are going to feel a little pull and then it is going to sting for a minute or so," he said and then pulled the tube out.

It didn't take very long and didn't hurt at all, at first.

He jammed all the stuff into the hole in the table and then headed for the door.

"Someone will be in to help you in a minute," he said and dashed into the hallway.

"It doesn't hurt that …." I started to say and then sat straight up in with an incredible burning feeling. I chewed on the heel of my hand while my eyes filled with water.

Soon the patient assistant – the same guy who had helped me through all my biopsies came in the room.

The pain actually lasted for exactly a minute and then diminished completely. A later "scoping" of my urethra was much worse.

He helped me sit up on the table and then noticed what I was wearing (navy blue sweat pants).

"It is so smart to wear dark pants," he said. "You would not believe how many old men come in here wearing khakis!"

He laughed and then praised me again when I showed him the infant diaper I had brought.

"That's perfect," he said. "You don't need nothing fancy, but you do need something."

The infant diaper was left over from Lucy when she graduated to bigger wrappings.

I fits right over all your stuff and is held in place by your pants. You don't have to worry about losing an entire bladder load, you just have to protect yourself from a little seepage.

recovery

I woke up in the recovery room telling the doctor that I had to pee.

“We’ve inserted a catheter,” he told me. “that’s just pain you feel.”

Well, it felt like I had to pee. I felt pretty good almost immediately.

I can’t remember when I saw Mary. I know she was with me when I got to my room, but I have no idea if she was in recovery or not.

It was pretty typical.

They had me hooked up to all kinds of monitors. A blood pressure cuff blew up automatically about every 5 minutes and I had oxygen blowing up my nose.

My major first discomfort was a sore throat from the intubation.

When I got to my room I turned on the TV and learned that U.S. forces had entered the city of Kabul.

I grabbed the phone and called the office.

“Have you got this posted on the Web site?” I asked the person who answered the phone.

“Is this Graser? Aren’t you supposed to have surgery today?”

“I had surgery and I am in my room and watching TV and we just got troops inside Kabul. Have you got it posted on the Web site?”

“Are you nuts? Get off the phone and don’t worry about the Web site.”

Anyone that has ever had abdominal surgery will tell you that some of the worst pain comes from gas.

It was a solid five days before I had a decent bowel movement and until that time my belly was round with gas.

I couldn’t see much, but I had a row of staples that started from just below my navel and went almost as far as you could go.

There was a button sewed to my belly and a clear rubber bladder attached to a drain.

Of course there was a catheter coming out of my penis to a bag hanging on the side of my bed.

The nurses were wonderful. They gave me all the painkillers I wanted, flushed the catheter and emptied the bag.

Early in the first morning when one suggested I sit up on the edge of the bed, I thought she was nuts. But, I made it and later that day I was doing slow, shuffling walks, pushing my IV pole with a bag of fluid at the top and my catheter bag on the bottom.

I developed a fever in the hospital and ended up staying 4 full days.

I got home late Friday night.

I was really afraid of going home with the catheter. I was sure I would catch it on something and rip a hole in my bladder. But it turned into something routine. Of course, in the beginning Mary helped a lot and you can’t say enough about a wife that will empty your catheter bag for you.

Of course, getting out of the hospital takes forever. They had to remove the drain – you would not believe how long the rubber tubing was that was stuffed inside me. And all sorts of people had to get paperwork signed.

If you took me to that hospital today and asked me to find my room, I could not do it.

I have no idea what part of the building we were in. It seemed like the wheelchair ride was over a mile with three different elevators.

My mom and dad were there when I got home.. I missed dinner. But I did get a piece of cardboard lasagna at the hospital.

I hadn’t seen Lucy the entire time.My clearest earliest memory was that she was gaga over two books.”Brown Bear, Brown Bear,” which I sort of liked and “Man Gave Names to All the Animals,” which I hated with all my heart.She wanted me to read those two books over and over. I couldn’t refuse, even though one literally made me sick.When I could get out of bed, I used to hide the book and she would find it and bring it back.

Convalescence at home was really sort of nice.

More on that later.

My column on marionstar.com today

 Here is the column I published in The Marion Star today and on marionstar.com:
Learn from my experience: See your doctor regularly

When I was 41, I had a blood test returned that indicated that I might have prostate cancer. No one was too concerned.

One doctor explained that the blood test was the only factor against me. My age and family history, which are very important, suggested that cancer was not a great possibility.

