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 healthca

In this episode of The Prostate Paper, Gary comes out of the prostate cancer information rabbit hole and takes stock of what he has learned.

Gary Ebersole again. I’m back with another report on my journey into the “prostate zone.” As I mentioned in the previous episode, I’m not a medical professional, and I’m not giving medical advice. My objective with these podcast episodes is to share the experience and knowledge I have gained with our listeners. Make your decisions based on your research and the advice of your medical team.

In this episode, I’ll take a break from my nonstop research and take stock of what I’ve learned. First, a personal sidebar. My journey began eight weeks ago when my second PSA test results in two months were posted to my medical portal. Damn, that was my first thought. Another big jump in two months (20%) after the 33% increase over the previous year. Not good. I had just entered the prostate zone. For me, that didn’t mean rushing to my urologist and demanding immediate treatment. I wanted more information. He ordered an MRI scan, and the intervening three weeks gave me plenty of time to understand my situation better.

My research became the catalyst for The Prostate Papers. Prostate cancer was more complex than I had thought, and perhaps what I learned over dozens of hours of online research could offer some guidance to other men entering the zone. So, here we are, eight weeks later, and I still haven’t had a prostate biopsy. What, you may say? No biopsy yet? Perhaps the best virtual advice I received during my research was listening to a YouTube video featuring Dr. Mark Scholz, a well-known medical oncologist in Los Angeles. He’s specialized in managing prostate cancer (not treating) for the past 30 years.

In this video (https://www.youtube.com/watch?v=aotF2SPzCmU), Dr. Scholz tells patients to “Go slow…do your research…talk to a lot of people …give yourself time to process the complexity of the situation”. The essence of his advice is simple—you have time. Yes, you have cancer—the big ‘C’—and that creates an incredible sense of urgency. Your first response is, “I want it out, and I want out now.” But stop, take a deep breath, do your research as Dr. Scholz says, and talk to your doctor. You’ll discover two important things. First, some forms of prostate cancer are what is called “indolent” and grow very slowly. Second, even if your cancer is considered high-grade or aggressive, it still grows slowly compared to many other cancers.

You certainly have a few weeks, even longer, before committing to a diagnostic and treatment pathway. Google the phrase “How quickly does prostate cancer spread?”. You’ll find many credible sources that support the premise you have time to understand your disease and your choices. Whatever you do, don’t choose to do nothing. That would be stupid. You wouldn’t be at this point if there weren’t some solid prostate cancer signals. Listen to what these signals tell you, and if your doctor recommends active surveillance, follow their advice for regular PSA testing and, in some cases, routine MRI testing. You are in the prostate zone. Deal with it.

Back to my biopsy status. I’m glad I took the time to research prostate biopsies. No, a prostate biopsy is just any old biopsy. There are several approaches that I plan to explore more deeply in the next episode when I take listeners into the prostate cancer maze. I’ll explain what I discovered and how it impacted my biopsy path.

In addition to the

In this episode of The Prostate Papers, Gary goes way down the prostate cancer information rabbit hole.

Welcome back to one man’s trip into the dreaded “prostate zone.” Before I start, let me remind listeners that I am NOT—repeat—NOT a doctor. I’m just a reasonably well-informed patient, and I’m sharing what I have learned in the hope that other folks entering the “prostate zone” might find it useful. Do NOT treat anything I say as medical advice.

I closed the first episode with a simple question—is there just too much online information on prostate cancer for a reasonable person to discover and process? The classic answer—and my response—is “It depends.” For almost all of us, at the outset of our research, the amount of information can seem overwhelming. Just getting started can be a challenge. Googling “prostate cancer” gives over 412 million results. But is it too much? For many men, a fair answer is “yes”. TMI. Too much information. That’s what highly skilled, experienced doctors are for. A good doctor can guide you down this path to a successful outcome. You don’t need to enroll in the Google School of Medicine to be a good patient.

Other folks eagerly head down the prostate cancer “rabbit hole.” There can never be too much information. One more query to post, one more paper to read. I’m one of them. When we “data hounds” go into our doctor’s office, we’re ready for a serious discussion, not a lecture. In my case, after a follow-up PSA test came back showing yet another significant bump in my score, my urologist recommended we proceed with diagnostic testing, beginning with an MRI scan.

In the three weeks before the test, I went down the prostate cancer information rabbit hole. Way down the rabbit hole. I spent dozens of hours clicking through long lists of Google search results. No surprise, there’s almost an endless supply of information scrolling across your screen. Equally unsurprising, the quality is all over the board. You can understand why doctors seldom look forward to seeing patients who have consulted with Dr. Google. Some may come in with a preconceived notion of their diagnosis and even have a treatment plan.

