PSA 0.05 

My PSA is maybe rearing its head after 15 years. An ultrasensitive test in mid-2020 was .02. In August it was 0.05 (different lab).

I saw a medical oncologist who specializes in prostate cancer. His advice: don't sweat it, we'll start monitoring every 3 months for a while, see if anything is really going on. I'll get tested again early next year.

Meantime, I've got lymphoma, and start seeing a specialist for that soon. Doesn't appear to be an immediate problem--the kind I've got is incurable, but highly treatable, and median survival times are now stretching out to 20+ years for it.  The close monitoring and scans by the hematologist (who works at the same practice as the prostate oncologist) should help insure neither cancer poses a serious threat anytime soon.

 Good news! Colonoscopy was fine, no cancer, no polyps.  Nada. Good for 10 years.

Iron is back to normal levels. That's after being off iron supplements for a month. So probably the low iron was just a glitch, bowel issues just diet and getting older.

 Well...crap (potty humor for a potty post)

I saw the physician's assistant for the gastroenterologist I've chosen. She was kind, and not rushed, and agrees I need a colonoscopy for diagnostic, rather than screening, reasons. I'm booked. For July 7. That's nearly two months from now.

She didn't talk about cancer, but she did say that there were different flavors of colitis that could cause mild iron deficiency. Okay. I know. Let's not put the cart before the horse, etc.  But still.

Here are the symptoms of colon cancer, according to "Colon & Rectal Cancer: From Diagnosis to Treatment, 3rd ed., by Paul Ruggieri, M.D., and Arti Lakhani, M.D.

1. Fatigue caused by iron deficiency anemia.  CHECK. 

2. Change in bowel habits. CHECK.

3. Rectal bleeding. NO.

4. Chronic abdominal pain, bloating, or fullness. CHECK (bloating & fullness)

5. Painful urge to have a bowel movement. NO.

6. Decreased appetite or unintended weight loss. NO--BUT--I started a new weight loss regime, just cutting calories a little, and was shocked by the rapid change on the scale.

Here are the symptoms of colitis, according to MayoClinic.org

1. Diarrhea, often with blood or pus. (yes to diarrhea, no to blood/pus)

2. Abdominal pain and cramping. NO.

3. Rectal pain. NO.

4. Rectal bleeding. NO.

5. Urgency to defecate. Maybe.

6. Inability to defecate despite urgency (no, at least not until the iron pills!)

7. Weight loss. (Maybe--see above)

8. Fatigue. CHECK.

Now colitis is no walk in the park, it seems, and in severe cases, people do end up with colostomies.  I really, really want to avoid a colostomy, so I'm not "hoping for colitis" or the misery that illness portends. But another way to end up with a colostomy is to have your colon cancer spread undetected for a while. 

The physician's assistant suggested Benefiber, because Metamucil gave me diarrhea. Okay, I tried it. First day, I tried the normal dose. 18 hours later, diarrhea. So I waited until that afternoon, and took a half dose. 18 hours later, the worst diarrhea of my life. So I guess I'll just have to suffer constipation on the iron supplements until oh, sometime late this summer when the medical system can spare the time to do a colonoscopy and figure out if I have a terminal disease or not.

Ever have a dream where you call 911 and you get put on hold forever? Or some disaster is unfolding and your feet move like you're in deep sand?

Fine. I'm just going to wait while all these people who were too frightened to get their 10 year colonoscopy done during 2020 get in front of me.

 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.