We kept testing, however, and eventually it was determined that I did have cancer.

I did what my doctors suggested and had surgery to remove my prostate in November of 2001.I was glad I caught the cancer early, before it had a chance to spread, and I was glad I worked at a newspaper.

Until I had a prostate specific antigen test (PSA), I had never heard of one. I had read plenty of articles about prostate cancer. But, I wasn't paying attention. Cancer happened to other people and prostate cancer was an old man's disease.

Since my diagnosis, I have made it a practice to write at least one column a year urging other men to have physicals. I am not arguing for blanket prostate cancer screenings. I am arguing for a healthy relationship with your family physician. Or at least having a family physician.

Having a good relationship with my family physician very likely saved my life.

At the Star, we try very hard to have a locally written editorial each day.

We try to make the topic local and relevant. Sometimes that's a tall order.

Personally, I could write an editorial a day about litter and one way streets, but we don't want to brow beat. Often we just want to spark conversation or pat somebody on the back.

Early in March I was stumped for a topic, when I read a press release on the visit of a giant replica of a colon to a nearby shopping mall.

March is Colorectal Cancer Month. It is also Women's History month and no doubt each day in March has been indicated by someone somewhere as national something-or-other day.

Honestly, if it is not National Muffin Day, it's Bring Your Cat to Work Day.

Colorectal cancer, like prostate cancer, was something that I have read and heard a lot about over the years. It seemed important enough to merit an editorial urging people to be alert to symptoms and to see their doctors if they suspected anything.

When I started typing a list of symptoms into the editorial I started to notice a disturbing trend.

I had a yes answer for each symptom except, of course, the one for unexplained weight loss.

I had been ignoring them, thinking it was a diet thing and that it would pass when I got over my current pierogi and hot dog kick.

I talked to my wife, she called the doctor, we scheduled a colonoscopy and now I am undergoing treatment for rectal cancer.

In the process of diagnosing the rectal cancer we discovered another suspicious mass on one of my kidneys. The diagnosis is still out on that one but it is likely cancer as well.

We are not too alarmed. We have good, aggressive doctors and again, we have caught this one fairly early.

But a day doesn't go by that I don't think about that editorial and about how I was too ignorant to act on what now seem like obvious symptoms.

I am so glad I work for a newspaper. The people I work for are kind and understanding and we have decent insurance.

Most importantly, however, it gives me a chance to use this space to urge all of you to make sure you have a healthy and regular relationship with your doctor. Make sure you are paying attention to your body and are not afraid to ask questions.

Cancer is an awful disease, but it can be beaten. You have to catch it early and you have to be aggressive.

Before summer is over I expect to be back to normal.

And now I know the topic of at least two columns per year.

Getting Ready for Surgery

It was a busy year for me.

My daughter, Lucy, was approaching her first birthday.

I had been put in charge of the copy desk just as we were transitioning to a new software program and almost as soon as that was complete they made me the online editor, again, just as we were beginning to use a new software system.

Shortly before my final prostate cancer diagnosis, the managing editor phoned me to tell me that somebody had flown a plane into the World Trade Center and could I come in to work a little early to post some stories and coordinate our Web coverage.

I remember telling Mary that I thought I would be gone for an hour and that I would come back for lunch before going in for my usual evening shift.

I ended up staying longer than an hour.

It was exactly nine days after the attack when I was told I had cancer.

I might have mentioned before that I got the news on my birthday which I share with Lucy.

Prostate cancer is, for the most part, an old man's disease. When I started looking around for information on fertility after prostate cancer, I didn't find much. It is, really not much of an issue.

Mainly because, as I was soon to find out, there is not much in the way of fertility after prostate cancer.

The prostate is, of course, where your semen is made. The sperm come from your testes but they have to have some sort of medium to get to where they gotta go and that is where the prostate comes in. No prostate, no semen, no transport for the sperms.

We went to see the urologist with Lucy in tow shortly after he called with the diagnosis.

I had a bunch of questions, but I was already sure that the only course for me was a radical prostectomy. Any other treatment such as radiation, at the time, only bought you about 12 years before returning. My plan was to live much more than 12 years. The radical surgery eliminates the problem.

"Is this your only child?" the doc asked us?

"If you want to have more, you have to bank some sperm," he added.

So, three minutes after finishing our consultation with him and setting up surgery dates we were across the street at the fertility clinic finding out about the storage of sperm.

