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Short version of this post: I probably don’t have prostate cancer, but I’ll test for it a little more often than usual from now on, just so the doctor can keep an eye on things.

(No advice, please.)

Long detailed writeup below. Arguably slightly NSFW for description of a prostate exam. Also, content warning for needles and a potentially claustrophobic situation.

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I went in for my annual checkup a few months ago, and one of the standard tests they did was the prostate-specific antigen (PSA) test. The result came back a little high, which can be (but isn’t always) a signal of prostate cancer. So my doctor had me do the test again, and that result came back similarly high.

(At the time, I poked around online and found one reputable-seeming site that said that doctors don’t do PSA tests any more because the chances of a false positive are too high; but I also found another reputable-seeming site that said that PSA tests are our main way of preliminary testing for prostate cancer. So I gather that there’s some disagreement in the medical community about how best to approach this issue.)

(I know that using Google for medical advice is contraindicated, but these were websites from major reputable medical institutions.)

So my doctor referred me to Urology. PAMF scheduled me for an appointment with a urologist in Mountain View, then changed the time of the appointment five times over the course of two weeks, without giving me the option to agree to the change any of those times. The night before the appointment, they changed it to a time when I couldn’t make it; when I told them the next day that that I couldn’t make the new time, they told me I would have to reschedule for a month later. But then they told me I could see a urologist only two weeks later if I went to the PAMF San Carlos location instead, so I did that.

The urologist I saw in San Carlos asked me a few questions, then asked if I had ever had a prostate exam; I said no; he asked if I would be okay with his doing one today. I said sure.

In the past year or so, for various unrelated exams, I’ve had several occasions when a doctor needed to look at some part of my body that’s generally covered up. Each time, a medical person has left me a paper hospital gown (or, in one memorable case, a paper hospital vest with no bottom-half-of-body covering) and left the room, and I’ve changed into it, and a doctor has come in and has been very solicitous about when and whether they expose various parts of my skin.

So I was expecting that again, but no, the urologist just told me to stand in front of the examination chair/bed, facing it, and drop my clothes, and lean forward onto my elbows. His phrasing was slightly ambiguous, so I asked if the idea was that I should go ahead and lower my pants and underwear and lean forward, and he said yes. So I did. He had put on a glove and some lube, and he stuck his finger in—mildly uncomfortable, but not painful—and wiggled it around for a couple of seconds; then it was over, and he said there were no lumps.

I put my pants back on, and he entered some information into the computer and then showed me the probability chart it had generated. (Made out of smiley faces and frowny faces.) The chart said that there was an 80% chance that nothing was wrong, a 15% chance of the kind of prostate cancer that doesn’t need to be treated, and a 5% chance of a more serious prostate cancer.

The doctor said that in the old days, we would jump immediately from this to a biopsy, but recently MRIs have started to be useful for this kind of diagnosis.

So he scheduled me for an MRI a month from then (which he said was the earliest available, even labeling it as stat), which is to say mid-October, and said that the MRI would tell us one of three things:

A. All is well. Or:

B. Definitely need a biopsy. Or:

C. Uncertain; need to do a different kind of urine test that might help clarify.

I was pretty much fine, emotionally; I wasn’t consciously stressed about any of this. But I think that the possibility of cancer, even though small, did add a small layer of general underlying stress.

And that stress layer increased slightly when the MRI people told me that the earliest they could schedule the MRI was Oct. 31—two weeks later than the doctor had requested, and thus two weeks beyond the end of the prior authorization window that the doctor had specified. And so they needed to submit the request to the prior authorization group for approval. The MRI people were cheerful about this, and seemed to think it was just a formality; but it ended up taking until Oct. 11 (more than three weeks after it was submitted for approval) before the prior authorization came through. Meanwhile, the MRI date was moved to Nov. 1.

But none of the bureaucracy failures that I was expecting ended up happening. (I had figured that the prior auth would be extended to Oct. 31 but not to Nov. 1, and that my change of insurance on Oct. 1 would cause problems. But nope, neither of those were an issue.) So everything was fine, and the MRI was scheduled for Nov. 1. (And for once, that schedule worked out fine.)

A few days ago, they sent me a questionnaire asking about my history and whether I had any metal body parts. It was mostly easy to fill out, except for the part where they asked if I had ever had any surgeries or “medical procedures”; I’ve never had surgery other than dental surgery, but I’ve had lots of minor ordinary medical procedures, none of which seemed relevant. So I marked that question as “Unknown” rather than “Yes” or “No.”

They didn’t send me anything about what to expect for the MRI (though I’ve heard friends describe their own MRIs). They did say that there were no dietary requirements and that I should be well-hydrated. I ended up doing some web searches last night about whether there were any preparations I needed to do before a prostate MRI; all the reputable pages I saw said that you need to not eat anything for at least four hours beforehand, and should refrain from any kind of sexual activity for n hours beforehand (I think n ranged from 24 to 72, depending on the site). But PAMF hadn’t said anything like that to me.

