You’ve had the PSA test – or more likely, several of them – plus the digital rectal exam, and one or both of these suggested that you needed a biopsy. The biopsy was not fun, but you did it, and then you waited for a pathologist to look at the tiny, needle-sized cores of tissue removed from your prostate. Maybe you managed to forget about it while you were waiting – maybe you feel perfectly healthy, and this all seemed surreal. Or maybe you let some dark thoughts creep in, and you started thinking about cancer and remembering everyone you ever know who has had cancer and not done very well. The waiting’s over now. Your doctor has just given you the news: there’s cancer in there. What are you going to do?
The very first thing you should do is, don’t panic.
If you have cancer in your prostate, it didn’t just spring up like a mushroom. It has been there for years, maybe even a decade, growing very slowly, taking a long time just to get big enough to be discovered. “Even in a fairly aggressive form, prostate cancer grows slowly compared to other cancers,” says urologist and molecular biologist Christopher E. Barbieri, M.D., Ph.D., on the faculty at Weill Cornell Medicine/New York Presbyterian.
What this means for you is: brush the dark thoughts away. Nobody wants to have cancer, but if you have to have it, there has never been a time of more hope. There have never been better treatments. There have never been so many men not dying of prostate cancer, and not having bad side effects from treatment.
You are going to get through this.
If your cancer was diagnosed through regular screening, that’s an extra reason to be upbeat: Just a couple of decades ago, before the PSA test and regular screening became widespread, most men didn’t know they had prostate cancer until it was often too late. Either it had gotten advanced enough to cause symptoms like back pain or urinary problems, or it was big enough for a doctor to feel it during a rectal exam. Many men used to be diagnosed when cancer was no longer confined to the prostate, and was more difficult to treat.
That’s no longer the case. Thanks to regular screening, most men are diagnosed at least five years earlier than they used to be. Most men are diagnosed with cancer that is very curable. In fact, many men are diagnosed with cancer that maybe shouldn’t even have been found – cancer that doctors call “incidental,” which means it’s just there, but it doesn’t do anything. It just sits there in your prostate, just a few very slow-growing, not aggressive cancer cells, and you could have lived your whole life never knowing they were in there. Many men die with prostate cancer, not of it.
So the second thing you need to do – the first, remember, is do not panic – is figure out just what kind of prostate cancer you have.
If you were diagnosed at a smaller medical center, doctor’s office, or hospital, it’s a good idea to have your biopsy results sent out to another pathologist at a large medical center, where they see a lot of men with prostate cancer, for a second opinion. Prostate cancer can be tricky to interpret, and it’s a good idea to get a second opinion from somebody who specializes in looking at it – not breast cancer, not ovarian cancer, not colon cancer, just prostate cancer.
The third thing: Take your time.
Once you know what you’re dealing with, your first reaction should not be, “Oh, my God! I’ve got to get this out of here!” or other words to that effect. Do not feel rushed to get treatment right away. First of all, your body needs several weeks to heal from the biopsy. Second, now is the time – and we can help; read over the information we have here on this website, and check out some of the resources mentioned here – for you to figure out which treatment is right for you.
Remember, that cancer has been in there for a long time. It’s not going to grow very much over the next few weeks; in fact, it may not grow at all. Regularly scheduled monitoring over time, called active surveillance, may be an option. If you and your doctor decide you need surgery or radiation to kill the cancer, you then need to find the best place – it may be nearby, or in another city in your state, or even further away – for you to have this done. It is far better to take a little while – not much time at all in the greater picture of your life – and make a decision that is right for you, than to rush into treatment and later regret being so hasty.
Do not despair. Take heart, take a deep breath, and figure this thing out. You are not alone. There are millions of us here in the “reluctant brotherhood” of prostate cancer (and plenty of sisters, too – wives, daughters, sisters, girlfriends, mothers – who have shared this journey). Reach out to us. We have been where you are now, and come through it. You will, too.