Not Even Close
David R. Weiss – June 17, 2025

I’ll spare you the suspense. I had my first post-prostate surgery PSA test on Monday, June 16 as part of a follow up consultation with my urologist. It was NOT the good news we hoped for. Not even close. There is still cancer present in my body—and unmistakably so. As a result, I’ll begin radiation treatment, probably by summer’s end.

That news made for a long quiet day for me and Margaret. We mostly managed to keep busy, getting necessary things done, while also pausing just to sit with each other now and then.

As usual in my cancer journey, at any given moment there is more I don’t know (or don’t fully understand) than I do. But I know enough to realize that while this is not the path I had hoped for, it is the path I am on. With Margaret at my side. And so, we ready ourselves—each of us—to walk this path with as much presence as we can muster.

Here’s what I know.

Our hope on Monday morning was that the PSA blood test would return an “undetectable” score. The test measures “prostate specific antigen,” a protein made by prostate cells that ends up circulating in your blood, where its level can be easily and precisely measured in nanograms per milliliter (ng/ml). Since I just had my prostate entirely removed (March 5, 2025), in theory my PSA score ought to be zero. No prostate; no PSA. Alas, cancer doesn’t like zeroes.

My particular prostate cancer was quite aggressive (graded as a 9 on the Gleason scale where 10 is the worst score) and extensive (rated stage T3b, meaning it had grown beyond the prostate, though only into adjoining structures or tissue). So, we knew there was a very high likelihood that some cancer remained behind. Any of these cancer cells would bear the telltale prostate specific antigen identifying them as cells that originated in my prostate. Over time these cells might die off or be killed by my immune system; but if there were enough of them, they might successfully regroup and multiply, leading to a cancer recurrence.

In my case, zero cancer isn’t a realistic hope. So, we settle for “undetectable.” Which is to say, we hope there are so few cancer cells left in me that their prostate specific antigen doesn’t even register on the PSA test. They’d still be there, but too few to make any mischief. That would be a PSA score of less than 0.1ng/ml. And, in the best of all possible worlds that PSA score might remain undetectable for years. Perhaps even a decade. Maybe even a lifetime. Alas, that world is not my world.

Sooner or later my cancer was almost certain to have a recurrence: a moment when my PSA edged above that 0.1ng/ml mark, indicating that the relative handful of cancer cells left behind had begun to organize and multiply. I was given a 70% chance of recurrence in the first two years and 90% by the tenth year. Hardly encouraging odds from the get-go. Still, we weren’t ready for 100% at the 3-month mark.

An initial post-prostatectomy PSA test (done three months after surgery) with a score between 0.1 and 0.2ng/ml would indicate that some unmistakable residual cancer had been left behind. Were it to hit .2ng/ml, that would trigger an alert, suggesting that a follow-up course of radiation might be in order. As we learned, within the first two minutes that my urologist joined us in the room, my score . . . was not even close.

Just three months after surgery, my PSA level came in at 0.48ng/ml. Rather than an alert, it felt more like a tornado siren going off right next to us. Honestly, even though he delivered the news with calm and compassion, Margaret and I both felt the breath sucked right out of us. We had hoped for “undetectable”; we had braced ourselves for the possibility of 0.1-0.2ng/ml. We were unprepared to hear “zero-point-four-eight.” Shit.

It tells us that the cancer, which we knew was aggressive, had indeed off-loaded a bunch of cancer cells before the prostrate was removed. Most likely those cells are still in the “prostate bed” (the tissue in the pelvic area where my prostate used to be), but they were definitely not in the bag that brought my prostate and related tissue out during the surgery. And so here we are. Margaret and me. On a path not chosen, but with our feet firmly planted by choice other than ours—and now determined to follow it forward . . . since retreat is not an option.

This is what happens next.

(1) I will undergo a PSMA PET scan at the University of Minnesota Imaging Center sometime before the end of June. This involves receiving by IV a radioactive marker that chases down prostrate cells and “lights them up” for the PET scan. It will pinpoint where the remaining cells are—hopefully(!) confirming that all the cancer is still in the prostrate bed or at least no further afield than a nearby lymph node. Later, the image obtained from this PET scan will be used target the radiation very precisely at these cancer cells.

