hpr-knowledge-base/hpr_transcripts/hpr2615.txt

Episode: 2615
Title: HPR2615: Cancer
Source: https://hub.hackerpublicradio.org/ccdn.php?filename=/eps/hpr2615/hpr2615.mp3
Transcribed: 2025-10-19 06:36:02

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This episode of HPR is brought to you by AnanasThost.com.
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Hello, this is Ahuka, welcoming you to Hacker Public Radio, and another exciting episode in the health series that I've been doing.
What I'm going to talk about this time is my experience with cancer.
Again, nothing that is uniquely happening to me, I use myself because I actually have a fairly average person in a lot of ways.
As I related my article on diabetes, one of the symptoms of diabetes is that you drink more, and when you drink more you pee more.
That is an unavoidable consequence.
But when I treated my diabetes, I reduced my need to drink, and therefore my need to pee for a while at least.
But in 2009 I noticed I seemed to feel the need more often.
The funny thing was that I didn't seem to have all that much volume.
We tested for the most common cause, a urinary tract infection, and that was ruled out.
Then I got the old finger in the south end test, and it seemed like there was swelling of the prostate.
So I was referred to the urologist for more tests, and meanwhile sent to the lab for a blood test for PSA, which is prostate-specific antigen.
And this is a very common test to assess whether or not you have prostate cancer.
My urologist got the blood results, and my PSA was definitely elevated.
He also found abnormal swelling of the prostate, and decided he wanted a biopsy to tell more.
The biopsy was done through the rectum, using a device that would punch through to the prostate, grab a piece of it, and pull it out for examination.
While it was not a fun experience, it was not excruciating either.
Uncomfortable, but certainly quite bearable.
The samples they took then went to the pathologist for analysis.
The main thing that came out of the pathology analysis was something called the Gleason score, and there's a link in the show notes if you want to know more about this, which is expressed as two numbers which together estimate your risk from the cancer.
My score was on the high end of intermediate risk.
Now, risk is an interesting topic, and I speak partly as someone with a background in statistics.
I was a professor of economics, and if you're in that area, you're also going to have a lot of experience with statistics as well, the two things go together.
So I understand how risk works, and it's something that confuses a lot of people, because we tend to think that everything should have definite answers, and that's what we want.
You know, tell me if I have a problem or not, but as someone who has taught statistics and used it professionally, I thought, okay, I know how this stuff works.
In any case where risk is measured, there are two possible ways to go wrong, statisticians call them type 1 and type 2 error.
It's so imaginative.
Medical people are likely to use terms like false positive and false negative to refer to the same kind of thing.
Most medical tests have some degree of uncertainty in terms of what they predict.
And if you get a test that says we found no sign of cancer, there is still a chance that you do in fact have cancer.
Now, that would be an example of a false negative.
Or maybe you get a test that says you do have cancer, but on further investigation, they can't find any.
Then that would be a false positive.
Now, sometimes additional tests can reduce the degree of uncertainty, but generally they cannot eliminate it all.
You just have to deal with it.
Now, this is a general topic I'm going to come back to probably in a show down the road to just talk about the whole issue of risk and how you assess these things and make informed medical decisions.
And informed medical decision is not necessarily do everything all the time.
Now, in making a decision in an uncertain environment, you have to look at the possible outcomes.
And then you make your decision based on that.
In my case, my urologist outlined several possible courses of action.
Course 1, do nothing.
Prostate cancer does not always turn fatal, although it is a leading cause of cancer deaths in men.
The fact is that so many men get prostate cancer that even a small proportion of them dying adds up to a lot of deaths.
And this is something that people talk about a lot.
And you will hear people say, oh, you should never, you know, this is all overstated.
Just because you have prostate cancer doesn't mean you need treatment or what have you.
And again, I always say to people, talk to someone who has the letters MD after their name.
You know, don't make your medical decisions based on something you read on the web or in a magazine.
You know, get actual medical advice because these people know more than you do most of the time.
Now, the second course of action is something called radiation therapy.
This uses high energy radiation to try and kill the tumor cells.
Of course, one side effect is that it can affect other cells.
Worst case scenario in killing the prostate cancer creates some other kind of cancer.
Course 3, surgery.
That means cutting out the cancerous tissue.
And in prostate cancer, that is generally going to mean removing the entire prostate.
Now, there are some other options.
My impression is that they are not used as much.
I have another link in the show notes if you want to follow up on some of this stuff.
But again, as I say, talk to a doctor.
Get someone who actually knows what the heck they're talking about.
Now, based on my Gleason score and on my PSA numbers, my doctor did not think that doing nothing was a good idea.
We looked at radiation.
And with that, the question becomes, how likely is that treatment to be successful?
Of course, that's true for every treatment.
Uncertainty exists at every stage.
The best you can do is give yourself the best possible chance, recognizing that while medical advances have made great strides, there is no sure thing.
My wife and I looked at the options.
We asked questions of the doctor and decided surgery was our best option.
But as one last check, my wife asked one of her clients.
She does a lot of independent web work, websites, and things like that for a variety of private clients.
And one of them was the company that runs the pathology lab at our local hospital.
So she went to the head of that company and said, hey, my husband is looking at doing surgery.
Here's his doctor. What do you think?
And the answer that she got was, well, if I was getting the surgery, he's the doctor I would want.
That really can't get a much better recommendation than that from a federal medical professional.
So we said a date in early 2010.
Now, once it was scheduled, I had some paperwork to do.
And it's rather a lot of it.
Surgery is almost always perfectly safe, but that doesn't mean it's 100% safe all of the time.
