Cut From Steel

One elevated number, three biopsies, twenty-seven more years.

Harry Belafonte went to his doctor twice a year, the way you are supposed to and mostly do not. At one of those appointments his doctor noticed that his PSA had climbed. Belafonte was sixty-nine years old in 1996, with a career behind him that included the first million-selling album by a solo artist and a seat at the centre of the civil rights movement.

The first biopsy came back clean. His PSA kept climbing, so his doctors went in again, and the second biopsy was also benign. Most men would have stopped there and taken the reassurance home. Belafonte let them do a third, and the third found the cancer.

Belafonte started with radiation and hormonal treatment, took opinions from several cities, and settled on surgery. He talked publicly afterwards about the incontinence and the impotence, which is a rare thing for a famous man to do, and he called them minor inconveniences against the price of survival. Exercises beat the incontinence, he said.

Belafonte died on 25 April 2023, at ninety-six, of congestive heart failure. He lived twenty-seven years past the diagnosis and died of something else entirely, which is the outcome most men with prostate cancer get.

You are not being asked to be brave here. Belafonte's story turns on one boring detail... he kept going to the appointment, and he kept asking after two tests told him not to worry. The screening conversation is the whole hero moment.

You did not vote for four trips a night

You get up at one, then again at three, then somewhere near five. Cutting out water after dinner made no difference at all. Your wife sleeps through it now, and you have decided this is simply what men do after fifty-five.

I want to name the thing behind it. Your prostate sits directly around the tube that carries urine out, and that gland keeps growing through the second half of life. Doctors call the growth benign prostatic hyperplasia, and the NIDDK is blunt that it is not caused by cancer. Cleveland Clinic reports that around half of men have some signs of it by sixty. Size and symptoms do not track together either, so a slightly enlarged gland can cause more trouble than a big one.

Three things you can act on this month

So what does a man do with a night like that? I count three moves, and the third is the one you keep postponing.

01 / The Hours Before Bed

You can shift the load off the small hours. The NIDDK advises drinking fewer liquids before bed, limiting alcohol and caffeine, and emptying the bladder completely rather than rushing. None of that shrinks the gland, and all of it changes how many times you stand up in the dark.

02 / The Couch

You have another lever that nobody mentions at the appointment. The NIDDK lists physical inactivity among the things that make BPH more likely, and it says being physically active may help reduce the risk. Prospective studies link activity to fewer urinary symptoms over time. The trial evidence is thin, so I will call this a good bet rather than a guarantee.

03 / The Test You Keep Postponing

You need one conversation, and the guidance genuinely disagrees, so go in informed. The American Urological Association says clinicians may offer a baseline PSA between forty-five and fifty, and regular screening every two to four years from fifty to sixty-nine. Federal advisers on the US Preventive Services Task Force start at fifty-five and call it an individual decision. Both want you deciding with a doctor rather than alone.

Book the conversation this week

You can do the easy part tonight. Move your last big glass of water to an hour after dinner, and put the nightcap down, since alcohol and caffeine both push the bladder. Walk after dinner instead of sitting straight down.

You should also go in knowing what raises a PSA besides cancer. An enlarged prostate does it, prostatitis does it, recent ejaculation does it, and a long bike ride may do it. If one number comes back high, the AUA wants the test repeated before anybody books a biopsy.

One last thing. Belafonte got twenty-seven more years out of one raised eyebrow at a routine appointment, and he had to keep asking to get them.

— Travis

Insider Member's Corner

6 free habits for the man who is up four times a night:

You didn't put in 45 years to settle for beige.

01 / Watch · Omega Speedmaster Professional

Omega asks about $7,800 for the steel Moonwatch, and it is the only watch NASA flight-qualified for manned missions. Buzz Aldrin wore his on the lunar surface in July 1969, after Armstrong left his in the module as a backup timer. You wind it by hand every morning, which is a small daily argument with convenience. Nobody has ever regretted owning this watch.

02 / Fire · Big Green Egg, Large

Big Green Egg lists the Large at about $1,200 for the ceramic egg alone, and closer to $1,700 or more once it sits in a nest or a table. Thick ceramic holds heat and moisture, so one vessel will grill a steak, smoke a brisket, and bake bread between 200 and 750 degrees. You will cook things you never bothered with on a gas grill. A twenty-pound turkey fits inside the Large.

03 / Chair · Eames Lounge Chair and Ottoman

Herman Miller introduced this chair in 1956, designed by Charles and Ray Eames, and still assembles it by hand. The standard configuration runs about $8,700, with the range depending on leather and wood. You sit in it once and understand the price is about the twenty years after the purchase. Put it where the light is good and keep the television out of the sightline.