The final chapter of my book Midpoint: Manhood, Midlife, and Prostate Cancer, ends with my nervously checking the results of my first post-surgery PSA test. The news that day was good—none of the antigen was detectable in my blood, which indicated that, for then at least, the cancer was beat back.
Since then, I’ve lived a routine of semi-annual PSA tests. Each of these milestones brings a couple of weeks of nervous anticipation, a trip to Memorial Sloan Kettering in New York City to give blood and see my surgeon, and the heart-thudding moment when I log into the MSK portal to see the results. My surgeon tells me that the longer I go without PSA showing up in my blood—what’s called a biochemical recurrence—the more remote my chances of encountering the cancer again. “It’s just time,” Dr. Touijer reminds me as patiently as he can.
The Problematic Concept of the Future
Anyone who’s had cancer will tell you that time and the future can be vexing concepts. As a prostate cancer patient, I live from PSA test to PSA test, which divides life into discrete six-month periods; all of them have a similar narrative trajectory—at least as far as the cancer goes. Each good test grants permission to advance in life, to make plans, fantasize about living to ninety, and see my daughter have kids some day. But as the next test approaches, those dreams tend to be replaced by more anxious ruminations: Will the PSA suddenly reappear? Will I face six weeks of radiation? Do I face hormone therapy and the prospect of chemical castration? That species of fear, which I’ve heard referred to as “scanophobia” in the context of melanoma, is familiar to most cancer patients.
One of my favorite blogs on prostate cancer is Dan’s Journey, the author of which was diagnosed at an even younger age than I was (he was 52, I was 56). Dan’s pre-surgical statistics (Gleason score and PSA number) were less ominous than my own and yet, after five years of encouraging blood tests, he was stunned by a reappearance of PSA. Thankfully, Dan’s number seems to be rising very, very slowly, which hopefully signals many years of good health before him. But it’s experiences like his that make prostate cancer—and cancer in general—such a nasty and terrifying opponent: Just when you think it’s knocked out forever, it shows up again. It’s enough to make anyone a hypochondriac.
Ant or Grasshopper? Low Beam or High?
When I chastise myself for getting so spun up over my PSA tests, I remember that cancer is a lifelong, not a momentary, adversary. As long as the potential for recurrence exists, the fear of cancer is present in one’s everyday consciousness. For that reason, while having had a prostatectomy is no reason to put one’s life on hold, it tends to make you switch off the high-beams and focus more on the road right in front of you—the six months directly ahead. I think that’s where many cancer survivors find a silver lining, the hidden benefit of their disease: When we lose confidence in the distant future, we tend to regard the present with more urgency, to lean more into living, so to speak.
As for me, I welcome every encouraging PSA test as an invitation to take the long view while still remembering to savor the present. That’s the trick for all of us, isn’t it? Whether we’re cancer survivors or not, it can be tough to find the balance between Aesop’s grasshopper and his ant—living for the moment and hoping for a long future.
Dan recently posted that he debated about taking a planned trip to Europe because he was worried he might have to begin radiation. When his PSA numbers unexpectedly declined, he seized the opportunity to take the trip. Though I’m sure Dan is every bit as focused as I am on living a long life, I had to admire how he lived that moment—assertively, even insouciantly—in the low beams.