I woke up early this morning, after not enough sleep, and called the Imaging department at PAMF. Quite to my surprise, a human immediately answered the phone. I asked if I needed to refrain from eating before the MRI, and they said no. While I was on the phone with them, I also asked about the dental wire that’s been attached to my teeth for many years, which I hadn’t been thinking about when I filled out the questionnaire, and they said since I was going in feet first, I didn’t need to worry about that.

So all was well. I drove to San Carlos, found parking, and made it to the Imaging department about 20 minutes before the scheduled time. They showed me to a more-private MRI waiting room (with curtains between the chairs!), and then took me to a changing room and had me change into paper hospital shorts (they told me to keep my T-shirt and socks and underwear on) and put my pants and shoes in a locker. They had me stand in front of a magnetic detector device (I wish they had told me previously that they were gonna do a magnet check ahead of time; it would have saved me a bit of fretting), and when it didn’t detect anything untoward, I gave the technicians my glasses and they gave me a surgical mask (because my regular mask has a metal nose wire in it) and took me to the MRI room.

(They asked if I wanted a mask, and said it wasn’t needed, but I said yes, I did want one.)

They gave me foam earplugs, and then put a headphone-shaped thing over my ears—I don’t think it contained any electronics, I think it was just to further muffle sound. When they talked loudly, I could hear them through the sound mufflers, as intended.

I’ve heard about MRI patients being offered a choice of music to listen to, but they didn’t do that. (There was music playing over speakers in the room, but I could barely hear it.)

The MRI itself was fine. I determined experimentally that (as I already thought was true) I’m not particularly claustrophobic, at least not in that context. I was inside the tube far enough that I think only the top of my head stuck out; when my eyes were open, while I was flat on my back looking straight up, I saw the inside of the outer edge of the tube, but didn’t see beyond the tube to the ceiling.

The MRI sounds were loud, as expected. I amused myself by trying to describe them. Sometimes they sounded almost musical. I decided that they were a musical performance of a piece written by a composer with a sense of rhythm but no interest in melody, who was composing for the following instruments:

• Jackhammer
• Truck backup beep
• Radiator clanking
• Teletype terminal (the old kind that clacks as it prints onto paper)
• Air horn

I had no trouble lying still. I was a little tense about breathing, because the technicians emphasized that I should not move, and there was some kind of hard shield over my abdomen that made me feel like I shouldn’t inhale too much; but I eventually concluded that breathing is necessary and that if inhaling counted as moving they would have said something about it.

After about half an hour (I think that’s how much time they said had passed—I had very little sense of how much time was passing while I was in the MRI), they pulled me out and gave me an IV to inject a contrast agent called Gadavist (a.k.a. gadobutrol), which contains gadolinium. (They had given me an info sheet about it before the MRI.) That also went fine, and they put me back in the machine for another 8 minutes (iIrc). Then I was all done.

The info-about-prostate-MRIs web pages that I had seen earlier from major hospitals had said to expect results in 1 to 2 weeks, so I was assuming that I wouldn’t find out anything for a while. But the technicians said I would probably get results either this afternoon or Monday.

A few hours later, I got a notification saying that the results were available. I looked at them, but there was an annotation saying that my doctor hadn’t reviewed them yet, and I didn’t know how to interpret them. So I figured that I would have to wait until Monday or later, but then I got a call from PAMF offering to schedule a video call with my doctor for this afternoon. So we did.

The doctor said that the MRI had shown no suspicious prostate lesions, and my score was 1 on the PI-RADS v2 prostate-lesions scale—the best possible, indicating a “very low” chance of “clinically significant cancer.” He said that another factor in the evaluation is PSA density; the larger the prostate, the more PSA, so for a given PSA level, a larger prostate means lower PSA density, which is better. And the prostate tends to enlarge with age, as mine has apparently done; and so even though my PSA level is high for my age group, my PSA density is not particularly worrisome.

And so the doctor doesn’t recommend a biopsy, and doesn’t recommend treatment unless bothersome urinary symptoms develop. Instead, he says I should get the PSA test done every six months (instead of less often), and have a digital prostate exam every year. He’ll see the results of those PSA tests, and if the numbers seem to be climbing, we’ll talk about what to do next.

All of which sounds good. He did say that his model still shows the same 5% risk
, which confuses me—I would expect that the new information (no sign of suspicious lesions) would suggest that the chances are lower than they were before we received that new information. But regardless, the doctor didn’t seem at all concerned, so I’m content to just wait for my next PSA results. (Test to be done in February, which will be six months after the last test, because it took over two months to get from that test to getting the urologist appointment and then to getting the MRI.)