The Biopsy - 002

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. However, 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 he was almost done and took 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 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 will happen during a procedure. When I walked into his office that day, I still thought he was only going to take thirty core samples.

Based on our conversations, I paid extra for the ultrasound merged with the mpMRI film to direct the sampling by focusing on the areas that lit up on the mpMRI scan. This would theoretically allow my urologist to reduce the total number of samples, even with a saturation biopsy, while still getting 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 a saturation biopsy involves twenty or more samples. Mine was sixty samples!

You can read more about saturation biopsies here.

It was 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 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 you are to experience seeding. However, this “increased sampling = increased chance of seeding” theory is 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 diagnose localized prostate cancer definitively. 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, I think a saturation biopsy is sometimes necessary. 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; tears welled 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 almost constant prostate pain I had been experiencing went away. I talked to my doctor about it, and he said there was no logical scientific explanation for it.

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 but didn’t hear back. We were acquaintances, and he would usually text me back. A few more days passed, and I called his office. The staff member said the results were back, but he would have to give them to me 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 fifteen minutes, the office manager told us the urologist was at the hospital with his wife and that 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 our twenty years 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 he couldn’t believe this was happening. He said we’d been waiting over two weeks for the results and had both taken time off work. He said a few other things in a very stern tone, but thankfully, nothing he’d regret. She apologized.

I told her 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. 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's 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, which indicates 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-renowned urologic surgeon outside Orlando in Celebration, Florida.

This surgeon has performed over eleven thousand robotic radical prostatectomies and has a great reputation. Since it is well-known that you tend to be in better hands if a surgeon has performed many procedures and has a good safety record, 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 of surgical complications. So, I set up an appointment to see this surgeon.

I liked his bedside manner, and his office staff was top-notch. His office was modern and aesthetically pleasing. He even had a dedicated 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, I should be okay waiting that long.

There were too many variables to know the true 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.