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September is prostate cancer awareness month.

This is an edited excerpt of my response to recent exchanges I had with a couple concerning a health issue. The husband is nearly 71, and he and his wife are facing decisions about the prostate cancer evaluation process.

G: Prostate cancer evaluation is not easy to go through. There are plenty of reasons it is a frightening place for men.

Prostate cancer is the 2nd leading cause of death (Lung is number 1) in men. For prostate cancer that has spread beyond the prostate, the survival rate at five years is scary. Treatments can extend the years, but they can come with miserable side effects.

I think it is wise to have at least two and even three consults with different urologists. Certain men who may be at risk, may be candidates for a newer test called the 4Kscore, to have it worked up with the older test called the PSA (prostate-specific antigen).

Despite what some may believe, the PSA is not useless. Now that there is the 4Kscore test, the PSA can play a pivotal role in the diagnosis process.

When the 4Kscore test result is used in conjunction with the PSA result, it has been shown to be a game changer. Have the urologist explain this relationship, and seek all the latest information about how the diagnostic evaluation can lead you to the best option that works for your needs and goals.

But briefly, the 4Kscore test is designed to work toward evaluation of one’s risks of having the lethal (aggressive) form of prostate cancer. Urologists use the 4Kscore numbers along with the density and size of the prostate, and with the PSA number, to arrive at a percent risk number of one’s risk for having the lethal (aggressive) form.

This information then is used to decide whether or not a biopsy is recommended. But even before a biopsy is considered, the urologist may want the patient to do an MRI.

This combination: 4Kscore/density-size of prostate/PSA combo has helped minimize biopsies and treatments in those who may only have a more benign prostate issue, or the type of prostate problem or cancer that is more “safe”/not life-threatening.

There are prostate cancers found in men who do not have any enlargement of the prostate or who do not have any abnormal feel of it during the digital (finger) rectal exam. So, in my opinion, a man should not just rely on the prostate “feels” OK.

Many physicians no longer do the digital rectal exam frequently enough to have the wealth of experience to know what they are feeling or not feeling. Have it done by a very experienced urologist, someone who has dealt with many prostate cancer cases so you are more confident in their medical opinion.

The sad truth about prostate cancer is that often it is there without any symptoms at all.

My recommendation is to collect as much data as one can at this point as it won’t hurt. A patient still gets to decide what is right for him. It is a great idea to have the “baseline” information, if a man opts to go the wait and see, watchful waiting, route. Especially as a man ages, this data from the various tests could be of tremendous help, and used for relative comparative purposes.

A man can always choose what to do or not to do with the data and analysis the urologist reveals. But until a man is fully evaluated, he only has partial information and that is insufficient to make a fully informed decision.

What a man who has a concerning PSA number or a rising PSA number, or who may also have a 4Kscore result that indicates a greater risk of prostate cancer, decides to do or not do with these results is still in his control.

He can always choose to do nothing or have additional testing, and perhaps begin a treatment plan when options are the greatest.

Having said all that, my highest spiritual guidance includes for him to make appointments with several urologists for consults. Now that the boomers have aged into the prostate cancer risk bracket, there are long waiting times to get in for a consult. So, best not to needlessly delay getting an appointment scheduled.

Age does increase a man’s risk of prostate cancer, but so do several other factors.

Be sure to reveal if there is any family history of prostate cancer, any known co-morbidities such as high blood pressure, over weight/obesity, insulin resistance or any symptoms, for example, that may be related to the prostate, such as bleeding, pain, or difficulty with urination.

The uncertainty phase is an anxiety/stressful stage not only for a man, but can be hard on his partner or those close to him. There is a lot of information to process.

I am not a doctor but I have been in this prostate world since 1980 when a customer with metastatic prostate cancer came into our health food store seeking information about what nutrition and/or supplements might help.

My eyes have been open ever since then, and got widened when both a relative and a dear friend got diagnosed with metastatic prostate cancer. I learned way more than I wish to know about all those horrors of spine and hip pain that does happen once the cancer has left the prostate and settles in those areas, the first spots where it frequently spreads.

Between years of opioid painkiller dependency and the severe treatments of radiation, chemo and chemical castration that led to breast lumps that grew and needed to be treated, along with sleep disruption, hot flashes, severe mood swings and debilitating depression, it is nothing I would want anyone to go through.

Thorough evaluations may reveal a man does not have aggressive/lethal prostate cancer, and that would be cause for celebration.

But if a man does find that out, my hope is that it is found sooner rather than later, when he still has the option and can get a cure, and not when it is out of the barn as they say.

Like it has been said countless times before, early detection can save lives. And suffering.

I caution anyone facing a cancer concern about the bias that can exist from seeking confirmation.

My own bias is based on what I have learned through my study, and what I have experienced with at least eight men in my circle (that I counted, there may be more!), who have addressed the prostate challenge.

I feel for anyone going through this health issue as well as those who are supporting their loved one as they sort through the treatment options.

I encourage every man in this situation to talk with other men in their circle who have gone through all of this – from testing, to biopsy to treatments so he can collect as much info as possible and make a decision that is fully informed.

But the bottom line is pretty basic: Only an actual biopsy, not talk, can provide the definitive diagnosis of what type of prostate cancer.

Go forward in peace and without fear or anger to retain one’s quality of life for as long as it may be.

Email Giselle with your question at [email protected] or send mail: Giselle Massi, P.O. Box 991, Evergreen, CO 80437. For more info and to read previous columns, go to www.gisellemassi.com