Thursday, July 19, 2012

Notes on a Prostate Biopsy: Don’t Fear and Don’t Hyper Google!

One thing I’ve come away with after the biopsy yesterday is that if you’re faced with any significant medical procedure it’s best not to google yourself silly! At work already is the selective attention to ferret out negatives – and these are bound to pop up in spades- then they get magnified out of proportion. This is no less true of prostate biopsies than many other interventions.


The fact is that more than 900,000 men: your fathers, brothers, cousins, uncles.....will be faced with this same procedure this year, after being advised by their primary care physicians that it is indicated, most likely by rising PSA levels (mine doubled in one year). Never mind that eventually 75% of these biopsies turn out to be negative, right now they're the only thing that-  given adverse indicators -  may spare a guy from a gruesome end. I.e.  if cancer IS present and “breaks out of the capsule”,  to use the phrase of oncologists. (One thing that pushed me to getting it done even after I hesitated following the free PSA test was my wife’s description of her uncle’s final days in the throes of prostate cancer, after it had metastasized and spread to his bones, lungs, liver, etc.)

So on that basis I want to provide these notes in the belief that other guys, faced with a similar procedure, can take heart. My mistake, in the wake of accepting the need to get it done, was going nuts by compulsively googling and working myself into a fretful lather. If you must google , keep it under control:  bring up two pages at most, and don’t be selective by focusing on only the worst case descriptions. Oh, and don’t google “prep enemas for prostate biopsy” either! (I made the mistake of doing that and learned about Fleet enema complications that I’d prefer to forget)

Now, some notes on what happened, which is another big reason I chose not to sedate. You can recall everything that goes on if you are fully conscious:

- ON arriving at the office, Urological Associates, I had to supply my consent form acknowledging risks, then make a trip to the restroom to supply a urine sample. This is done to ensure there’s no urinary infection in which case the procedure would be called off.

After waiting about twenty minutes, it was ‘showtime’ and they said my wife could accompany me if she wanted. As a retired medical professional (radiotherapy) this was her cup of tea as she would get to watch the ultrasound imaging screen as the procedure was carried out. Much less boring than sitting in a humdrum waiting room and reading page-curled magazines!

After undressing (you get to leave socks on) I got on a table and had to lie on my left side, with knees toward the chest. A surgical cover was placed over me,  open at the back. First step was application of a numbing gel and shot of lidocaine. The pain was roughly equal to that from a dental injection on your gum before they start to drill. Probably less. After the lidocaine, I was given a few minutes respite before the ultrasound transducer was inserted and sound waves bounced off the prostate gland to get its mass, density, size. Nothing abnormal was detected in the imaging, though the technician did state that he was somewhat concerned that my PSA levels were so large for a prostate mass of about 36 g.

The ultrasound device was then removed and there was another 5-8 minute respite before the physician assistant was to arrive and perform a 12 -extraction needle biopsy. I talked with my wife during this interlude and she admitted she was shocked at the size of the needle used to administer the lidocaine. She asked if it hurt and I said ‘Only a bit’.

I don’t know exactly what I expected when I heard the knock on the door and knew it was the physician assistant. I suppose I expected someone older in lab whites. Therefore I was surprised to behold a young, blonde woman of about 30 in black pants suit. She smiled broadly – in a welcoming way – and shook my hand, telling me her name was “Jen” and she would be doing my biopsy. I began to worry about possible inexperience, but quickly got that under control as I reasoned she wouldn’t be doing this if she wasn’t trained extremely well. So, get over it! Also, that an attractive young woman was doing it!

Meanwhile, my wife was mesmerized by Jen's apparatus- the needle firing ‘gun’ - which was brought out after she donned her latex gloves. My wife observed intently as Jen loaded the needle for each extraction then re-secured it before each subsequent ‘hit’ ( I couldn’t see a damned thing.  All the action was unfolding to my rear, and all I could see was a wall. )

I had some discomfort as the ultrasound probe (through which the needle to be delivered)  was re-introduced. Jen told me that the greatest pain would be from the first hit, and it ought to die down somewhat after that. She advised me to take several long, slow, deep breaths and she’d alert me to when the first needle would strike. I waited, trying to stay calm and kept breathing long, deep breaths. Jen told me to inhale deeply as the first hit was on its way ……


When it arrived I gasped and my wife said later I yelped “AIEE!” Truthfully, the first thought was that I'd maybe made an error by not going for sedation after all. The needle sting  (it penetrates the rectum wall) was maybe comparable to a large red ant’s on a sensitive area but even worse was  the accompanying sharp, burning pain extending all the way from base to tip of penis. It was as if the urethra had briefly filled with acid. I commented on this, and related to Jen how it felt and also that there was a powerful feeling of almost imminent urination.

Jen explained that the penile sensation was "referred pain", i.e. from nerve associations and she had me take several more deep breaths. She told me I might “leak” (urine) but assured me the burning feeling in the penis would abate. She allowed me several more minutes to recover while doing deep breathing, obviously she’d witnessed this effect many times before. Finally, she asked me if I was ready for the second strike. In a hesitant voice, I replied, “I think so!” She advised to take a long, deep breath, then exhale.....

That next hit of the needle was nowhere as bad as the first, and as she promised, the pain ebbed with each subsequent strike. Maybe the lidocaine was finally working! 10 more strikes followed, and I was grateful it was over, but appreciative of the professional PA . After Jen detached the needle from the gun and removed the last tissue sample, carefully labeling it, she shook my hand and told me she hoped the results would be good. I thanked her and began to get up, but had to be helped. I surmised I was experiencing some mild dizziness from the antibiotic taken about an hour and half earlier (the bottle label declared, ‘may cause dizziness, do not drive or operate machinery’)


Thankfully, by the time I got dressed, the burning sensation had abated as well as the overpowering urge to urinate. I was advised to take it easy for at least the first 24-48 hours, and to expect blood in the urine for up to two weeks. Blood in the stool for up to a week, and blood in the semen from up to eight weeks. I was also told to call the office in case of fever or chills (denoting an infection) and also if there were any blood clots in the stools the “size of quarters”.

Needless to say, on my first post-procedure urination some two hours later, I was concerned at how much blood I’d see. Amazingly, there was nothing there…or at least none I could detect. This despite doing a no-no and popping a 1.2 grams Omega-3 capsule after breakfast, which I was told was a “blood thinner”. Who knew? I sure didn’t. You find something out every day. After a consult with my urologist, on whether I ought to be allowed to go forward with the procedure, the urologist gave a nod yes, so long as I’d remained off the aspirin for at least five days. I had.

My advice to other guys, is ‘go for it’. The procedure is nowhere as terrible as made out to be in a lot of the websites you likely will excavate from Google pages. The pain is tolerable and brief, and to me being aware of the experience is worth more than being clocked out like some zombie. Besides, if you’re in that state you won’t get to see the pretty physician assistant who may be doing the biopsy!

Now, it's a matter of waiting for the results. But I am already promising myself not to over-google potential treatments!

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Footnote: 1 day later. If there is any downside it's the bloody semen! I hadn't been prepared for it so was aghast at the sheer volume of blood on a first ejaculation after the procedure. (I forgot to mention that Jen had advised 'clearing out the blood' accumulated from the needle extractions as soon as possible.)  I am hoping that I never see that much blood again! Still, don't let this scare you from getting a biopsy!

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