(2) Soon after the PET scan I’ll start hormone therapy with an injection of Lupron—a drug that suppresses testosterone. Prostate cells use testosterone to fuel their grow. Depriving them of it slows or altogether stops their growth and can weaken them, making them more susceptible to radiation treatment. This injection is delayed until after the PET scan, because (ironically) we want the cancer cells to still be “strong and bright” as possible on that day. Hormone therapy can be a strong ally in cancer treatment, but it comes at a cost: it will effectively “chemically castrate” me. A phrase that hurt just to hear the doctor say it.

(3) Also, yet this month, I’ll meet with a radiation oncologist, a colleague of my urologist who specializes in radiation therapy as a cancer treatment. We’ll discuss options for radiation treatment depending on what the scan shows. I know nothing about this yet—except that it’s in my future. And now key to my survival. My urologist thinks I’ll most likely start radiation late summer, after the Lupron has had a chance to starve the cancer cells of testosterone for a while. But this decision ultimately rests with the radiation oncologist.

From here on, my urologist, my radiation oncologist, and if needed, a medical oncologist (someone with expertise in cancer treatment medications, including chemotherapy) will be charting my moves on this unchosen path. Well, them, plus a host of support staff and whole generations of medical research and knowledge. (The type of life-saving research and medical knowledge being actively defunded by this administration.)

So, I am in good hands. And grateful for that.

As of today, I really have NO IDEA about the schedule, exact form, or possible side effects from radiation. And, really, my plate is more than full for one day. I do know that being on Lupron will probably destroy my sex drive, lower my energy, and maybe give me hot flashes. Not to mention weaken my bones if I’m on it too long. And all of that is just to put me (and the cancer) in the best position for radiation. Thankfully, all these side effects will reverse themselves once I stop Lupron. Fingers crossed I don’t find myself unexpectedly in a committed relationship with this drug. (There are cases where Lupron is medically useful over the long-term; for now, I’m hoping that’s a path I don’t need to take.)

The only thing about any of this that “excites” me is that it’s my best path to long-term survival. It’s hardly a cheap thrill. Not even close. The costs come physically, mentally, emotionally, and spiritually. But because I have high confidence in my urologist, I’ll take the best options he offers me. And today, that best option is all of this.

I’ll write more as my understanding of this unchosen path deepens. I’m committed to understanding it as best I can for myself. And writing it up for others is one way to achieve that understanding. It also enables me to be the most active partner in my own health. With Margaret’s birthday, our wedding anniversary, and Father’s Day all in the past two weeks, being the most active partner in my own health feels like a damn big deal.

I won’t lie. Monday was a tough day. For both of us. Our summer slipped sideways. Our future held its breath all afternoon. And our eyes were moist more than once. But from the quality of my medical care to the loyalty and love of our family and friends we are blessed with goodness on all sides.

And we know we’re not in this alone. Not even close.

NOTE: I’ve written a series of posts about my journey with prostate cancer. So far the posts include:
1. January 30 – “When Cancer Comes Calling”
2. February 16 – “Waiting in Mutual Ambush”
3. March 11 – “My Prostate is History” (on the surgery)
4. March 13 – “Letters Before Surgery” (saying goodbyes)
5. March 14 – “Cancer Prognosis: Uncertain Grace”
6. March 22 – “Post-Surgery Incontinence”
7. June 3 – “To An Unknown Friend Facing Cancer”

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David Weiss is a theologian, writer, poet and hymnist, “writing into the whirlwind” of contemporary challenges, joys, and sorrows around climate crisis, sexuality, justice, peace, and family. Reach him at drw59mn@gmail.com. Read more at www.davidrweiss.com where he blogs under the theme, “Full Frontal Faith: Erring on the Edge of Honest.” You can support him in Writing into the Whirlwind atwww.patreon.com/fullfrontalfaith.