The Diagnosis

(When Runner’s World cut me loose as a columnist in 2004, I wasn’t ready to stop magazine work. This year I post the continuing columns from Marathon & Beyond. Much of that material now appears in the book Miles to Go.)

2008. One day before my 65^th birthday I felt great, as young and healthy as anyone could expect to be at this age. On the birthday itself, both feelings changed dramatically. A visit to a urologist that day led to a diagnosis of prostate cancer, and all the tests and treatments that had to follow.

My first reaction, not counting the initial uncertainty bordering at times on panic, was to keep this condition secret from all but the immediate family. This would have been a mistake. Even this relatively mild form of cancer is too big a burden to bear alone.

Fortunately I was far from alone. This is the most common cancer in older men, matching breast cancer for women in incidence and cure rate. (Both are highly curable if found and treated early, the big “if” that’s the focus of this column). If you must have cancer, better to have a common type that the doctors have had lots of practice at beating.

Three of my great friends in running have dealt with prostate cancer. George Sheehan lost to it, but Paul Reese beat it with radiation, and apparently so did Bill Rodgers with surgery. None of them was secretive, so neither am I.

George wrote a book about his final fight, titled Going the Distance. His illness was advanced when discovered, at age 67, and was beyond the reach of standard treatments. He lived another seven years, mostly actively and productively. He ran his last race in his final year and completed his final book in his last week. George lived a line that he had written about “finding a healthy way to be ill.”

George’s illness might have been discovered in time for successful treatment with a routine PSA screening. That blood test wasn’t common in the 1980s but is now.

A climbing PSA reading led me into two biopsies, a year apart, that both were negative. The third wasn’t. Now I thank Dr. Sheehan for his inspiration and Dr. David Esrig, my urologist, for his vigilance.

Paul Reese’s prostate cancer was diagnosed soon enough and treated with radiation. Three years later became the oldest person, at 73, to run across the United States.

Paul wrote in his book about that trek, Ten Million Steps, that the purpose of his run “wasn’t to say, ‘Look at me, Mr. Genes, Mr. Macho. I didn’t want to come off like, ‘Boy, I had cancer and I’m a tiger now.’ I was just lucky that my cancer was detected early. It hadn’t metastasized. The early detection and my recovery are a tribute to modern medicine, not running.”

Paul lived another 17 years after his treatment. He died at age 87, from complications of heart surgery unrelated to prostate cancer.

If running protected against this illness, then Bill Rodgers should have been granted lifetime immunity. Few runners have run more miles, faster. Yet Bill has joined this reluctant brotherhood of prostate-cancer battlers.

He went public about his illness in Sports Illustrated. Diagnosis was made as he turned 60, and surgery removed his prostate in January 2008.

After reading the magazine report, I sent Bill a note of commiseration. The reply was typical him, deflecting attention from himself toward others. He dismissed his own case in a single sentence: “I had surgery, started back walking a little in a few days and was running in two to three weeks, mixed with walking.”

Bill had a bigger matter in mind: “About 200,000 men will be diagnosed with PC [in 2008]. It hits men with about the same numbers and lethality as breast cancer hits women. Yet PC research is way lower funded, perhaps at about a third of total dollars.

“I’m working with the Prostate Cancer Education Council, out of Colorado, to try and develop the momentum for a ‘Race for a Cure’ attack on PC by raising awareness on the need for earlier PSA testing (age 40) and research dollars. Would you be interested in getting involved?”

I was, and would after taking care of personal business. Meanwhile I write this column to help break down the reluctance of men to take simple tests to expose this enemy when it’s most beatable.

Middle-aged and older men: swallow your embarrassment and get regular PSAs and rectal exams. Women: work on your men until they relent.

Later. My original diagnosis of early, localized, treatable prostate cancer threatened to become more complicated before any treatment began. A CT-scan revealed “suspicious spot” (as the doctor ominously called it) on a lung.

A first biopsy of that spot was ruled inconclusive. The second assured me that I’d done right by hiding nothing from the marathoners I coach.

One of them works in the pathology lab that would handle my repeat biopsy and said, “Let me know when you’re having this done, and I’ll make sure it gets special attention.”

The pathologists there agreed that it merited one another of the best words in our language: negative. So we returned to treating the original problem, at a stage when it was most treatable.

Before the medical machine sucked me in, I’d planned to run a fall marathon. If you want to make the gods laugh, tell them about your long-range plans. They had other plans for me that season.

I still would train for a “marathon,” except that it was medical and not athletic this time. I would accept the schedule and check off the sessions one at a time, trusting that they’d lead to a successful finish.

(Photo: My prostate-cancer “teammate” Bill Rodgers also was diagnosed in 2008.)

[Many books of mine, old and recent, are now available in two different formats: in print and as ebooks from Amazon.com. The titles: Going Far, Home Runs, Joe’s Team, Learning to Walk, Long Run Solution, Long Slow Distance, Miles to Go, Pacesetters, Run Gently Run Long, Running With Class, Run Right Now, Run Right Now Training Log, See How We Run, Starting Lines, and This Runner’s World, plus Rich Englehart’s book about me, Slow Joe.]