Or maybe it is more accurate to say that today the test takes me.
This will be an intensely personal post. If you came to this blog expecting something else, you might want to take a break from reading this now, head over to the archives, and wait until the more characteristic posts make a comeback.
This afternoon I will be heading over to my doctor’s office, a urological specialist, and have a transrectal ultrasound-guided prostate biopsy. This test will be used to determine whether my elevated PSA blood test results are indicative of prostate cancer or infection or something else altogether.
Since getting the report of my PSA (prostate specific antigen) levels ten days ago, I have only talked about this with my wife, pastor, and three trusted friends. Those who know me may be surprised that I told that many others about the impending biopsy. When it comes to such personal details, I tend to be intensely uncommunicative, a New Englandish “It’s my business, and only my business” attitude–although I have never lived in New England. I have decided to leave my comfort zone and journal about this experience for two main reasons. First, as a coping mechanism to help give the swirl of emotions some expression and a place to “live” besides in my gut. And second, the majority of my male friends are in their forties and fifties (the women are never older than twenty nine), and if the sharing of my journey–wherever it may lead–gets even one of them into the doctor to begin getting an annual PSA, than this breech in my personal space will be very much worth it. Well, maybe a third reason: wives and mothers get your forty-year-old husband or son to the doctor annually–the years of health and life you will give them is worth the nagging!
My father died on February 3, 1993 at the age of 66. He died from the complications begun by prostate cancer. When Dad was diagnosed in 1989 or 1990 his cancer was already well advanced and had already advanced into his lymph nodes. If prostate cancer is detected and stopped before the lymph nodes are involved, there is every chance that it can be “cured”. However, from everything I have read, once it moves from prostate to the lymph nodes a nearly unstoppable progression has begun that will lead then to bone cancer and death. Prostate cancer is slow-growing. That is one of the characteristics that gives those who are diagnosed early great hope. It also means that Dad could have had his prostate cancer for eight or ten years before the back aches and the blood in his urine finally sent the stubborn man to the doctor.
Much like the plumbing in the walls of our homes, us men don’t think about our plumbing until there is a problem. The prospect of the doctor inserting a finger where the sun don’t shine to palpitate the prostate through the wall of the rectum is generally less uncomfortable than it sounds, nevertheless it makes most men anxious and, I suspect, most men would certainly choose to avoid the whole issue if offered, say, a beer instead. Really. Every man age forty and up should have a digital rectal examination as part of his annual physical examination. At age fifty the blood test for PSA should be done annually as well. Yes, guys, preventative maintenance. We understand preventative maintenance is necessary for our cars, why is it so hard for us to translate that truth to our own bodies?
If there is a history of prostate cancer in the family, as there is in mine, the PSA testing should begin at age forty. For most men, a PSA below 4.0 is seen as being acceptable. Because of my family history, my doctor wanted to see a PSA level below 2.5. Truth be told I have been less than regular about my annual exams and my last PSA was when I was forty-seven. So now, the 4.8 result from my PSA has prompted the next step: a biopsy of my prostate.
After Dad was diagnosed, and again after he died, I did some reading about prostate cancer. Knowing the details of the disease didn’t help me cope with the loss of my father, it just gave me more information. Well, it is sixteen years later and thanks to the web information is much easier to come by. And for the ten days since I heard the news and that I was scheduled for a transrectal untrasound-guided prostate biopsy, I have been overloading on information. Intellectually I am as prepared as one can be for the procedure. Oh that the knowledge would ease my unease and anxiety. Quite simply, I want to back myself into a corner and tell everyone to just leave my butt alone. Okay, that had to be said, but I guess I have to push on.
Today is an exploration to get answers. What we know is my prostate is slightly enlarged and my PSA level has put my doctor on alert. I have no other symptoms. The ultrasound wand will go in, and working through the wall of the rectum (!) the biopsy needle gun will take ten to twelve core samples from the prostate. These will be sent to a lab for examination and interpretation. The likelihood of cancer will be determined using a Gleason scale. If cancerous cells are found, the technicians and doctors will assess this according to a scale to better determine how the treatment will be handled.
Time to get ready. I have picked up from the pharmacy an interestingly-shaped bottle from Fleet that is supposed to make the work site a bit cleaner. I have my antibiotics that I will start taking two hours before the procedure, and I know as much as I can know about what to expect. If my resolve to journal holds, I will post later about the procedure.
Other posts in the Prostate Cancer Journal can be found under Categories in the sidebar of this blog.