It's a fairly simple process. You pay about $1,000, go into a room with some magazines and they send your essence off to Atlanta where it is kept frozen until you call for it.

Oh, and every year they send you a bill for another year's storage.

The surgery was scheduled for Nov. 13. I remember one friend wondering about how serious they were, if they were going to wait almost two months to do the work.

One reason for the delay was that the doctor wanted me to bank my own blood. Another reason is just that there are so many things you have to take care of.

One was getting an HIV test. You can't bank sperm unless you have an HIV test. The urologist ordered the test as part of my pre-surgery work-up although it is usually not a part of that.

Our insurance would pay nothing for fertility treatments and that was his little way of helping us out.

What it meant to me was that every time someone looked at my chart they saw that I had had an HIV test and they were required to counsel as to the results. I got the little boilerplate spiel at least three times on the morning of my surgery.

Now they are doing robotic keyhole prostate surgery, but way back then in 2001, it was lay 'em out on the table and split 'em open abdominal surgery.

I shaved my head before the surgery, because I knew I was going to spend at least three days in the hospital and I didn't want to look like Billy Bibbet from "One Flew Over the Cuckoo's Nest."

The doctor told me later that his heart leapt when he walked into the operating room because he didn't recognize me with my bald head and thought he was in the wrong place.

I worked until the day before my surgery. That last day I was mostly sending e-mails telling people what to do while I was away.

We actually had a new editor have her first day in the newsroom on my last day.

"You're having surgery tomorrow?" she asked me. "What are you doing here? Aren't you scared?"

I think I was more afraid that they would find out that they didn't really need me at the newspaper. And, truthfully, I was scared that if I made a big weepy deal of this, other guys I cared about would avoid testing. I didn't want that.

My parents came to Asheville to stay with Lucy while Mary took me to the hospital. It was very early in the morning and I only remember the highlights – putting hosiery on my legs, being visited by a nun, getting counseled for my HIV test.

The next thing I knew I was in recovery.

It is sad to say that I have a lot of experience waking up from being anesthetized, but I do. And, I always wake up talking – I am sure I am always saying something stupid.

Between biopsies

A lot happened between biopsy one in the doctor's office and biopsy three at the hospital (besides biopsy two I mean).

We got pregnant twice. One ended in miscarriage. We started trying to get pregnant a little sooner that recommeneded after the miscarriage because of the upcoming first biopsy. The second pregnancy, of course, turned out to be Lucy.

I also went through a lot of moods.

At first I was convinced I had cancer and was angry that the doctor could not find a way to confirm it.

Then I became convinced I was just some sort of freak with wacky PSA.

Then I swung back to cancer again.

After the third biopsy samples came back positive, we didn't have a lot of time to think about anything. The doctor immediately swept us into the system and we were under the knife in about a month. It would have been sooner but they wanted me to bank my own blood.

After the operation, I became convinced that I didn't really have cancer and that the doctor was just trying to justify all the procedures.

Now, I am convinced that I did have cancer and that I was extremely lucky to have doctors who kept searching diligently.

The odd thing about my prostate cancer is that I had no symptoms. The only suffering I did came directly from the surgery and its aftermath.

With the rectal cancer I have now, I know something is going on. I can feel it – although lately it has been feeling better –

And I have seen it both in the picture behind the link and in a CAT scan.

There is no doubt about this cancer, but I am still hoping somebody made a horrible mistake.

More about the surgery prep in my next installment.

KY is your friend

The transrectal needle biopsy is not nearly as awful as it sounds. I had three of them, but only two while conscious.

The idea is to take a number of samples from all areas of your prostate for a pathologist to examine.

The worst part for me was the self-administered Fleet Enema.

I think every doctor is different, but my guy wanted me to do this a few hours before the procedure.

The instructions on the box are fairly simple to read and fairly difficult to follow through on.

They assume that you are nimble enough to reach behind your back and perform small motor tasks with accuracy.

You also have to consider that it is an emotionally sensitive event. You know that in an hour or so there are going to be three or four people huddled around your butt seeing whether you did a proper job with your enema. That's a little bit of pressure.

The only plus side is that the enema does give you a "clean" feeling. If it were not so unpleasant I could see why people have them voluntarily.

For the procedure, you strip down, put on one of those ridiculous medical gowns and lie on your side with you face to the wall and your knees slightly bent.

The doctor, who will never look you in the face after this, enters the room and starts to explain the procedure.

