A Lonely Journey.

I began getting PSAs in my early fifties. As is typical for many physicians, I had not had a complete exam for several years. The first test came back showing a PSA level slightly above normal. The decision was to do another test in a few months after taking precautions against activities that could falsely elevate the result of the test. The second PSA was slightly lower. Six months later, it was slightly higher. And so it went, hovering between a value of 4 and 5 for a year and a half. My rectal exams were all normal, and I felt as well as a busy pediatrician ever feels. Finally, my internist suggested that I see a urologist.... Of course, I knew that referral to a urologist in this setting meant I would receive a recommendation to perform a biopsy....

... Still seeking to avoid biopsy, I ... discovered that the local university center had embarked on a very sophisticated form of prostate MRI that could accurately inform a physician about the likelihood of finding cancer.... I began what remains one of the most tension-arousing states that characterizes this whole business: waiting for results. Be it a study, a biopsy, a PSA, or what have you, waiting for results is nerve-wracking. A patient knows that whatever is there simply is, and has been for some rime. The study will only disclose the truth, not create it. Yet the mind plays tricks on you, and you imagine that positive thoughts or prayers can somehow magically change something bad into something good. I suppose this magical wishing and thinking is part of human nature, yet I blush inwardly each time it happens. I waited and waited. Over a week went by. Eventually I heard from my shocked urologist the same day I received the report in the mail as though I were the referring physician. The MRI definitely suggested tumor, and a lot of it. The only good news was that there was no evidence of spread beyond the anatomic capsule enclosing the prostate gland.

I was devastated and frightened beyond words. From having read the research papers, I knew I now had a 96 percent chance of having cancer of the prostate. The only question now was, how bad? ...

I have come to feel that there is great loneliness among men who carry the diagnosis of prostate cancer. The illness arises and is tackled in a male world, one in which feelings are not readily revealed and burdens are often shouldered in isolation. Boys tend not to talk about their feelings. Men are more likely to lock up what they view as personal, and, if they share such matters at all with other men, the exchanges tend to be incomplete or truncated. Sex, family, money, job insecurity, child rearing, conflict, often receive tangential treatment or become jocular, fleeting exchanges. More often, they are suppressed entirely. In a close relationship, they may surface, but most emotions are quickly buried and left to fester within. Perhaps it takes a doctor-turned-patient to share the emotional experience of having prostate cancer, to reveal everyone's sense of vulnerability and fear though his story....

The full impact of treatment goes well beyond facts. It is one thing to read about loss of hair. It's another to see your pubic hair thin to a point you haven't known since before you began adolescence, to see it almost gone ... to look at yourself while in a public shower surrounded by other men and notice how you have been transformed by your treatment. It's one thing to read that you may lose sexual interest, and it is another to walk down the street, see a gorgeous woman, and have your mind register familiar sexual attraction but only in theory.... It is one thing to read that hormones may cause depression. It's quite another to note that your every response, even when you are joking or laughing, winds up negative, morbidly pessimistic, doubting, full of self-pity....

People meet me today and ask whether I have completed treatment. I tell them that I have. They then often ask, "So are you a survivor?" or "Are you cured?" or "Does this mean the cancer is gone?" No questions could be stranger when applied to cancer in general and to prostate cancer in particular. To both doctors and laymen, the word "cure" means the illness is over for good. Cancer is never really over unless you die, have an autopsy, and are shown to be cancer-free, in which case it is of no interest to you. The passage of time simply reduces the chance of recurrence, but it never completely eliminates it....

... In the end, this is a lonely journey no matter what the outcome. Every traveler forges his own path through a thicket of information, decisions, hopes, and consequences. Each of us winds up alone, confronting his mortality and vulnerability. Nothing, not family and friends, nor knowledge, nor level of education, nor money, nor power on earth totally insulates a man or woman from the anguish caused by the threat contained in the word "cancer." ... To all my fellow travelers, I say the words spoken to me by countless colleagues and consultants: Good Luck!

F. Ralph Berberich is a pediatrician and former oncologist who was diagnosed with prostate cancer in 1998 at the age of 55. In his new book, Hit Below the Belt (Celestial Arts; $14.95), Berberich recounts--with remarkable candor and courage--the white-knuckle experience of being diagnosed with cancer, the difficulty of choosing and undergoing treatment, and the challenge of learning to rive with the cancer that strikes 200,000 American men each year. Here are several excerpts.

Reprinted with permission from Hit Below the Belt: Facing Up to Prostate Cancer. Copyright [C] 2001 by F. Ralph Berberich, M.D., Celestial Arts, Berkeley, California.