Dear Horace,

I, too, have serious other problems plus PCa.  (I am 76.)

First, having an enlarged prostate does not mean that you have PCa and there
is no reason to fear something that you have no reason to think that you
have.  Nor do I think (and others may help on this) that any consequences of
an enlarged prostate include great pain or pain that can't be managed,  Has
your doctor taken PSA tests as part of your usual blood work?    You can
certainly ask him point blank if he has considered a biopsy and just tell
him your worry.

But I would tell you not to worry yourself about pain--you have enough to
deal with.  Even if you were to develop PCa, the pain you fear would still
be down the road.  Don't upset yourself about something that may never
happen and you have no real reason to think will happen.

1. RUN to a different doctor.
Not because you MAY have PC; because your doctor is all but useless when you
need facts for your peace of mind, not merely procedures and pills to
preserve your pulse.

2. Keep asking questions here, elsewhere, and with your next doctors, and
take advantage of your sedentary lifestyle to dig into the internet and a
bookstore. There's great peace of mind in knowledge, and it can get you
through much of this.

3. I hear that pain part. Living's fine, death's fine if inevitable and
imminent, but dying in severe pain is a crappy, avoidable way to end a good
life like you've led (else you'd be depressed). Pain is curable in at least
four, often sequential, ways: a) meds that leave us conscious and alert, b)
meds -- primarily big doses of morphine -- that render us essentially
unconscious, c) refusing food and water, and d) more active solutions. I
have no intention of putting my wife through prolonged (b), so if (c) is
denied by some damned lawyer or judge or whining activist, my (d) is going
to be highly dramatic, very messy, thoroughly explained, and very public, to
make a point for all to consider. No one but my wife or myself gets to
dictate the end of my life.

I.P.

...

If your enlarged prostate makes urinating difficult, your doc's may
recommend medication or surgery to open up the passages, but nothing
like what you experienced with a triple bypass.  

At your age and with your other health issues, if you are diagnosed
with prostate cancer in the future, they might recommend a
dose of hormones or some external radiation therapy.

For either hormones or rad, the side effects generally fall into the
category of "mild discomfort", easily tolerated.  

I say that while griping about hormones.  What happened to me is
probably not applicable to you or it may be an issue.

When I was diagnosed with prostate cancer, I also clocked a fasting
blood sugar of 130.   My doc said to handle the cancer, 1st
priority and knock off 10 pounds, then we'll look at the sugars.  

A fasting 130 isn't good but when you weigh 197 and stand 5'7" and
fly a desk, it just says to get off your butt, knock some weight
off, and get some exercise.

Well, I went around the barn and back with the cancer, lots of
high tech tests, two Lupron shots, 25 IMRT sessions, 97
Palladium-103 seeds, I was buying Fleets by the caselot.  

I was feeling good about the cancer, two < 0.1 PSAs, the hot flashes
were fading, I was sleeping through the night, but then the doc did
another fasting blood sugar, 300.  

The kicker is, this is after losing 12 pounds.

It's been suggested (by I.P.) that the Lupron slamming my
Testosterone is responsible for the high blood sugar.   I sure hope
so.  

I was supposed to get the 3rd Lupron shot at the end of January.  I
declined it.  At that time I had one < 0.1 PSA, since then, early
March, I had the 2nd < 0.1 PSA.  

I'm a little more confident that I did the right thing.  (I'm going
on and on about the sugar because diabetes is one of your issues.)

The doc put me on Glucophage in February.  He doubled the dose a
couple weeks ago.

I'm 2 months past due for the Lupron.  My weight is dropping
at the rate of about one pound a month.   As the fatigue (a side
effect of both the Lupron and Radiation) fades, I've been increasing
my level of exercise.  

In the last two weeks, my morning blood sugar has dropped from 200
to below 150 in a gradual descending arc.  200, 180, 160, 150,  I've
had a couple readings below 150 so I am encouraged.

I don't know if it's the glucophage, the exercise, the diet (no
more 32 ounce Pepsi's, no white bread, small quantities of carbs),
the weight loss, the rising testosterone, or what.

My opinion - The treatment for prostate cancer can be very easy, no
pain, not even discomfort.

There are complex side effects to the treatments.  I am very wary of
the Lupron.   I actually hope it's the Lupron, which will fade, and
not some catastrophic endocrine system failure.

That my blood sugar is falling is encouraging.  

I'll close with my pain story, hopefully you'll get a laugh at my
expense.

Last summer, the guys I work with were going on and on about a Ryobi
weedwacker with detachable cutting heads.  I got one.

I was eager to try it out.  I filled the tank with the 2-stroke fuel
and,  PULL!  P-p-p-pup-pup.

PULL!  P-p-p-pup-pup.

PULL!  P-p-p-pup-pup.

PULL!  P-p-p-pup-pup.

Then I looked down and saw the red switch. OFF-ON.

The next day my arm hurt.

Over the next few months, it kept on hurting.   I didn't pay much
attention as I was pre-occupied with finding the best prices for
Fleets, it's the six-pack at Sam's Club.

Then after all the treatment, about December, I noticed that my
right arm was hurting like I've never felt pain before.  

If I picked up my umbrella from the passenger seat, my shoulder hurt
like a knife stabbing into the joint.  Once I reached back to get a
newspaper off the back seat and it hurt so bad that I almost passed
out.   This is a blinding, paralyzing pain.  

I finally went to an orthopedic surgeon.  It's called a "frozen
shoulder", he said.   It will get better on it's own over 3-5 years.

I can go to physical therapy where a 6 foot tall blonde Valkyrie
named Brunhilde will teach me discipline and the joy of pain.  

Or, the doc can knock me out for 2 minutes and just YANK on my arm.  

I looked up some exercises on the Internet and have been doing them
for the last month.  I do not have full mobility yet but I am much
better.   The doc said, "you can't do it yourself, it will hurt too
much."

Well, maybe.