I've been dealing with an enlarged prostate since my 30s. I'm 60 now. For years, I managed it, monitored it, and did what I was supposed to do — regular exams, tracking numbers, staying on top of my health. Then my PSA numbers climbed. Two MRIs, both came back negative for cancer. But the numbers refused to cooperate. My urologist sat me down and laid out my options: take a biopsy now, or wait another six months and recheck the PSA.

I chose the biopsy.

I want to tell you about that decision — and what happened after — because if you're a man over 40 dodging your annual check-ups, rationalizing why you don't have time, or just hoping things will work themselves out, this one's for you.

The Procedure Nobody Warned Me About

I'd done my research before going in. I knew a transrectal biopsy wasn't exactly a pleasant afternoon. What I didn't fully anticipate was lying on that table, staring at a painting on the wall, trying to focus on anything other than the sensation of the doctor taking tissue samples from my prostate. Local anesthetic helps — but "helps" is doing a lot of work in that sentence.

Then came the vagal response. For those unfamiliar, a vasovagal response is a sudden drop in heart rate and blood pressure triggered by stress or pain. My body decided right then was a great time to introduce itself to this phenomenon. I felt a wave of heat, broke into a drenching sweat, became nauseated, and lost the ability to respond verbally to the doctors asking me questions. That's a terrifying experience — not being able to answer even though your brain is screaming that you need to.

I was taken to the emergency room for observation. The response wore off. I stabilized. And I sat there thinking.

The Decision I'd Make Again

Here's where I landed: every uncomfortable moment of that procedure — and there were plenty — doesn't come close to what battling prostate cancer looks like.

Prostate cancer is the second most common cancer among American men, according to the American Cancer Society. In 2024, the ACS estimated approximately 299,010 new cases of prostate cancer in the United States, with around 35,250 deaths. The survival rates for prostate cancer caught early are dramatically better than for cancer caught late. The five-year relative survival rate for localized prostate cancer is nearly 100%, according to the National Cancer Institute's SEER database. For distant-stage prostate cancer — meaning it has spread — that number drops to around 34%.

Those are not abstract statistics. Those are men. Men who had families, jobs, plans, grandchildren they wanted to meet.

Deciding to get the biopsy, despite its unpleasantness, is the only decision that makes sense when the alternative is finding out too late. I'll get my results in the coming days. Whatever they show, I'll know where I stand. And knowing is power.

Men and Their Complicated Relationship with Doctors

Men — particularly men over 40 — have a well-documented history of avoiding medical care. A 2019 survey by the Cleveland Clinic, reported in Forbes, found that 72% of men said they would rather do household chores than go to the doctor. A separate survey published in the American Journal of Men's Health found that men are significantly less likely than women to have seen a doctor in the past year, to have a regular physician, or to seek care when symptoms appear.

The reasons are familiar: we're busy. We don't want to hear bad news. We think we can tough it out. We convince ourselves that if something were really wrong, we'd feel it.

But prostate cancer, high blood pressure, Type 2 diabetes, and a host of other conditions that disproportionately affect men over 40 are notorious for developing quietly. The Journal of Urology has published multiple studies showing that elevated PSA levels alone are not definitive indicators of cancer, but they are important flags that warrant further investigation. My two negative MRIs were reassuring, but they weren't conclusive enough to stop there — which is exactly why the biopsy conversation happened.

Former U.S. Secretary of State Colin Powell was diagnosed with multiple myeloma, a blood cancer. He continued to receive treatment and lived publicly with the illness, which brought widespread attention to the importance of cancer screening. His story is a reminder that serious illness doesn't discriminate by status, strength, or perceived invincibility.

The Bottom Line

I'm not telling you what medical decisions to make. That is between you and your doctor, full stop. What I am telling you is that lying on that table was far less scary than the alternative of never knowing.

Whatever's waiting in my results, I chose to face it head-on. And whatever it is, I'll deal with it with information, with clarity, and with the support of people who care about me.

You deserve that same clarity. Book the appointment. Take the test. Get the scan.

Show up for your body the way you show up for everything else in your life that matters.

Your family is counting on you being here. So is the man you're becoming.