If you choose to arm yourself with information available online, let me offer some advice. First, hone your search skills. The value of the returned results depends on composing good queries and comprehending and filtering the flood of information. As you drill down, your queries should be using more specific keywords. Second, select your data sources carefully. As we all know, information on the web can range from gold to garbage. I’ll drill down on the sources in a moment. Third, check the dates of the published information. Prostate cancer diagnostic tools and treatments have made significant progress in the last ten years. There is decent quality information that is a decade old, but try to focus on research and reports from the last five years.

So, what online data sources do I think are good? Even though it’s far more challenging to process scientific research reports, they can offer some of the highest-quality data. In this project, PubMed Central from the National Institute of Health became my new best friend, but I wish I had paid more attention during my stats class in college. Processing medical research reports demands a basic understanding of statistics. And having enough information to understand the research context, its language, and its relevance is essential. It’s not always easy. That said, I read them anyway.

For most people, the best resources are medical information websites curated by large clinical and re

In the first episode of The Prostate Papers, Gary explains how accelerating PSA scores sent him into the "prostate zone" and off for an MRI.

Welcome to The Prostate Papers, one man’s trip into the dreaded “prostate zone.” You might reasonably ask, “Whoa! Where did this ‘prostate papers’ conversation come from?” And you might also ask why I’m turning my very personal story into a public dialogue. I’ll address the second question in the next episode when I discuss the prostate cancer information overload challenge. For the first question, a little backstory to get started.

I’m like most guys in my mid-70s age group and am keenly aware of prostate cancer. I have several friends and family who have been treated for prostate cancer. It would be surprising at this point in my life not to have friends and family who have been treated for it. Like many of my peers, I have been on and off the PSA testing regimen. Over a dozen years ago, at the recommendation of my then-primary care doctor, I stopped taking PSA tests. From what I had read at that time, it made sense. Over-diagnosis with what were less accurate tools 15 years ago often led to over-treatment. My doc used the old medical cliché that, at my age, I probably already had very slow-growing prostate cancer and would be more likely to die from some other affliction. Watchful waiting (or active surveillance) was the order of the day.

That worked for me until 2020 when my new primary care doctor suggested we start PSA testing again. That seemed reasonable if we agreed to be wary of the over-diagnosis/over-treatment trap. All went well until earlier this year when my PSA scores started climbing. No panic. Watchful waiting, right? After all, PSA test results can be volatile and often reflect non-cancerous issues with the prostate, right? Well, after another test and another bump up in the PSA score, it appeared it was time for me to enter the PSA cancer maze. And it is a maze.

A couple hundred thousand men in the U.S. enter the prostate zone every year through the same door I used—rising PSA scores. It’s not the best indicator, as doctors repeatedly remind you, but it is a signal that can’t be ignored. I’m still early in the diagnostic process as I prepare this episode. I haven’t even had a prostate biopsy yet. Rising PSA scores could be BPH-related, it might signify asymptomatic prostatitis, or it could be cancer. It’s just too soon to tell.

I should note that I’m playing a dual role in this podcast series on The Prostate Papers. On the one hand, I want to be a dispassionate, helpful observer who finds researching and comprehending this subject compelling. I tend to define myself by my projects, and this is my latest project. Of course, on the other hand, I’m also the patient. What I’ll discover through my research and clinical experience will directly impact my life. As you listen to these episodes, you’ll hear these distinct voices. The observer will share what I am learning with listeners who might be traveling the same path. The patient might be a bit more pensive and introspective.

This series is not intended to be another “my-cancer” story. Well, I suppose it is, but I’m not looking for sympathy. If I do have prostate cancer, I fully expect to survive. At this stage of my diagnostic testing, the odds are very much in my favor. It’s a story about navigating this unique cancer and the medical-industrial complex in which it operates. I hope to explain the diagnostic and treatment process that makes prostate cancer so challenging for patients.

The Land of the Very Old is growing closer for Gary but he's not at the border yet! He filed the following report about an article he recommends about traveling to that not-too-distant land.

A couple of months ago, a friend sent me a link to an article titled In the Land of the Very Old (https://sundaylongread.com/2024/01/23/in-the-land-of-the-very-old/). My first thought was—huh? What does this have to do with me? I’m not “very old”, just "old". At the time, Bee and I were on our infamous road trip to Florida, so I put it aside for reading later. I finally picked it up again a few weeks ago and discovered a great story. In this article, the author, 90-year-old Sam Toperoff, looks back on his journey from the “Old Country” (where I still reside) to the “Land of the Very Old”. It's a sprawling piece that touches on many aspects of aging.

Toperoff opens the narrative by describing a scene he is watching while waiting for his 84-year-old wife. He observes a steady flow of older people slowly and carefully descending a flight of stairs outside a doctor’s office. He has an epiphany—he realizes he’s in the Land of the Very Old. In this article, the author takes us through aspects of his aging journey. At one point, he touches on the idea of a newspaper-like “corrections column” for your life.

