Do you know your PSA? Have you done your DRE?

Reflecting on a prostate cancer diagnosis and treatment

EDITOR’S NOTE: This article includes a frank and sometimes graphic account of a Soldier’s experience with prostate cancer and the medical procedures involved. Due to the personal nature of the article, editing was limited to grammar and spelling.

FORT KNOX, Kentucky — What does actor Ben Stiller, the Honorable Colin Powell, the Honorable John Kerry, Sir Roger Moore (James Bond 007), actor Robert De Niro, Marvel X-Men actor Ian McKellen (Magneto), Governor Jerry Brown and icon entertainer Harry Belafonte have in common? Emmy? Golden Globe? Hollywood Walk of Fame Star? Presidential Medal of Freedom? They all had prostate cancer and most recently NBC Weathercaster/Journalist/TV Personality Al Roker was diagnosed with prostate cancer.

Prostate cancer is the second most common cancer after skin cancer in men in the United States. The American Cancer Society estimates one in seven men will be diagnosed with prostate cancer. The disease is easily treatable if caught early. I really must emphasize “if caught early” because my disease was not caught early.

In late June of 2020, I applied for a 10-year term life insurance policy with USAA as a transitioning Soldier that did not want to pay higher rates with Veterans Group Life Insurance upon separation. My blood and urine were collected by a contracted nurse for USAA Life Insurance companies. I had thought they were checking for AIDs, diabetes, drugs, and other health items such as blood pressure and cholesterol levels. However, I was denied life insurance on 01 July due to a high PSA that was out of tolerance.

I never heard of PSA other than public service announcement, Photographic Society of America or product sharing agreement. PSA stands for prostate-specific antigen (test) and every man has a number! Do you know your number? The number could change on a yearly basis. Do you know what is a number of concern or a number for immediate surgery? I did not, unfortunately. I had several tests and each time the score went up over four months.

Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood.

The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. USAA turned me down for life insurance because I had an unusually high PSA score of 22 when the normal tolerance is zero to four. Prior to surgery I had a 33, 33 is almost seven times the average score that leads to radical surgery called radical proctectomy to remove the prostate. Because my scores were so high, other options were not really on the table due to aggressive cancer at the age 50. My prostate cancer cells had to be aggressively attacked.

What is the prostate? The prostate gland is a part of the male reproductive system that helps in semen production. I always liked Marvel’s X-Men, but I never thought a cell in my body would mutate, in this case my prostate cells mutated into cancer cells. So, I guess I am an honorary mutant for a bad reason.

A lot of people had said “you looked fine, you are healthy, you traveled a lot, you performed a lot of community service and you are motivational and inspirational with Toastmasters and Boys’ and Girls’ Club.”

“I don’t believe you have cancer,” is what a lot of people said. I agree with them, I did not believe it either and I still do not, but you cannot argue with medicine and science. The unfortunate truth is prostate cancer is a silent killer and there are some signs, but they can easily be masked by serving in the military and drinking lots of water and taking Motrin for our aches and pains.

Some possible symptoms include the following: trouble urinating, frequent urination, decreased force of urination, difficulty starting or stopping urine stream, pain in ejaculation, blood in semen and pain or discomfort in the pelvic area and bone pain.

Some of these symptoms unfortunately are related to work, but we should not ignore them, and be vigilant and not stubborn about pain or an overactive bladder. What are the causes is still a big mystery, but some believe the following causes: increasing age; race, black men are at increased risk; family history; and obesity, which is like many illnesses and diseases. Genes and lifestyle fall into the category of many diseases, I am sure you all will agree.

Upon learning of my elevated score, I was referred to a local urologist who did a DRE, and my first thought was what does a deployment readiness exercise have to do with my mutated cells or why does the Department of Real Estate need to know that I have cells that have gone rogue, but I learned DRE is often what men fear. DRE: Digital Rectal Exam. The term of feeling violated can save your life if you had this simple exam done along with a PSA starting in your early 40’s especially if you have family history. The only person in my bloodline that had any time of cancer, which unfortunately was prostate cancer, is my deceased great uncle, and he was in his mid- seventies when he was getting radiation treatment, not in his early 50’s.

