Nothing has materialized so far from that one ultrasensitive PSA reading. I had a PSA test in February, the standard assay, and it was still less than 0.1. So I'm not worried about that.

But. (or Butt--ha ha!)

Sometime around the early part of this year, I noticed a change in bowel habits. Nothing too dramatic, just things were a little looser and faster than normal. Like diarrhea, but without the cramping and endless returns to the bathroom. Where before I'd go once or twice a day, now it was several. And it now included the night--sometimes I'd have to get up in the middle of the night to have a bowel movement. 

I was also feeling a lot of fatigue, and needed to take a nap after work for the first time.

I didn't do anything at that point.

Then I tried to donate blood later in the spring. For the first time in my life, I failed that iron test where they poke your finger (always the worst part of donating for me).  I didn't fail it big time, just one digit low.

So I arranged a televisit with my primary care doc. I explained the failure on the iron test, the fatigue, and the change in bowel habits. I mentioned that it was nearly 10 years since my first screening colonoscopy (that I passed with flying colors, aside from a bit of diverticulosis). I think for my own ease of mind, he agreed to refer me for a colonoscopy now, rather than waiting until next year. He also ordered a slew of blood tests, some of which I had never had before.

I was a little low on testosterone (he recommended more exercise), Vitamin D (get more sunshine, although I live in the Sun Belt and already get a lot), and I was still slightly prediabetic ("cut down on carbs").  My red cells, cholesterol, etc all were in normal range. So was the test that the blood bank had administered (hematocrit, I think).

But a couple of tests came in late, and his office called me.  My ferritin (a measure of iron in the tissues) was low. Iron saturation was slightly low. And something called RDW, a measure of how wide the variation is in the size of red blood cells, was high. All of those point to iron deficiency.  He recommended 65 mg of iron supplements daily, and a retest in a month or two.

I naturally checked Google, WebMD, Mayo Clinic's site, PubMed, etc. Turns out that men should really never have iron deficiency, and the number one cause of iron deficiency in men (and menopausal women) is blood loss somewhere in the digestive tract. And the big monster under the bed here is colorectal cancer, especially right-sided colon cancer (far enough away from the exit that small amounts of blood get absorbed into stool, so patients don't see blood right away). 

In women who are not menstruating and in men, “anemia is colon cancer until proven otherwise,” said one expert, Dr. Thomas Weber, who serves on the steering committee of the National Colorectal Cancer Roundtable.

(Roni Caryn Rabin, "What Young People Need to Know About Colon Cancer", New York Times, 16 March 2017. https://www.nytimes.com/2017/03/16/well/live/what-young-people-need-to-know-about-colon-cancer.html?searchResultPosition=1)

 

So I try to get that colonoscopy appointment. Guess what? So is everyone else, now that pandemic fears are lessening. The GI guy I was referred to was booked up for over 2 months. My previous gastroenterologist died years ago--from gastric cancer. And the telephone screeners don't care about your blood tests or your previous radiation treatments, or your fatigue--they all have set questions "family history? polyps? when was your last colonoscopy?".  Anyway, I managed to find someone highly rated that I can see for the initial consultation this week. Oh, wait--the doctor isn't available, but his PA is. Okay.  Maybe I can still get things going. 

I'm very worried, to say the least. I read a journal article that said in the UK, a man with iron deficiency gets fast-tracked to colonoscopy. Here in the US, I seem to be on the slow train.  

If it's cancer, could it be from my salvage radiation in 2007? Who knows? Maybe it's just too much processed food over a lifetime. One hot dog too many. My first colonoscopy didn't reveal any sign of radiation (it was five years later). Colon cancer is very common, anyway.

Stay tuned. It may be time to dance with the bear again.