The wrap and final episode of The Prostate Papers. It's time to draw this story to a close.

Gary Ebersole here, back with the closing chapter of The Prostate Papers. You might have noticed the recent “dead air” from the Camp Codger podcast. I haven’t abandoned Camp Codger, but I couldn’t bring myself to deliver another long episode about prostate cancer. Sometimes, you can get too close to a topic, and this was one of those topics for me. Anyway, my personal experience with the scourge of prostate cancer has reached a significant juncture, and I feel a need for closure, hence this final episode of The Prostate Papers.

I went to Denver in early July for my biopsy, and the results came back a week later. To understand how I ended up 400 miles from Santa Fe, where I live, for this critical procedure, read my blog post on the biopsy dilemma. As you might expect, I hoped the pathology report would let me move into “watchful waiting” or even “active surveillance” mode. Unfortunately, the Denver urologist who performed the biopsy and did the cancer staging said that I needed treatment—surgery, radiation, or even focal therapy. He said it wasn’t urgent, but I did need to do something sooner (measured in a few months) rather than later (a year or two).

For the curious, I have chosen to undergo external beam radiation therapy using the SBRT protocol rather than have a radical prostatectomy via robotic-assisted laparoscopic surgery. What a mouthful! Anyway, the treatment will occur during the last two weeks of October in San Francisco. Yes, I’m also traveling out of state for my treatment. I explain my rationale for this decision in a blog post on CampCodger.com.

Let me leave you with a couple of closing comments. First, an important point to leave listeners with is that your level of involvement in your diagnosis and treatment is your choice. You can follow my over-the-top path and go into a research frenzy. It was perfect for a geek like me since understanding how things work matters. My immersion in the world of prostate cancer has led to the diagnostic choices I made. It also determined my treatment choice. That said, what works for me may not work for other guys. If you have an excellent urologist that you trust and a support system to give you wise counsel, the low-research approach can be the right path for you.

Second, for the guy or his family who must know as much as possible about the diagnosis and treatment of prostate cancer, do your online research, as I suggested in an earlier episode. Then check out Dr. Patrick Walsh's Guide to Surviving Prostate Cancer. This comprehensive book loads you up with detail, often more than you want. I was well-informed when I finished reading the book.

So, it’s a wrap for The Prostate Papers. Developing these episodes has been cathartic for me, but the interaction with my new “prostate buddies” in our special club has been even more amazing. Thanks, guys. It really made a difference.

Before we go, let me reassure our listeners that I am convinced everything will turn out well. My doctors and all the data I hav...

In The Club episode of The Prostate Paper, Gary discovers new friends with a shared experience dealing with prostate cancer.

Gary Ebersole here, back with another chapter of The Prostate Papers. When I closed the last episode, I said I’d discuss the challenges of choosing the optimal diagnostic path. I had recorded and edited the episode and was about to publish it. It was at that point I decided I was feeling drained after my intense research on prostate cancer. At the same time, I was dealing with my challenges in trying to gain access to the medical system. I have a good Medicare Advantage PPO plan, yet two of the top cancer centers in the country (I’ll name names—MD Anderson and the Mayo Clinic) refused to take my insurance, which would require me to go out of network and pay out-of-pocket for charges not covered by my plan. To add to my frustration, I discovered my geographic location had a significant impact on my choices for diagnosing and treating prostate cancer.

So, I went looking for something positive from this prostate cancer experience and didn’t have to go far. I have been overwhelmed by how open men who are dealing with prostate cancer have been. Under normal circumstances, you wouldn’t expect guys to talk openly and candidly about sexual dysfunction, urinary incontinence, and even bowel problems. When all is well, we may joke about these topics but don’t talk seriously about them. That all changes when a man receives a prostate cancer diagnosis and mentions it to someone else who is dealing with the same thing. The sharing begins.

It's a club with a singular and obvious membership requirement—being treated for prostate cancer. Some men may be among the lucky who are diagnosed with indolent, slow-growing cancer and avoid treatment for now. However, even with active surveillance as the treatment, you’re still in the club. It’s a lifetime membership.