So one of the things that happens is that you're going to say, okay, does someone have medical power of attorney, which in this case, my wife.
My wife is empowered to make any decisions on my behalf if I'm not there to make them myself.
They will start asking things like, well, do you have a do not resuscitate order, as a matter of fact, I do.
And what that basically means is, don't do extraordinary things.
It's an extremely small probability that I'm ever going to come back, just let me go.
Then there was some education on what the aftermath would be like.
So what a radical prostatectomy, and that's complete removal of the prostate, has certain side effects.
And the most noticeable of the two are incontinence and impotence.
In most cases, these are temporary. Everyone is different though.
And in my case, the incontinence has continued so that I have to wear what are essentially adult diapers.
But I was prepared for all of that.
The surgery itself was done using a da Vinci robotic device that involves several small incisions.
Which means that at this point, and we're talking eight years since the surgery, you have to look pretty closely to see any scar at all.
So basically what they do, they pump up your stomach with gas to expand everything.
And then each incision is maybe half an inch in diameter.
So they can insert a camera here, an instrument there, what have you.
So it's really, it's very small incisions and they heal very nicely.
So they go in, they cut out the prostate, remove it.
And then once the prostate has been removed, and the way it works in men, the urethra, which comes from the bladder,
and is how the urine comes out, passes through the prostate.
So what happens when you remove the prostate is you have also, by default, removed a small section of the urethra.
So what they have to do is sew the bladder onto the remaining part of the urethra so that they can reconstitute the urine flow.
And that meant for about the first week or so after the surgery, I had a catheter installed that drained into a bag.
It was mostly bed rest that week, but I did join a few telephone calls for work.
Once the healing was sufficient, basically no more red in the urine, the catheter was removed and I went on with my life.
All in all, it seemed pretty uneventful for abdominal surgery.
My surgeon did a good job and was able to remove all of the cancer and leave nothing behind but healthy tissue.
Meanwhile, the removed prostate was sent to the pathology lab for further analysis.
And the report was that the gleecein score should have been even higher than was indicated by the biopsy.
And as I said, this is decision-making under uncertainty.
I happen to think I made the right decision.
Well, you know, everyone has to make their own decisions in life.
So what's the aftercare look like?
Shortly after the surgery, the doctor, the urologist that I had moved away and I transferred to a new doctor at the practice.
He had me on Cialis for a time to help recover erectile function.
And I have to say, at no time did the Cialis cause my wife and I to suddenly materialize on a hillside in adjacent bathtubs.
I have no idea what that one's about.
Fortunately, I've not had any problem there after a few months of recovery.
I no longer take any medication for that.
I do get a PSA test once a year and come in for a follow-up exam.
But ever since the surgery, my annual PSA test has always been they can't detect any at all.
And that's what you want to have.
So there's a pretty high probability that this cancer is history and never spread.
You know, I had my annual follow-up just a couple of months ago.
I will do one again.
I think it was March or so.
So do one again next year.
The new doctor generally looks at my medical record and says you're a very lucky man.
Which I tend to agree with for a number of reasons.
Though I think he's saying it with regards to the seriousness of the cancer I had and how good the outcome is.
Bottom line, I'm convinced we made the right decision.
I am very happy with where I am now.
I think I have a decent chance at another 20 years fairly healthy.
And I want to spend a lot of it traveling with my wife.
Now, that was the cancer problem that I had to address then.
I have one other cancer concern.
Well, maybe two.
Major one is colon cancer.
My father died of it in his 50s.
His father also died of it at a young age.
With that family history, it should be no surprise that I have an ongoing relationship with my gastroenterologist.
Every three years or so, I have a colonoscopy which means an uncomfortable day of preparation.
Think of the worst diarrhea imaginable induced by drugs combined with no food.
I need to be careful more than most because I'm diabetic and I cannot drink some of the things they recommend.
But the procedure itself is no big deal.
They just put you to sleep and you know, little while later after that I wake up.
I don't feel any residual pain or discomfort.
My wife drives me home.
You know, you're not allowed to drive if you've just had anesthesia.
Generally a pretty good rule.
And you know, usually we'll stop at a local restaurant because at this point it's been two days since I had any solid food.
I'm not hungry.
Generally what they tell me is that they found a few polyps.
But when they cut them out and look at them, they always say, eh, nothing cancerous.
But it's the sort of thing they keep an eye on.
So I've done this probably a half dozen times so far.
And that's a good thing.
Colon cancer is eminently treatable but catching it early definitely improves your chances.
And you know, I really don't want to, well, I'm already older than my father was when he died.
And I'm sure, you know, he had plans for things he wanted to do in retirement that just never happened because he didn't make it to retirement.
I'm planning to retire in three years.
And I am very much looking forward to it and my wife and I are making plans.
Now the other cancer that I may need to worry about is lung cancer because I was a smoker.
It has now been 10 years since I quit and nothing has shown up yet.
Still, it is something to watch for since the risk does not appear to drop to non-smoker levels.
Though it does diminish over time.
The basic message is that the sooner you stop, the better you will be.
I wish I'd quit much sooner or better yet never started but I can't go back and change the past.
Right now I'm doing what I can to stay healthy.
And the nice thing is my doctor is pretty unconcerned about that.
He thinks at this point I'm largely out of the danger area for that.
But, you know, you have to keep looking at these things from time to time.
So, that's my history with cancer.
And this is a hookah for Hacker Public Radio signing off.
And as always, I suggest to you that you support FreeSoftware.
Bye-bye.
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