During my exam, I learned that my prostate was a normal size, but not smooth meaning there was the possibility the cancer may not be contained therefore removal or radiation was necessary. Because I failed the PSA scoring and the DRE, the next step was a biopsy that was performed on August 5 and this was the worst case of being violated as a man. Probing plus extracting and popping sounds, followed by blood in urine and semen was my experience, plus being on pins and needles for two weeks waiting for the results of the biopsy. The biopsy is based on a scoring scale called the Gleason. I was contacted on August 11 and told I had cancer and I need to bring someone with me to discuss next steps on August 18. I had to depend on a friend and former Army coworker to attend this meeting with the doctor.

Once again, I scored high scores on the Gleason scale, which confirmed cancer believed to be local. The rating was T2. At this point, I had two choices: radiation or surgery. Because of my age and aggressiveness, the better option was surgery. Radiation can lead to secondary rectal cancer and other cancer 20 years later, so preserving the quality of life was the goal.

I had to get a CT scan and bone scan followed by an MRI. I learned a new term called “with contrast.” The scan also showed something in my lungs that need to be closely monitored over the next five years. I got four opinions including a world-renowned expert in New York City. They all agreed the prostate removal was the best course of action.

I chose to go with Walter Reed for my surgery on December 3, I had my prostate removed at the Walter Reed National Military Medical Center. The surgery was over eight hours and I had to have a catheter for 15 days. I had to stay in the hospital for four days with no visitors due to COVID protocols.

I am thankful that my Army family was there to assist me as well as friends during this journey that is not yet completed. The prostate removal decision was difficult and very scary because once your prostate is removed, your urination pattern/control changes temporarily or permanently, your erection/sex life changes permanently and even more you are no longer able to father children because the prostate gland facilitates sperm movement outside the body i.e., semen fluid and ejaculation.

As a 50-year single male with no kids this was devastating to me but extending my life expectancy was the goal that the doctors and I had agreed upon. I am currently awaiting the pathology report on March 5, which will tell the level of spread in the body and what treatment will be next and the process to get to five-year survival rate. High chances are I will have to undergo chemo and hormone therapy for at least two years. I am also undergoing a lot of counseling and coaching because any future relationship will be challenging if not impossible. I am not sure what impact chemo and hormone therapy will have on my physical body and if it will be able to function properly on the job or in life.

My worst nightmare is now following into a category of pre-existing health conditions and being unable to afford or obtain health and life insurance because my body has mutated. My advice to men or anyone that has a special man in their life: know your PSA scores and get the DRE annually. Please agree to be violated so you can experience life to the fullest with no changes to your body and no impacts to your relationship and family. You cannot depend on your doctor, your employer or your PCM to monitor your PSA levels and schedule your DREs. If they did, I would not have cancer. Stay proactive and vigilant and stop the cancer spread in our families. During this journey, I have met a lot of people that are battling prostate and breast cancer. I ask as you meet these people, know there is no such thing as that’s good cancer to have; all cancers are bad.

Note: Lt. Col. John Davis Reynolds hails from Toledo, Ohio, and has served 34 years in the United States Army Reserve. He is leaving active duty with 17 ½ years of active federal service. Lt. Col. Reynolds will be separating from the Army this summer and is working with various organizations for continued support and disability and he transitions to civilian life and navigates around the issue and topic of pre-existing health conditions that will impact employment and insurance. He can be reached at johndavisreynoldsjr@protonmail.com

Resources:American Cancer Society https://www.cancer.org/cancer/prostate-cancer.htmlNational Prostate Cancer Coalition https://www.pcacoalition.org/Mayo Clinic Prostate Cancer https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087Track Your PSA https://www.mdanderson.org/newsroom/psa-test—prostate-cancer.h00-158596101.htmlWalter Reed Army Medical Center, Center for Prostate Disease Research https://walterreed.tricare.mil/Health-Services/Specialty-Care/Murtha-Cancer-Centerhttps://walterreed.tricare.mil/Health-Services/Specialty-Care/Murtha-Cancer-Center/Urologic-OncologyMD Anderson Cancer Center https://www.mdanderson.org/cancer-types/prostate-cancer.htmlDuke Cancer Institute https://www.dukecancerinstitute.org/prostate-urologic-cancers
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