Friday, July 15, 2005

Prostate fun...

PSA (Prostate Specific Antigen) is a protein produced by both normal and cancerous prostate glands. I have an elevated PSA reading, currently sitting at 5.8. “Normal” is a subjective word in this regard, but a normal PSA reading is between 0 and 4. So my reading is nearly 50% higher than the high end of the normal range. Lucky me. An elevated PSA can be caused by several conditions, the most serious and scary being Prostate cancer. Prostate cancer is the second leading cause of cancer in men; approximately 1 out of every 6 men will contract this disease. If you couple that fact with my family history, both my father and grandmother died of cancer, you can see why I pay careful attention to my PSA levels. Elevated PSA levels can also be caused by BPH (Benign Prostatic Hyperplasia – an enlarged prostate) or a prostate infection. The infection has been ruled out, so we’re now down to Door #1 or Door #2; Cancer or BPH. To test for Prostate cancer, one has to do a Prostate biopsy. I had one last year, which was, fortunately, negative. However, as my PSA level has continued to rise, my proctologist wanted to perform another biopsy. I thought I would start off the weekend with a bang and underwent this fun and invigorating procedure this morning.

If graphic descriptions make you queasy, you might want to skip the rest of this blog entry.

The night before the procedure, you start a 4-day regimen of antibiotics. This is to help prevent an infection which might be caused by punching multiple holes in your ass and in your prostate gland with a hollow needle. About two hours before the procedure, you have an enema to clean out your lower intestinal tract. So, if your procedure is at 9:00am, as mine was, you have your enema at 7:00am – a really swell way to start the day. Once you’ve satisfied the most frantic urgings, you then drive to the doctor’s office, with your anxiety alternating between the coming procedure and a need to visit the bathroom.

If your doctor’s office is efficient, they get you started right away – knowing that sitting in the waiting room is not conducive to a relaxed state of mind. Oh, and they don’t want you to use the bathroom just before the procedure begins because having some “fluid in the bladder” is conducive to a “better” test. So make sure you’re empty before you get in the car.

You undress from the waist down and climb up on a table. As you get on the table, you notice that they have absorbent pads covering the area where your genitals and your ass will be sitting. This does very little for your peace of mind. The nurse adjusts the pillow, has you raise both of your knees to your chest and covers up your front side with a sheet. Your ass is hanging out, your sphincter is twitching, and you feel thoroughly exposed. The nurse asks you if you’re comfortable. Of course you are…

Then the fun begins. The doctor first does a DRE (digital rectal exam) of your prostate. He gloves, lubricates a finger, and sticks it up your ass. He cops a feel of the prostate gland through the wall of the rectum (the prostate gland is located adjacent to it), looking for lumps or anything that might indicate something is amiss; anything other than “smooth roundness” (or "round smoothness"). Once done with that, he lubricates the business end of a “Specialized Anal Probe” and inserts that up your ass. This instrument has more gizmos on it than a Swiss-army knife. Its first function (after prying you open) is to do an ultrasound on your prostate gland. He presses the probe against your rectum wall, closest to your prostate, and moves it around, this way and that. He takes multiple ultrasound images of your prostate, again looking for anything other than “smooth roundness”, all the while telling you how “well” you’re doing. You’re thinking “just get the damn thing over with – I have to go to the bathroom.”

Once he’s done with the Candid Camera bit, Dr. Procto gets ready to perform “snatch-n-grabs” where the peppers grow. First, he needs to anesthetize the area. If you like needles, this next little vignette will really appeal to you. The “Specialized Anal Probe” has an opening in it which allows him to insert a needle full of lidocaine (or whatever the hell it is they use) up your ass to numb your rectum wall. You hate it when it’s happening and wish they had numbed your brain instead. He then begins taking the actual biopsies. Did I mention that he uses a “Specialized Anal Probe”? It has yet another handy-dandy feature, a spring-loaded needle that is used to take the actual samples themselves. As each sample is taken, you hear the “click” as the spring trigger is released and you feel a small pinch as Dr. Ahab launches the harpoon where the sun don’t shine. This needle goes through your rectum wall and into your prostate gland. While in the gland, it closes off, trapping a portion of your prostate in the needle. The good doctor then withdraws it, extracts the core sample and puts it on a biopsy tray. He’s then ready to plumb the depths once more. You thought there was just one sample? Oh no, he takes several. The actual number depends on how thorough he wants to be. My proctologist is pretty anal (pun intended) so he took 14 samples; 7 on one side of the prostate and 7 on the other. You quickly figure out that he’s going to take the same number of samples on each side, so the counting of odd and even number “clicks” quickly becomes an all-consuming.activity

And then, just like that, it’s over. When he pulls that probe out of you and allows your sphincter to assume its normally puckered state, it’s almost sinful how good it feels. And the best thing about all this is that when the procedure is finished, the doctor wipes your ass for you, a nice touch if there ever was one. The entire process is pretty quick. From the time I walked into the out-patient room until the time I began pulling my pants back on was only about 15 minutes. Time flies when you’re having fun…

I was able to view the biopsies. They look like skinny little pink or grey worms – about an inch long. They’ll get sent off to the lab and, in about a week or so, I’ll know if I have something to really worry about or not. But even these biopsies are no guarantee. If your PSA is elevated and your first biopsy is negative, there is still about a 15% chance that you may have prostate cancer. If the second biopsy is negative, your chances of having prostate cancer drop to about 5%. That’s good, but not perfect, of course. I guess I’ll have to resign myself to periodically having this procedure every few years for the rest of my life. Or maybe I’ll get lucky and my PSA will start diminishing, like my memory…

One other thing worth mentioning; you’ll be peeing and crapping blood for a day or two until your prostate begins to heal. Even though the doctor warns you this is going to happen, it’s scary to see it and is a reminder of how fragile life really is.

If I don’t have cancer, then I almost certainly have BPH. BPH is no picnic, but it’s not life-threatening. It has its own set of medical procedures which I will comment on if they occur.

On a serious note, I am thankful to my doctor for being there and doing this. Yes, the procedure is unpleasant, but it’s quick and really not painful. And, once it’s over, you can laugh about it. It sure beats not knowing about prostate cancer until it’s too late. Prostate cancer is very treatable if caught early. If you’re a guy, especially if you’re over 50, make sure you get regular check-ups and make sure that you have your PSA level measured. It may save your life.

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