PSA tests have two red flags to watch out for: a level above 4.0, and an increase of 0.75 per year over three successive annual tests. If either of those red flags appear, find out why. If it's just an enlarged prostate, which most guys get before retirement age, there are several ways to treat that. It can become a major nuisance, but it's seldom the life threat untreated PC will become. If PSA increases by 2.0 in a year, the patient's life expectancy declines significantly even with immediate treatment; don't let it wait that long.

If the doc suspects PC, s/he will probably schedule a biopsy. But never fear; the prostate biopsy is not a needle in the prostate. It's twelve needles in the prostate, one at a time, each precisely aimed by a sonar system up the usual place and fired from the usual place. (That usual place provides pretty good access to the prostate, so get used to it.)

Here's the big surprise about prostate biopsy: it doesn't hurt. If you didn't know the doc was pinging your heiney with sonar and plunging a dozen needles from there into your prostate, you'd never know this was any more than the annual, routine finger check. The ultrasound device is the size of your thumb, so it's no stretch (realize your wife ain't gonna wanna hear you whine about a little stretch, you wimp). And, believe it or not, you will hardly notice the needles, if at all. On a pain scale of 0 to 10, they were not even a 1; one Tylenol and I would have been unable to perceive them.

But they tell a big story. With fairly good reliability the biopsy tells the doc whether and where the patient has PC and how big a threat is it. If PC is already well established, as mine was because my original doctor ignored both of my PSA red flags, it may be time for a full-body bone scan and a pelvic CT to detect any PC spread beyond the prostate. Those tests are real doozies: you lie down on a table in your street clothes, snooze or count ceiling tiles for a while, and walk out the door. Done. While you were snoozing, a machine did all the work without ever touching you or making a sound.

The data from all those tests help your doctor advise treatment, if any, based on statistics from thousands of similar cases. If PC is not overshadowed by something more threatening (e.g., those three heart attacks, your looming 80th birthday), recent studies say treat it. The old plan of watching it progress at a snail's pace is no longer advisable, because 15 years after PC becomes detectable the snail's odds go way up. If you want to still be playing tennis -- or merely watching TV in comfort -- 20 years after that first PSA red flag starts the race, get any necessary tests and get any PC fixed before the snail wins.