I saw Dr. A promptly. He was courteous and had a warm manner. He noticed my limping and I told him I’d torn my Achilles while running. He expressed sympathy. He examined my prostate digitally and said it was not enlarged and had no lumps. He did an ultrasound and said he didn’t see anything troubling. He said the fact I had no urinary problems was a good sign. Still, he said he couldn’t tell if I had cancer without a biopsy. I agreed to have one. It was set up for the next week. This surprised me since I’d been told it would take a month to see Dr. X. Why is it Dr. A has openings a week away?
He prescribed an antibiotic called Ciprofloxacin (“Cipro”) to be taken one day before and the day of the biopsy. He said the biopsy would take only ten minutes and was an office procedure done with local anaesthesia. I also would have to use an enema the morning of the biopsy. He handed me a flyer about the biopsy procedure. I had also been prescribed a Valium to take before the surgery to relax me. The flyer said that was optional and that if I didn’t take it, I would be able to drive myself home. It sounded pretty mundane.
The day of the biopsy my Achilles was still bad, although better than before. I did the prep but did not take the Valium since I did not want to bother my wife with having to drive me. She doesn’t like to drive in the afternoon. I’ve never been particularly anxious about medical stuff. I limped in and was seen immediately by Dr. A. The biopsy was not nearly as mundane as I had thought. I got the anaesthetic shot and then a topical one in gel form was rubbed on the area of the rectum adjoining the prostate. So far, not bad. Then the doctor sticks an instrument in there and begins taking samples. I could not see it from my vantage point but it sounded and felt like a staple gun, the kind carpenters use with the heavy duty staples. There’s a loud snap and an impact accompanied by a pain. Then another, for a total of 12 times. I had expected it to be painless. It wasn’t. I guess I couldn’t call it a sharp pain, but it was pretty close to that. It definitely felt like I was being seriously traumatized. I’ve had dental crowns and root canals and this was worse. The device shoots a needle into the prostate to take a sliver of cells. It pierces tissue and causes lots of bleeding. The doctor has to take samples over all the regions of the prostate, three in each quadrant. By number 12 I was ready to get the hell out of there. It was over quickly, although not as quick as I would have liked. I had assumed it would be only two or three samples.
When it was over Dr. A told me to come back in a week “to get the good news.” I drove myself home and took that Valium. I did not want to move. I spent the rest of the day crashed in my recliner. The Valium knocked me out and I was glad of it. A prostate biopsy is not something you can do on your lunch hour and then return to work, believe me.
Maybe Dr. A says the same thing to all his patients. No point in making them worried sick over what may turn out to be a negative test, right? Maybe. But in my case, it was a disservice. That statement, combined with his previous statements that my prostate was not enlarged and he saw nothing on the ultrasound, along with my general lack of symptoms and overall good health, led me to believe there was little chance of a positive test. Because of this I did not research prostate cancer and educate myself about the test readings and treatment options (or non-treatment) in the case of a positive result. I was not prepared to ask good questions when I came back for the results. I now know that about 30% of prostate biopsies are positive, so it is not all that certain mine would be negative. Perhaps Dr. A’s Pollyanna manner was a mistake, or maybe not, but he did make one mistake that I’ve described here. Read part 3 to understand what it is.