I was quite taken by the idea of looking back on your life and identifying “corrections”. It's much better than wallowing in regrets which can seldom be resolved. In the last year or so, I have found myself looking back occasionally trying to understand why I made certain decisions or the way I behaved in some situations. I’m almost always able to let any regrets go, but I do find the mere act of exploring gives me some insights into my current behavior. And guess what? I’ve discovered old dogs can learn new tricks and I’m embracing my “corrections”.

More than anything else, this article was a reminder that, like it or not, I’m approaching the border of the Land of the Very Old. I haven’t reached it yet, but the “diminishing” that Toperoff describes as a sign of passage into this new land is more noticeable than just a few years ago. I’m resisting the diminishing, but I can’t stop it.

“In the Land of the Very Old” is a long read but, in my opinion, worth the time and effort. If you’re still in the land of the middle-aged or younger, it may not resonate at all. For those of us living in the “old country”, on the border of the Land of the Very Old, the article strikes a chord. I encourage you to read Toperoff’s closing paragraphs because it does give the “old” reader hope that residing in the land of the “very old” can be a good thing. It surely beats the alternative.

By the way, the striking image tied to this article was taken from Sam's house in the French Alps. The story about how three generations of his family decided to move from the U.S. to France when he was 80 years old adds a nice dimension to his story.

Would you like to know when the co-hosts of Camp Codger get together to talk about a new topic? Subscribe to our weekly Camp Codger newsletter to receive an email not

Camp Codger 2.0 has arrived in your podcast feed!

Surprised to be hearing from us again? After all, didn’t we say goodbye a few weeks ago? Are the codgers back in the game?

The short answer is “maybe”. This is an experiment and may end up being a very short comeback tour. When we decided to wrap up the Camp Codger podcast, Gary Ebersole had convinced himself that he was ready to move on. However, to be honest, a lot of his retirement identity was wrapped up in Camp Codger. In our circle of friends, we were the old guys who did the podcast for seniors. Most folks thought that was pretty cool. So did we. But, after much pondering as well as consulting with his fellow codgers, Gary decided to relaunch what he is calling Camp Codger 2.0.

This version of Camp Codger will be different in several ways. First, the codger participation will be different. Randy has moved into the role of Codger Emeritus, perhaps appearing in a short episode on occasion. Richard wants to take on a less active role not driven by the demanding weekly publishing schedule we followed for seventeen months with Camp Codger 1.0. Gary completely agrees with that sentiment. In the new Camp Codger, episodes will be published pretty much when we jolly well feel like it. Frequently enough to stay engaged with our listeners, but not so often that doing Camp Codger feels like a job. After all, we are retired, right?

With Randy retired and Richard’s participation reduced, that leaves Gary, the Chief Codger, responsible for most of the content we will be producing for Camp Codger 2.0. Richard may contribute the occasional, short solo episode on a topic that strikes his fancy, or he and Gary might engage in a conversation on a topic that grabs their attention.

We’re leaving the topics wide open at this point. What you can expect is that we will continue to focus on topics that are relevant to our fellow Baby Boomers. And we may frequently touch on more controversial subjects. If you don’t agree with our opinions in an episode that we publish, we’re counting on you to tell us where we went wrong or, just maybe, let us know when we hit the mark and tell your friends about the new Camp Codger 2.0.

As a rule, you can expect these episodes to be shorter, ideally under ten minutes. Don’t be surprised if some are just a few minutes long. After all, nobody really wants to listen to an old codger drone on endlessly, even if he speaks in the most dulcet of tones. You can think of what we will be publishing for Camp Codger 2.0 as opinion pieces delivered as Goldilocks-style audio essays—not too long, not too short, just the right length for the topic at hand.

Finally, our audience expectations for Camp Codger 2.0 are now far more realistic. Our main motivations for bringing back Camp Codger are personal. We enjoy the creative process of producing episodes and think we have something to share with our listeners. Even if we only have a small audience that appreciates what we have to say, life is still good!

Would you like to know when the codgers have something new to say? Subscribe to our weekly Camp Codger newsletter to receive an email notification each time we publish a new episode. You can also subscribe and listen on your favorite podcast app. And, if you enjoyed this episode about the return of the codgers, please click the Share button below and Like Camp Codger on our Facebook Page. Finally, have some feedback for the old codgers?

It's been a good run, but, with a heavy heart, it's time for the old codgers to say goodbye. We hope you enjoyed listening to Camp Codger as much as we did creating and publishing these last 72 episodes. In an epilogue episode, Gary explains how we came to this difficult decision. Leave a comment below or send an email to campcodger@gmail.com if you have any last thoughts.

Goodbye!

Gary, Richard, and Randy