Most men over fifty have a yearly digital prostate exam and a PSA test,which is done from a blood sample. I've discovered that the men who have this test rarely know their numbers so long as the numbers are safe. It's not a problem that they don't know the number; their doctors know the numbers. By the way, if you change doctors, it is important for the doctor to have a record of your previous readings.

If your doctor decides that your PSA reading indicates that you should have a biopsy, do it. I was told that it wasn't a big deal, but for me it was a discomfort for a few days. The biopsy is done through the anus with a spring loaded mechanism that penetrates the colon wall and extracts samples from the prostate. These samples will come from part of the prostate; it is impossible to sample all of it.

At this point, you will be told that either the sample is clear (in which case the doctor will probably want to do another biopsy because your PSA numbers indicated that there is probably cancer) or that the biopsy indicates there is cancer. You will be given a Gleason Score which indicates the aggressiveness of the prostate cancer, and you will be told how many of the samples were cancerous and how many were clear. So, now you have three data points: your PSA , your Gleason Score, and the number of cancerous samples. Other factors that will be important in this equation are your age and the prevalence of prostate cancer in your background.

You may not, however, have all the factors that allows you to intelligently choose "watchful waiting." After my doctor explained watchful waiting, he followed it with the comment, "You may not choose watchful waiting as your therapy." I was given a book about prostate cancer and an appointment a week later when I was supposed to have made my decision as to the therapy I would have. I read the book, but I didn't have the decision; I needed more time.

My advice at this point for men in my position is to start talking, and, yes, I know that you don't want to talk about this, but you need information. Join a support group (my doctor did not tell me about the support group that I attended). The men in the support group will be a source of information. Don't think that because you read one book that you know everything that a layperson can understand about this type of cancer and therapies. I read three books, and I felt that one, Surviving Prostate Cancer was the best (I don't know if it has been updated). In my experience, I've found that most doctors leave their patients to make the decision as to the therapy they will have.

I was told that surgery is the "gold standard" for results of being cancer free, but there are so many other therapies, hormones, heat, cold, high frequency ultrasound, and different methods of delivering radiation -- coming in future Hubs.