Unbounded terror gripped me. My urologist's secretary had just given me the results of a routine follow-up test for prostate cancer.
Since my prostate had been surgically removed and the area treated with localized radiation more than five years earlier, all traces of a substance produced only in the membranes of prostate and specific cancer cells had literally disappeared.
Now, I was being told that, although I was feeling fine, the substance had somehow reappeared, meaning that there must be a recurrence of cancer somewhere in my body.
Horrid images, of chemical castration or, worse yet, of actual castration to halt the growth of the cancer, flooded my consciousness. A thought: If women can get artificial breasts, I wondered, can men get artificial testicles to reduce self-consciousness in locker rooms?
Our family cat and I: We may have more in common than I had previously thought, now with castration looming on the horizon. Is there, indeed, a male equivalent for getting spayed?
Images of a premature death, a death in my early forties, a death that would prevent me from watching my children grow into adolescence and adulthood. Images of a special intimacy with my wife that was to be no more.
My body had already been mutilated by prostate surgery and radiation, and my sex drive was only beginning, over the previous three years, to return to normal.
My fears were confirmed in subsequent conversations with a radiation oncologist and urologist. While CAT scans and bone scans showed no evidence of cancer, this prostate-specific test signaled a recurrence.
There is no curative treatment, but my urologist insisted I start hormonal manipulation, a fancy term for chemical castration, immediately.
Hormonal manipulation is considered "palliative." It is not a cure but would make my existence more "comfortable" and possibly add a few months or years to my life.
Palliative castration -- an oxymoron to beat all others -- for what purpose, I wondered. I was feeling fine physically, despite my panic and terror over this test. I still was playing basketball three times a week, and I had recently been "carded" at the Capital Center to determine if I was old enough to buy beer.
Actually, I figured I had already gone through palliative hell by becoming a cruciferous vegetable freak and by eliminating virtually all animal fats from my diet.
When I obtained second opinions that contradicted the need for this palliative castration, it made me think about the medical establishment's push for "early detection" of disease. Sure, early detection may help in curing many diseases, including some forms of cancer.
But what is the point of early detection of disease when the person feels healthy and when no suitable and effective treatment is available? Are physicians inadvertently torturing many of their patients? Are we creating a class of patients whom I would call the "terrified well"? Perhaps I might live an extra few months from the benefits of early detection of this recurrence. But will I ever again sleep beyond 4 a.m. without waking in a panic?
I feel a special kinship with anyone who tests positive for the human immunodeficiency virus that causes AIDS. For many people infected with the virus, early detection may lengthen life by allowing treatment to begin earlier.
But healthy HIV-infected individuals make up an enormous segment of what I would call the "terrified well." Recent reports indicate that the hidden killer in HIV disease is not necessarily the virus but, sometimes, suicide. Terror and panic have their consequences.
Don't get me wrong: I like predictions as much as the next guy. Weather reports are fine, but do I really need to know when I am going to die?
The psychic costs to me of early detection of a recurrence of prostate cancer have been profound. But what are the benefits?
Admittedly, I am left confused by my illness, much as Tolstoy was confused just before his death, when he remarked, "I don't understand what I'm supposed to do."
Yet there appears to be some truth to the paradox that one cannot truly live until one has faced death. Can I transcend myself? Do I have the courage to write about the relationship of sexuality and prostate cancer?
In 1982, Anthony J. Sattilaro, a physician in Philadelphia, wrote inspiringly of his extended remission from prostate cancer in "Recalled by Life."
He described his transformation from abject despair to wondrous hope, as he moved into a life-prolonging world that provided nutritional, spiritual and emotional sustenance. He mentioned only briefly his orchiectomy, his literal castration, which may have provided the initial biological reason for the disappearance of his metastatic prostate disease.
No doubt his new lifestyle was an integral part of his remarkable recovery, no doubt his immune system was given a helpful jolt.
But how sad it is that we men have not been able to talk easily about the ravaging of our bodies, unlike women who have described their ordeals with mastectomies.
When I spoke with Sattilaro several years ago, I asked how he had managed to cope with castration.
He replied that it indeed had not been easy, that castration had been the subject of hours of psychotherapy.
But, alas, in his writings, there has been no acknowledgement of this psychotherapy; and, although he hoped to write of his psychological and emotional experiences, no new writings, as far as I know, were published before his death last year.
I am left with the rebellious urge to cry out, "Eunuchs, unite; be not proud." Chemical eunuchs can join forces with those who have been castrated surgically.
If 96,000 new cases of prostate cancer are being diagnosed in this country each year, how many eunuchs may be among us?
A considerable political force, to be sure. Who said eunuchs were a thing of the past, merely the court jesters of Shakespeare's plays?
But enough morbid humor. Summer is here; my hormones are flowing still. I may no longer be 16, but I shall hold on to my testosterone as long as I can.
The urologists who say that castration is not, as yet, necessary bring music to my ears. "To be or not to be" fades into "To be a sexual being or not to be a sexual being" or "To be castrated or not to be castrated."Paul J. Steinberg is a Washington, D.C., physician.