The appointment at the urologist's this morning (10.15) lasted at least a half an hour and included a review of family history (no prostate cancer) as well as previous infirmities, afflictions - from bronchitis to high blood pressure. Also a physical exam, which was passed with flying colors (i.e. no unuusal or abnormal growths, or enlargement of gland in question and no other evidence of anything amiss). These were all good signs, but alas, not enough to convince the urologist to leave out a biopsy.
His primary concern was the unrelenting increase in the PSA (doubling from 2.8 to 5.6 in a year, then increasing again to 6.1 in 3 months, and again to 6.5 in 3 weeks - registered in a most recent blood test that also found a low free PSA percent of 5.1. In combination, he said, all the numbers pointed to biopsy. There was only left the matter of scheduling it.
A range of dates, times was available at the front desk, but since the longer the time the longer the build up of anxiety, I decided to arrange it for next Wednesday morning, at 10.30. This would be the day after my last physical therapy session (for a strained lower back muscle) and also leave ample time to finish necessary chores ....like mowing the already overgrown lawn.
Also at the desk I was advised by a nurse of all the things which had to be done prior to the procedure, including filling prescriptions. The key one is for the antibiotic, Levofloxacin (500 mg), one of which is to be taken 1 hour prior to the procedure and the other the next day.
The issue of antibiotics and their potency is an especially critical one for me, as my wife had to be hospitalized twice for c. diff. infection in late 2006, and early 2007, after taking only four days of Augmentin.(Augmented Amoxycilliin) for a sinus infection. This high potency antibiotic essentially erased nearly all her "good" gut bacteria, leaving her prey to clostridium difficile, which had her running to the toilet 22-25 times a day for over a week, until she had to be hospitalized for treatment....ending with vancomycin - the only thing that would stop it.
On questioning the urologist about the antibiotic prescribed and possible risks of acquiring c. diff. he assured me that its emergence was more an issue of duration of use. And since I am only on it for two days (as opposed to the normal three or four) there was little chance of redux situation, with me now as the 'star'. He didn't rule out, however, adding yogurt and acidophilus to my diet to ramp up the good guys in the gut. Just as an extra precaution and because I also likely have latent c. diff. spores in the gut.
Also emphasized by the RN was the importance of following instructions on administering an "Adult FLEET Enema" 2 hours prior. The accompanying biopsy fact sheet and summary states in loud caps: IF YOU DO NOT USE AN ENEMA YOUR APPOINTMENT WILL BE CANCELLED! Fair enough! It's probably not as bad as the "cleansing" one must undergo before a colonoscopy, drinking all that disgusting pineapple tasting stuff - then having to sit on the can for eight hrs.
Before the actual procedure I have to provide a urine sample to rule out any urinary infections. Immediately before the actual biopsy there will also be an ultrasound examination, in which an ultrasound probe is inserted into where the sun don't shine. Transducers on the end of the probe then will send sound waves into the prostate. When different textures and densities are encountered to those deemed normal, the waves are reflected back to the transducer. A computer then measures the time for the sound waves to travel out and back, dispatching the information to the urologist.
The importance of the ultrasound can't be overemphasized, as it can well reveal conditions (not cancer) that are present and may have incepted high PSA readings. These include: inflammation, cysts, vascularity, and prostate stones. (One must magine they're somewhat like gall stones except maybe a lot smaller!)
Finally, the biopsy is done by insertion of a spring-loaded device (through the ultrasound tube) which injects ten fine needles, five on each side of the prostate. The end of each needle snatches tissue each time, which is recovered as a sample for the histology. Ultimately, that histology will be scored on what's called a "Gleason score" with 5 being the highest....and also indicating the worst, cancer. Two samples bearing cancer cell histology are then added together to yield the total score. What you do not want to see is anything like a '10' which basically means your choice of options for treatment is pretty limited.
I am hoping for a 1, 2 or better, 0! Anything to avoid a next round requiring treatment that can leave you in a hospital and with surgical risks, not to mention having to deal with urinary catheters, associated infections!
As for the pain aspect, the urologist was most sympathetic since not all males experience pain, but many do (leading 1 in 3 to never have a biopsy again!) The difference is attributed to whether the injecting needle hits a nerve or not. Contary to some myths, the prostate is not unenervated! It's got nerves all right, it just depends whether the biopsy needle hits 'em or not! If not, the guy brags he felt no pain. If they do, the guy goes into a ball and lets out a primal scream vowing no more tests....ever.
Anyway, I will be allowed to have a light sedative (versed) during the procedure....and yes, my wife can be there too! Perhaps the ideal nerve-calmer of all!