My Dreaded Prostate Biopsy

From the beginning, the pretense of my blog has been that many biopsies are probably unnecessary, given the sheer number that are done (about a million a year) and the large percentage that turn up negative.  I didn’t have any “smoking gun” that indicated I was at risk, other than a PSA level that was somewhat high for my age.  In fact, my DRE and PCA3 tests did not indicate suspicion of cancer and my ultrasound and MRI results only had minor areas of suspicion.  Had they been completely normal, I probably would have opted not to have a biopsy at this time.  In that the MRI identified at least one suspicious area deemed very low risk, the biopsy seemed necessary. 

(There’s a little TMI in this long blog entry, so don’t read on if that kind of detail makes you queasy or whatever)

I was nervous about it, having postponed mine for two months now.  Reading all the internet horror stories didn’t help, either.  It didn’t help much knowing that the odds of being one of those horror stories are very long.  After all, my experience with urologists includes a failed vasectomy.

I was a little more nervous when I checked in a bit early and some of the information I was given conflicted a bit with the schedule I had received previously.  Nothing major, but I was told they needed an EKG, chest X-ray, blood and urine, all things I had given just 2 days earlier.   I balked a little bit at having a second X-ray unless there was a reason.  I also wanted to know if there was some medical concern as to why these were ordered again.  They did contact one of the physicians and cancelled the X-ray.  I never found out for sure, but I suspect it was just standard practice upon being admitted, but whoever ordered them didn’t realize I had the same tests as an outpatient 48 hours earlier.  Always good to question what you are told or have an advocate with you!

I was also a little more nervous when their schedule for antibiotics was different that what I had been told, but the doctor confirmed it. 

I got more nervous when they also wanted to do an IV right away.  Didn’t seem necessary to me, given my procedure (practically an outpatient one) was not until the next morning,  The person doing it didn’t seem to be very experienced.  They poked and jabbed around enough that I started getting light headed and needed to lie down; a first for me.

I was a little more nervous finding that my roommate in the shared room was having a robotic radical prostatectomy for what I gather was an aggressive cancer.  I’ve read enough about the treatment options to know that they are not pleasant by any definition, let alone worrying about the cancer itself.

I was a little more nervous when I had a slight fever when they woke me up at midnight to take my second dose of preventative antibiotics.

The nervousness was not reduced by the lack of sleep, the 5AM wake up call, the required enema and the mandatory shower with a syrupy disinfectant soap.  Normally this is TMI I know, but anyone else doing this should know what to expect.

I was more nervous when they took my vitals again and my temperature was over 100 degrees F.

Even more nervous as they rolled me away to the OR.  I waited for a while on the stretcher in the recovery room, until a nurse came to give me final details of the procedure, most of which I already knew.  There was clearly concern about my temperature amongst the members of the team.  When Dr. Pinto arrived, he and the anesthesiologist had a number of discussions.  In fact, they started to wheel me back to my room with the idea of postponing it to later in the day (if my fever subsided).  The anesthesiologist didn’t seem to think it was worth the risk, given it was an elective procedure.  Dr. Pinto caught me on the way out and had them wheel me back.  They decided to take a chest X-ray to make sure there was no congestion that might interfere with breathing.  They listened to my chest again and my temperature had dropped very slightly in that time.  I had no other indications of a cold or flu and so ultimately they decided to go for it.  The waiting might have been the hardest part.

I had been really nervous about going under and even moreso as it seemed imminent now, even though this was apparently just a “moderate to deep” sedation that wasn’t a general anesthesia.  That’s about when the anesthesiologist gave me the much needed relaxing medicine.  That helped.

I recall making some light conversation, checking out the instrumentation in the OR and being told to turn on my side.  Then the anesthesiologist told me it was sleepy time.  I said, “Goodnight,” and the next thing I knew I was back in the recovery area waking up.  I guess some people have some memory of vague events while under this kind of monitored anesthesia care (MAC sedation).  When I woke up, I had the notion I had just had a dream but remembered nothing at all after saying goodnight.  I also had to pee.

One thing that kept me on the positive side of this whole experience was that it wouldn’t be as bad as my cysto.  Well, I as soon as I tried to pee I knew something was up and asked if I had needed a catheter or scope of some type.  Sure enough, it seems they take a look around to make sure everything is intact.  Great.

I was back in my room a little while later.  I was told I was out for about an hour and the procedure took somewhat less time than that.   I said a prayer of thanks and also one for my roommate.

On the plus side, my temperature was back to normal and has remained so for the remainder of the day so far.  I had some urinary discomfort that is mostly gone at this point, about 6 hours later.  I had some visible blood in the urine for a few hours but that is normal.  I had a dull throbbing in my butt, too.  It was slowly getting worse, presumably as a local anesthetic was wearing off.  The pain was starting to hurt enough that I was going to ask for Tylenol (for starters).

Instead, I distracted myself for an hour or so by doing some errands.  One stop was to turn in my receipts for vouchers.  Since I was admitted to the study and had the biopsy, I qualified for reimbursement of my airfare as well as a small portion of my lodging and meal expenses for the 3 days before I was admitted, at some standard government rate.  My total was $389.20, cha-ching.  Another errand was  heading up to the NIH patient library to print out my boarding pass.  Given my newly found wealth, I quickly spent $150 of it to go home first class (again).  I deserve it!  My last stop was to get another gift for my daughter.  I had already gotten my sons a couple items, but only one for my daughter, and it would certainly not be a good idea to leave it at that…

When I got back to the room, my discomfort level was very tolerable.  That was a few hours ago and I’m doing even better now.  I just finished a light, late lunch over an hour ago.  I’ll see how that goes, then get some real food.  I barely ate anything yesterday and the hospital food has been reasonable so far.

Keep in mind that most biopsies are done in a urologist’s office under a local anesthetic (given as an injection around the prostate) and take maybe 15 minutes.  You don’t usually have to deal with any of the issues I experienced, except the after effects, of course.  Being under anesthesia has advantages and disadvantages, as you can appreciate, but I was told it is preferable for a longer procedure like my targeted fusion biopsy.  In fact, Dr. Pinto said it was possible even to do this procedure with a local if the anesthesiologist had been concerned about my fever, but it wouldn’t have been ideal.  You can find mixed reports on an internet search about the pain and discomfort of a normal prostate biopsy.  They range from the tough guy’s “no big deal” all the way to some pretty graphic accounts of pain during the procedure as well as issues afterward.

Though I’m enjoying the relative privacy, I also await the return of my roommate.  As I was about to click “Publish”, his wife came back and said the surgery went well and they believe they removed everything and that the cancer had not spread from the prostate, but of course you don’t know for sure until a biopsy is completed.

Dr. Pinto’s associates just stopped by, too.  Nothing much to report.  The procedure went as they planned.  They did a standard 12-core biopsy, followed by 4 targeted samples, 2 each on two separate areas they deemed again as very low risk.  They apparently appeared only slightly unusual on  second pass of the “T2W” 3T MRI scan, which was in addition to three other types of high resolution MRI scans they also took Friday (DWI, MRIS and DCE).  I gathered that what they judge as a higher risk (low, moderate, high or very high) to be a tumor is not only more clearly apparent on the images as being more well defined and/or larger, but that aggressive ones appear on more than one type of scan, if not all of them.  It is not completely clear to me if either of these two areas correspond to the ultrasound findings from last month, but I will certainly ask.  I also forgot to ask for them to order this annoying IV to be taken out of my hand.

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