After surgery for prostate cancer, there is really one primary marker to determine if the cancer is gone or if it's recurred. That is the blood test for PSA - Prostate Specific Antigen. Even when prostate cancer leaves the prostate and takes root in other parts of the body, those cells still produce PSA. The test is a measure of nanograms of PSA per milliliter of blood. When I was diagnosed with prostate cancer, my PSA was about 5. The upper end of the normal range is 4, and many doctors think scores above 2.5 should be investigated more carefully.
After surgery, the score should be as close to zero as possible. There are two types of PSA tests - a standard test and an ultra-sensitive test. If the ultra-sensitive test is used, even a person who has been cured by surgery will likely have a value of .02 or so. In the standard test, the hope is that the PSA will be undetectable - less than a certain value that is the machine's limit for detection.
These tests are done quarterly for a year or so after surgery, then every six months for a couple more years, and then annually. At age 75 or so, they can usually be discontinued. These tests create a lot of anxiety for post-op men. If that PSA get to 0.2, the doctors call this a biochemical recurrence, and this means you need further treatment. For me, this would probably mean radiation and drugs to reduce my testosterone levels to near zero. The side effects and quality of life issues with those treatments are not pleasant. So, heading into the test, I was certainly anxious.
Luckily, I had the opening day of trout season to keep me occupied all weekend. My son and I entered a fly fishing tournament in Middlebury for the second year in a row. We had to be there by 5:00 on Friday to register. On the way there, we stopped at two rivers to look at water flows. What we saw was disheartening - high, off-color water from melting snow run-off. The Neshobe looked fishable, but the Middlebury looked impossible. However, the temperature Friday night was supposed to go below freezing, so we hoped the run-off would subside by Saturday morning.
So, we went to the meeting. Then, we went to a fly fishing movie - the Fly Fishing Film Tour. I have to say that I enjoyed last year's movie a bit more. Last year was more pure "fishing porn", while this movie was a bit more political and also featured one sequence about super-rich guys and their private tarpon fishing tournament. Nonetheless, it was great to watch very good fishermen catching huge fish. A segment shot in Alaska, where people fished exclusively with mouse patterns for big rainbows and graylings was very cool.
After the movie, we grabbed a late dinner and then I set up our fishing rods for the next day. My son is not a morning person, so the plan was for me to fish very early and get him mid-morning. I headed to the Neshobe and had a nice stretch of water all to myself for most of the time I was there. However, the water was cold and the fish simply weren't cooperating. I didn't have a single strike the entire morning. I then got my son and we fished three different spots on the New Haven River. The first was tough because the water was so high. The second was more fishable, but wading was treacherous. The third was way up in the watershed, and wading was fine. The fishing wasn't though. We didn't get a strike all day, and at 1:15 we headed back to Middlebury to turn in our blank scorecards.
As things turned out, 70+ fishermen and fisherwomen combined to catch 5 trout all day. That's it.
My son and I took a nap after fishing, had a nice dinner, watched some hockey, and I got to sleep early. I woke up overnight to hear rain falling. I was up before first light and fishing the Middlebury before sunrise. Regretfully, the Middlebury gets a lot of runoff from a ski resort, and the temperature had not gone below freezing on Saturday night, and it was raining. The river was high and off color. Two hours of fishing in the rain left me cold and frustrated. Still no fish. We had changed tactics from the previous day, going with sinking leaders and stripping white streamers deep. That had been the ticket for the few fish caught the day before.
After I got my son, we headed to the New Haven River again, and this time, went to the most popular spot on the river. I caught my biggest brown trout of the season there last year. There were a few other fishermen there, but we had plenty of room. But, the remainder of the morning was a comedy of errors. My son's back cast landed in a tree. He couldn't get the flies back and had to snap the line. I gave him my rod to fish while I re-rigged his rod. Before I could get it re-rigged, he was stuck in the trees again. He walked away from the scene, clearly frustrated. I got him calmed down and we both got back to fishing. My streamer was deep and I felt it stop - fish or the bottom of the river? I set the hook and the rod simply snapped. It was an older rod, probably purchased in 1988 or so, and the manufacturer is out of business. The rod served me well for many years. Finally, about 11:00, cold, soaking wet, and without a single strike in two days, we decided we'd had enough.
We changed into some dry clothes and went downtown to turn in two more blank scorecards. Five fish were caught on Sunday, bringing the tournament total to 10. At the awards barbecue, my son won a nice box of flies from Montana Fly Company. I won a hat and a leader. The tournament winners each got an $800 fly rod. Someday maybe.
And then we headed home. Even though we caught no fish, it was fun to be on the water again. And, the fishing distracted me from that PSA test I was talking about.
Yesterday afternoon, I went to Dartmouth for that test. I got there about 90 minutes before my appointment and had my blood drawn. It's really nice that they do these results quickly, rather than making you wait a few days. I went for a run for about 45 minutes - another distraction. And then, it was appointment time. The first words out of my surgeon's mouth were "Your PSA is undetectable". After that, we talked about a number of other issues I've had recovering from the surgery. But, none of them really mattered. All that mattered was that I'd "passed" my first PSA test.
July 14th, I get it done again.