My guy explained the spring loaded gun he was going to use to shoot a needle through my rectal wall, guided by a view from an ultrasound, into my prostate and quickly out again with a tiny little sample.

"You will feel it," he said, "but it won't actually hurt."

He then fired the needle gun and reloaded it.

It sounded almost exactly like the cheap plastic dart pistols we had as kids. You could hear the spring squeaking when he cocked it. I was afraid to look. I was sure I would see a bright orange plastic gun and a blister pack on the floor.

My doctor must have had some sort of deal with the fine folks at KY Jellies because he wasn't shy about its use. He greased up my backside and inserted his devices.

It wasn't painful. It was uncomfortable and strange. I tried hard to relax.

He positioned the device and fired off the first shot.

Flick a finger from your right hand on the heel of your left hand. That's what it feels like – only it is inside your butt.

He took his time repositioning before each shot and the only discomfort I felt was the anticipation.

After he took four samples he had to shift the ultrasound wand to aim at the other side of the gland.

The rotation of the device made it feel like it was shaped like a hockey stick. As I recall this was the most unpleasant feeling of the day.

The next three samples went pretty fast.

I stared straight ahead at the wall about 6 inches from my faces.

The nurse, who had been silent, gently put her hand on my shoulder and leaned close to my ear.

She said with a smooth honey-laden southern lilt, "Just one more, honey."

The New Yorker in me sprang to the forefront.

"You think I'm not counting?" I said.

As soon as the procedure was over the doctor and nurse snapped off their gloves and were out the door in a flash. The patient's assistant, an elderly black fellow, who I immediately loved, came in the door to help me get up and get cleaned off.

As I stood in the middle of the examination room floor trying to wipe the KY from between my cheeks with wads of Kleenex he said, "The only way you're gonna get that clean is to go home, get in the shower, spread out your cheeks and let the water sluice on through."

He was right.

Of course for a few days I had a good amount of blood in my urine.

GRAPHIC CONTENT WARNING

The weirdest side effect however is that for a few weeks, my semen was bright red in color. Very strange.

The only other strange thing is that while the biopsy came back negative subsequent PSA tests kept coming back with more and more disturbing numbers.

That led to my second biopsy, which again, came back negative.

Finally, I met the urologist at the hospital, where they gave me a general anesthetic and performed a biopsy where they took 20 samples instead of 8. It was two years since my first PSA test – this one came back positive.

I got the news on my 42nd birthday. It was also my daughter Lucy's first birthday – Hurray!

My initial reaction

The PSA test is pretty simple. If the result come back under 4.0 you are fine. If it is over four (and exactly what is being measured, I have no idea) you need more testing.

PSA stands for Prostate Specific Antigen. When you pass the 4.0 threshold you have another blood test to measure your "Free" PSA. The lower your free PSA is, the more likely it is you have cancer.

When my family doctor called me to tell me my PSA was over four and that he wanted to see me again and send me to a urologist, I sort of panicked.

I immediately jumped on the Internet and was panicked even more. I foolishly joined a list serve where I started asking questions.

"With numbers like yours, there is no doubt that you have cancer," one person said.

Another gave me a list of tests that I should insist that my doctor order.

I sent my doctor a letter (yes, an actual snail mail letter) listing the tests I wanted.

When I went to see him, he explained that the possibility of my unusual PSA test being cancer was very low. Plenty of things could be causing the reading.

The tests I wrote to him about, he said, he had never heard of. He looked them up and said they were pretty old-fashioned and not used anymore.

He calmed me down and I vowed to stay off the Internet when it came to health questions.

Most of the well-known sites, like Web MD, were so generic, that the information was pretty much useless.

The sites that were run by victims or advocates were shrill and scary and often inaccurate.

Here is the funny thing I have learned about cancer: While it is just a suspicion, health-care providers move rather leisurely. I remember waiting a week or two before I could see the urologist and then all he did was order another PSA test and make an appointment for another week later.

Once cancer is diagnosed, however, they move fast and their schedule becomes your schedule.

So, the urologist ordered a PSA test and a free PSA test. The PSA test came back a little higher than the one from my family doctor and the free PSA test came back low.

All tests indicated that I must undergo a needle biopsy.

They tell you it is a needle biopsy, but they don't give you the full name – It's a transrectal needle biopsy.

I am going to let your imaginations play with that for a while and add more to this site later.