As a result of this podcast series, my Camp Codger chapter of the club already had a couple of members. The first guys in, Ron and Jimmy, were incredibly open about sharing what they had learned during their diagnosis and treatment. Several other guys among friends, acquaintances, and family had listened to the first Podcast Papers episode and surprised me by welcoming me to their club. Thanks to Kevin, Jack, Mike, Dan, and Owen for reaching out. It’s not a club I was interested in joining, but it has a great roster of members. We had some terrific conversations and email exchanges.

I also had the good fortune to meet Robert and Charlie through introductions from my friends Stewart and Peter. And Doug, a visitor to our Airbnb guest house, was a surprise club member. Over a glass of wine one afternoon, Doug mentioned that he had prostate cancer, which triggered an extended discussion about what I could expect.

I’ve really discovered the importance of community. The dialogues have been heartwarming and, at times, intense as we discussed the challenges of dealing with prostate cancer and its diagnosis and treatment. Talking about it makes a difference. A heartfelt thank you goes out to the members of my club. I am forever grateful for your support and friendship.

If you’re joining the prostate cancer club, my advice is to be open to talking with other guys. The first conversations may be a little awkward, but you’ll learn a lot, and you may make some new friends. I’m not typically a joiner, but in this case, I stepped out of my usual pattern. I’m really glad I did. Btw, ask your urologist to point you to local prostate cancer support groups. For some men, it’s an excellent way to connect with this community.

We get back on track with the next chapter of The Prostate Papers when I return to the topic of the biopsy dilemma.

In this episode, Gary enters the prostate cancer maze when his PSA test results increase rapidly.

This is Gary Ebersole. I’m back with another chapter of The Prostate Papers. In this episode, we get serious about all the decision points and choices that men must make in their journey through the “prostate zone.” As always, I remind the listener or reader that I’m not a doctor. I’m merely trying to provide a guide that might help you better understand what’s on the path ahead. These are my experiences and may not reflect your situation.

To illustrate The Prostate Papers journey, I’ll introduce a metaphor I use to describe my travels through the prostate zone to visualize what it feels like to be on this trip. I sometimes think of myself as a package going through a maze of conveyor belts and chutes in a UPS sorting facility. As you ride along, you’re confronted with a sequence of decisions, often with several options and various outcomes. Depending on your decision at any given point, a gate closes, and you are sent down a chute onto a different belt. As much as you would like to return to the beginning of your trip and find a more pleasant adventure than dealing with prostate cancer, the belt only moves forward, and the ride continues.

Let’s start with the first decision most men think they must make—should I have my PSA levels tested yearly? In truth, your first decision is often whether to submit to a digital rectal exam (or DRE) by your primary care physician during your annual physical exam. Unfortunately, the evidence supporting using a DRE to identify early-stage cancers isn’t great. If the DRE is part of your yearly exam, welcome to the prostate cancer maze and hop onto the “watchful waiting” conveyor belt. Another, possibly even earlier, access point to this conveyor belt is when patients report lower urinary tract symptoms to their doctor. Google “prostate cancer lower urinary tract symptoms” to get the long list of symptoms. You can expect a DRE and a baseline PSA test if you report any of these symptoms. You’re also on the “watchful waiting” conveyor belt.

Back to PSA testing, which is a stronger indicator of possible prostate cancer than either the DRE alone or patients reporting lower urinary tract symptoms. Confusing for both patients and doctors, there is no consensus on prostate cancer screening guidelines. The American Cancer Society, the American Urological Association, the United States Preventive Services Task Force, and the National Comprehensive Cancer Network all have different (sometimes contrary) recommended guidelines. For instance, the USPSTF, a government-funded nonprofit organization, recommends against PSA testing for men over 70 (I’m 75). The ACS is more nuanced and recommends continued annual screening if baseline test results reach a certain threshold. The other groups are similar. There are very good reasons for this ambiguity. The risk of overdiagnosis (and overtreatment) for prostate cancer is high. Nobody wants the prostate cancer treatment side effects if they don’t have cancer. By the same token, nobody wants an aggressive cancer to go undetected. It’s a conundrum.

As I mentioned in the first chapter of The Prostate Paper, I entered the maze voluntarily (no symptoms) and jumped onto the “active surveillance” conveyor belt four years ago at age 71. My decision was based on several factors. First, I always believe it’s better to have information on which to base rational decision-making. Ignorance is not bliss for me when it comes to my health. Second, I have always been an active participant in my healthcare decisions. I rely on the advice of medical professionals, but I’m always well-prepared...