I rechecked my PSA and found that it had risen to 47! For it to go from 19 to 47 in a short time suggests an aggressive type of cancer, but I was still having prostatitis symptoms, so this clouded the PSA results. I prayed on the way to the urologist’s office as Mike, my husband, drove me to get my prostate biopsy. The nurse gave me 5mg of Valium to take by mouth and brought me into the procedure room. It took a while for us to get set up and the Valium kicked in so I didn’t mind baring my rear end to the four people in the room. But the Valium’s effect didn’t help alleviate the discomfort of having a probe stuck up my rectum in preparation for the biopsy.
My urologist had initially told me he was going to take about thirty biopsies of my prostate, which are called cores. To get the prostate tissue, the urologist must stick a needle through the rectal tissue each time he takes a core sample. This explains why some men get infections in their bloodstream during prostate biopsies. Surprisingly, these types of infections are rare.
The urologist electronically merged the mpMRI film with the ultrasound of my prostate in real-time and then injected the nerve plexus near my prostate with lidocaine. It felt similar to getting a lidocaine injection in your mouth in preparation for a dental procedure but just in a different part of your body. It hurt, but the pain wasn’t unbearable. He then began to do what’s called a saturation biopsy, meaning he was going to take so many biopsies that most of the prostate gland would be saturated with biopsies.
By about the 45th biopsy, the lidocaine began to wear off. I let him know that I was starting to feel the injection of the needle into the different areas of my prostate and that it was hurting. He told me that he was almost done and then proceeded to take fifteen more cores. By the last one, it was extremely uncomfortable.
In retrospect, had I known he was going to take sixty cores, I would have opted for doing the procedure under general anesthesia. This is an example of why it’s important to have clear and direct conversations with your doctor about exactly what’s going to happen during a procedure. When I walked into his office that day, I was still thinking he was only going to take thirty core samples.
Based on our conversations, the reason for merging the mpMRI film with the ultrasound, which I paid extra for, was to direct the sampling by focusing on the areas that lit up on the mpMRI scan. In theory, that would let my urologist reduce the total number of samples, even with a saturation biopsy, yet still, get accurate information.
Most of the time, based on what I’ve read, urologists will take twelve to fourteen core samples during a prostate biopsy. A saturation biopsy involves sampling more areas of the prostate with the intent to diagnose prostate cancer that might go undetected. Some major cancer centers say that a saturation biopsy is twenty or more samples. Mine was sixty samples!
You can read more about saturation biopsies here.
It was definitely the worst experience I’ve ever had in a medical setting. You’re in a very vulnerable position and despite telling the doctor I was having increasing pain, the procedure continued. I also couldn’t help but think about any “seeding” that might be taking place from having cancer cells spilling out of the prostate and tracking along the needle’s path. In my mind, the more samples you take, the more likely one might experience seeding. That “increased sampling = increased chance of seeding” is my theory and not proven in the medical literature.
Doctors who perform biopsies don’t like to talk about the potential for seeding cancer cells to other parts of your body during a biopsy. In addition, a prostate biopsy is the only way to definitively diagnose localized prostate cancer. Some will tell you there’s no proof that seeding occurs. That’s because they haven’t read the research that shows it does occur.
I’m sure the authors of this journal article received a lot of grief from doctors and were accused of fear-mongering, but it’s the truth. Thankfully it appears to be a relatively rare event given the number of prostate biopsies done and the number of cures associated with definitive therapy for localized prostate cancer. Regardless of the potential for seeding to take place, I think a saturation biopsy is necessary in some cases. For example, I’d recommend a man have a saturation biopsy if he’s at high risk for prostate cancer, had repeatedly normal prostate biopsies, and his PSA continues to rise.
After it was over, I walked out of the procedure room and into another room where my husband was sitting. I laid my head on his shoulder and tears welled up in my eyes. I felt as if I’d been violated. My urologist told me the results should be ready in about four to five days so we went home and tried to return to a normal life. At this point, I still thought that my results might be negative for cancer. It was a combination of hope and denial.
An amazing thing happened after my biopsy, the prostate pain I had been experiencing, almost constantly, went away. I talked to my doctor about it and there was no logical scientific explanation for that. My explanation is that my body had been crying out with pain and warning me that I needed a biopsy, and once I got the biopsy, my pain went away. Always listen to your body.
After a week, I texted my urologist and didn’t hear back. We were acquaintances and he usually texted me back. A few more days passed and I called his office. They said the results were back but he would have to give me the results personally. I scheduled an appointment for the soonest available appointment. A few days later, my husband and I left work early and drove separately to the urologist’s office. My heart was pounding. Strangely, there was no one in the waiting room. I checked in and we sat down. After about fifteen minutes, the office manager walked in and said that the urologist was at the hospital with his wife and I’d need to reschedule. I was furious! Are you kidding me? I’d been waiting over two weeks for my results and now he wasn’t going to show up.
I’d never seen my husband “lose it” with someone in the twenty years we’ve been together. He’s the kindest and sweetest man I’ve ever known, but people underestimate the stress levels of spouses and loved ones of cancer patients or potential cancer patients. He stood up and said that he couldn’t believe this was happening. That I’d been waiting over two weeks for the results and we had both taken off work. He said a few other things with a very stern tone but thankfully nothing he’d regret. She apologized. I told her that I expected the doctor to call me with the results as soon as possible and we left. Five minutes later, I received a call from his office asking me to come back to the office. She said the doctor would be there in ten minutes. I turned the car around and went back to the office, this time without my husband for support. He had to return to work.
The urologist shook my hand and after exchanging some pleasantries, he said, “Well I’m glad we did the biopsy…” At that point, I had an out-of-body experience because I knew what was coming. “…because there’s cancer there.” He then went on to tell me that my Gleason score was 4+3=7, an intermediate-grade cancer. Anything higher than 7 is considered high risk. In addition, there are two types of “7” Gleason scores, 3 + 4 and 4 + 3, with the latter being riskier. He said mine was a 4+3, which made my intermediate-risk significantly riskier.
We talked about options for treatment and it was clear to me that the best option was the total removal of my prostate with pelvic lymph node resection, a radical prostatectomy. He recommended I see a world-renown urologic surgeon just outside of Orlando in a town called Celebration. This surgeon has performed over eleven thousand robotic total prostatectomies. It is well-known that you tend to be in better hands if a surgeon has performed a lot of the procedures and has a good safety record, so I agreed to see him.
He then told me that surgeons don’t like to do a prostatectomy sooner than two months after a biopsy because any earlier increases the risk for surgical complications. So, I set up an appointment to see this surgeon. I really liked his bedside manner and his office staff was top-notch. His office was modern and aesthetically pleasing, and he even had his own wing in the hospital across the street just for his patients. He clearly was good at what he did and took great pride in his work and facility. I knew I’d be in good hands with him, but he couldn’t get me on his surgery schedule until four months after my biopsy. That worried me, but I talked it over with my urologist and he said based on my Gleason score and because my bone scan, pelvic contrasted tomography (CT), and mpMRI showed no evidence of spread, that I should be okay waiting that long.
“Okay” is relative, and honestly, there were too many variables to know the best answer. I just went with it, because at the time, it was the easiest thing to do. What I was concerned about would reveal itself shortly anyway.
Hang in there, buddy. I’m thinking of you often. Thanks for sharing your story. 😘