Evan Saugstad: My prostate; my journey (part 1 of 8)

The following is dedicated to our health care workers who looked after me on my prostate journey.

My Prostate Journey was a story originally told in a seven-part series in the Alaska Highway News (AHN) during Cancer Aware Months in 2019 (Parts 1 – 4), 2021 (Part 5) and in 2022 (Parts 6 and 7). I also simultaneously posted the entire story to my Facebook page.   Some parts of my original story have been edited (mostly summaries of previous parts). The original story is now hard to find, as the AHN ceased publication in September 2023 and closed all their online digital files.  During the summer of 2023 Facebook removed all “news” content in their dispute with our federal Government over fees and taxes which erased my Facebook memories.

I now add a Part 8 as my journey continues to update what has changed since I last wrote in November 2022. 

My Prostate; My journey – I Have Cancer?

Part 1 of 8 – November 2019

Although September is known as Prostate Cancer Awareness Month, I have chosen to tell my prostate journey for Movember, Men’s Health Month. I have also chosen to discuss subjects that are not normally found in our local newspaper; one’s personal health, one’s sexual health and one’s cancer.

Movember is the month where the largest percentage of donations are made in support of curing men’s cancers and improving our health.  Please support Movember.  

If the discussion of a man’s body parts, or medical procedures or men’s sexual health offends you, then skip the rest of this.  Just be assured I am still alive, still kicking, still adjusting to life with cancer, cancer treatment, and missing and/or altered body parts.

My prostate journey started rather innocuously in August 2014.  I was in the middle of a driver’s license medical examination when my Dr. asked me “Ever had a PSA test?”

“What is that” I responded?

“Simple blood test to check for prostate cancer” she said, “Can be completed at the local lab in a couple of minutes.”  

She further explained that a PSA (prostate-specific antigen) test should be completed on all men when they reach their fifties as it can detect antigens that a prostate produces when cancer is present but cautioned that this test may or may not tell a complete story.  

“Any family members ever had prostate cancer” she asked?

“Don’t recall” I responded.

As she further explained that the risk of developing prostate cancer is greater if other family members have had it, and that this risk increases with one’s age (I was already 59).  She filled out the form and off I went.

A quick search of the internet, a bit of reading, and I got more up to speed on my prostate. Men have prostates, women don’t.  Prostates are part of what defines men as being different than women.  In short, the prostate gland is about the size of a walnut and located adjacent to the bladder, and integral to the male reproductive system.  It adds fluid to semen to help neutralize its acidity and helps propel this fluid out through the urinary canal during ejaculation (kind of like the fuel injection system is to a car’s engine). 

Results came back with a score of just over 4, which meant that it was of interest, but not too disconcerting.

“Better keep track of this”, said the Dr, and she scheduled me for another PSA test next year. 

Sept 2015 my PSA is up to 10.4.  “Better go see a urologist” she says, so search the urologist directory, select one based in North Vancouver and book an appointment for Jan 2016. Although the closest urologist is in Prince George, travel from Fort St John to Vancouver is about as easy and cost effective as Prince George.

After introductions to my urologist, the first question was interesting.  “You related to Stener” he asked?  “Yes”, I replied, “My father.”

“Removed his prostate in the early 90’s” he stated.  Informed him that I had forgot about that, as I was living up north and that my father had died shorty thereafter, from issues unrelated to his prostate.  I couldn’t recall Dad talking to me about his prostate and his operation, and I never asked any questions. 

A quick finger check of my prostate showed no signs of enlargement or hardness. Things appeared normal for a person my age.  Discussion then turned to what the prostate does, and what prostate cancer can mean.

He further explained that most men, if they live long enough, will develop some sort of problems with their prostate. About 1 in 9 will develop cancer, and if left long enough with no intervention, about 1 in 39 will die.  Prostate cancer is men’s most prevalent cancer and the leading cause of cancer related deaths. 

With those discussions over, the next step was a biopsy at Lion’s Gate Hospital (LGH) in April 2016 to discover what was going on.

A biopsy is not an enjoyable process and is about on par with a colonoscopy.  An overnight fast followed by a couple of enemas to empty one’s lower bowel allows for a device to be inserted through the rectum and into the colon.  This device then shoots a hollow needle out through the colon and into the prostate on a gird pattern, guided by ultrasound.  Kind of sounds and feels like an industrial stapler being shot off inside you. 

Results from my first twelve core samples showed 3 mm of cancer on one of the samples.  Gleason score of 3+4 (used to rate prostate cancer on a scale of 1 to 5, with 5 being highest), suggesting an intermediate probability of further growth.

I have cancer…… would have never guessed.  I feel fine.  Nothing wrong with me.  All body functions are working.  Doesn’t seem real.

After further discussions with both Drs and armed with this information and these thoughts, it was agreed that we would adopt the “watchful waiting” approach, rather than proceed with any direct treatments.  Will do PSA tests every three months with another biopsy in June 2017 to monitor for any further changes.

Back to LGH for another biopsy with my PSA relatively steady at 10.99.  Results show about 1mm of cancer on one of the twelve samples, and a Gleason score of 3+3, suggesting a low probability of growth.  Good news.  Will continue with PSA tests every three months for another year, and if no real changes, once every year after that.  Schedule another biopsy in 5 years.

Three months later my PSA is up to 12.28 and in Dec 2017, up once again to 14.07.

“Something is going on in there,” said the Dr.  “Need more tests, but this time, will try an MRI, as there have been some great advancements in prostate cancer detection and monitoring”.  Earliest time and place available was Oct 2018 at Vancouver General Hospital (VGH).  Also told that no need for more PSA’s as they weren’t sure if they were telling a true story.

My MRI revealed “dark shadows” on my prostate.  Nothing definitive so schedule another biopsy in a month.  Same process but with more samples from the “shadow”; sixteen in total.  Three show positive with 12 mm of cancer and a Gleason score back to 3+4 (intermediate risk for further growth).

March 2019 PSA now up to 18.32, and with that, both my Drs. suggest no more watchful waiting.  Need to face the reality that this cancer is growing; need to address this issue, either through surgery or radiation.

Please support Movember as Men’s Health Month, give generously, and help fund cancer research. If you are over 40 and have not had a PSA test, ask your doctor to prescribe one. If you wish to skip that part, book your own appointment, pay $35, and get your own.  It could save your life. 

Evan, and always willing to talk about my journey and answer any questions you may have.