PSA - Prostatic Specific Antigen OR Perennial Sinister Alarm

When you are in your sixth decade of life or older, there is NO good news about your health other than no news. 

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I was waiting for the letter from DLS and it came in the same thin neat envelope as before. The letter was sent to me as a courtesy since I am a physician and can demand copies of laboratory tests performed on me by my caregivers. I kept on peering out the window for signs of the mailman and finally gave up.  So I got into my car and drove down the driveway on the way to my doctors appointment for my biyearly prostate check. I didn't want to have to look into his eyes for the results. I wanted to know before whether my day would be a good one or not. 

Just as I was about to turn on the street, the mailman was working his way to my house. I eagerly abandoned my car. Engine still on, our eyes met and he quickly sorted my mail. I met him half way to receive my daily ration of junk mail and the results of my latest PSA test drawn 3 days before. 

Almost exactly two year ago, a prostate biopsy was done for a PSA that rose to 6.34! (see my previous blog poem - MY PSA) Thankfully, it was negative!  But the internet is filled with stories of unfortunate souls who have lived with a roller-coaster PSA! Multiple biopsies are performed to torture the life out of these individuals, many of whom get the bad news after a few months or years - having to endure the ramifications of a sinusoidal PSA level over time, and dozens of holes drilled into their prostates from the repeat biopsies that have been done (10-20 punctures are performed during each biopsy).

I don't need any external prompt to make me worry. Maybe I inherited this from my mother.  Its part of the reason I was a good doctor - I was never able to walk away from a sick baby without taking every detail with me to ruminate over. I developed a sixth sense that other good doctors have, but it was mostly worry and concern mixed with intuition. I could wake up in the middle of the night and know that one of the babies in the Intensive Care unit needed me.   

The letter came, hidden in the middle of a stack of others from politicians, and cruise lines. My hands were trembling as I discarded the other mail on the passenger seat, fidgeting with the letter from DLS to get it open. The letter did not care that it was making me anxious. The letter did not care that it was carrying my fate embedded in its neatly worded print. This was not a personal letter but the results of a laboratory test, done on an automated mechanical devise, printed by codes sent to its printer, and sorted by laboratory staff for direction in where to send the original and other copies. Even if they looked at the results, there is no human form behind the print. Laboratory personnel must think nothing of a normal test or one that is way off the chart. People live, people die, labs are done on both and that is the job of the laboratory.  Do you think you would get a letter from the laboratory saying they were sorry to have to inform you about your metastatic cancer?  After all, this is the business of the laboratory.  If no one got ill, the laboratory would go broke.

I was tearing apart the envelope hoping the letter would somehow indicate to me not to sweat - that my PSA was fine. But the laboratory form looked the same as it did in the past when it was normal, when it was abnormal, and now when it continues to work its way down toward normalcy. Indeed, 3.88 is the lowest PSA value that I have recorded in more than 26 months. Doctors say that anything over 4.0 is of concern, and I'm very very grateful that I have finally made this transition back under this seemingly arbitrary and artificial threshold of concern. 

I'm writing this for no other purpose than to celebrate my health. I'm certain this writing will generate little if any interest, and for good reason. But all to often, I find myself passing defining moments of my life without bothering to reflect and celebrate. As my hands trembled when opening the letter, my heart was racing and sweat was forming all over my body. When the joy of the results finally sunk in, it still took several hours for my body to feel the joy of the moment. In addition to everything else, a 90 minute massage helped me regain my composure and rewarded me for being alive and as healthy as I currently understand myself to be.