Biopsy
Hi, Tracy.
As I've said in earlier blogs, the PSA test (prostate specific antigen -- the indicator of possible prostate cancer) is highly controversial, largely because prostate cancer is more or less going to come to all men who live long enough, and most will die of something else before the cancer becomes serious enough to treat. The PSA can be accused of creating a lot of useless worry.
But perhaps that consensus -- or majority opinion, or whatever it is--was just emerging at the time of my first biopsy. Whatever the case, I had one in 2005 because my PSA was 6, when the normal level was 2-4 for a 60-year-old man.
Biopsy the first
The "high" score led to my being alone in a small room with the doctor. He told me to mount the table and assume the fetal. And then he affirmed for all time that I was not a candidate for gay sex, by introducing me to the ANAL PROBE.Given the location of my eyes, I didn't get a good look at the instrument, but it appeared to be a funnel-like device with a bulbous tip through which a long needle was poked. The needle was some sort of tube that could penetrate tissue and grab a tiny piece of it -- something about the thickness of a pencil lead and perhaps one-eighth inch long, if that.
As he pushed this into my behind, I told him I felt a great deal of pressure to pee. "Oh, just go ahead and pee on the floor" he said. They would clean it up aferward. I decided to tough it out, and declined.
The doctor could take 8-12 samples. Each sample was preceeded by the sound of what appeared to be a gathering buildup of air that would then be released in a sudden burst, driving the needle through the wall of my rectum or intestine and into the prostate, where it would take a little snip. It was like a damned drum roll. I could feel the pressure building and then there was a sudden anticipated puff, a mild jolt, and silence after which he twisted the device to aim for a different part of my prostate.
I'm not a praying man, but I am a hoping man, and I hoped that he would stop at eight. My hope was answered.
About a week or so later I was on the subway at SeaTac airport, heading for the S gate and a flight to Kauai, my favorite Hawaiian island. My cell phone rang, and trying to be discrete in the presence of my traveling companion and several strangers, I learned that no cancer was discovered.
Biopsy the second
Time passed and my PSA went up a smidgen to 8 or 9 or someting.A second biopsy was scheduled. This one hurt. It really hurt. I want into shock and had to lay on the gurney for a while afterward. Imagine a probe wrapped in sandpaper. Rough sandpaper. That's how it felt. I don't know if he forgot the lube, or what, but it was not a good experience.
But the good news was that there was no cancer. In the post-biopsy consult the doctor explained that the odds of finding prostate cancer drop dramatically after two positive outcomes. So even though my PSA was high, I was clear.
Biopsy the third
The PSA kept going up. By now it was in the range of 10 or above, I believe. Group health has the figures on its Web site, but I can't access them right now because I'm in a plane over the Pacific, heading for Vietnam. It was high enough however, to have a third biopsy. You see, I am very healthy. I drink moderately, don't smoke, don't have heart disease, and get plenty of exercise as a ballroom dancer. I'm cursed with enough longevity that if I developed prostate cancer, I might live long enough that it would become uncomfortable.Remembering Biopsy Number Two, I asked the doctor whether anything could be done to make things more comfortable. He suggested a shot in the area where the Anal Probe penetrates. Great. One more needle before the big needle, I thought. But actually, that was a good idea. I didn't feel the deadening needle, and after this third biopsy I almost said "thank you sir, can I have another?" If you've ever seen the movie, Animal House, you may recognize the line as being spoken by a pledge who is having his hindquarters cruelly smacked with a paddle as part of his initiation into a fraternity of sadists. It was nothing like that at all. Quite accceptable, if not pleasant, actually.
No cancerous tissue from Biopsy Number Three. Now the odds of having prostate cancer really drop out of sight.
Saturation Biopsy
I moved to Seattle. My PSA was increased to the teens. I talked to a urologist, and understood him to say that, if I get to a score of 20 and have a cancer, there's a 50% chance it has spread beyond the prostate. I have since learned that this wasn't precisely what he said, but nevertheless we decided on a saturation biopsy -- 50 samples taken, this time under anesthesia.Biopsy the Fourth
I love nurses. They have a great sense of humor, or else they just are indoctrinated to believe the patient is always right.Or likeable. Or something. Whatever.
I think this was the time when I was laying on a gurney waiting for the biopsy when the short, round face beautifully homely nurse with thick glasses and a mouth full of smiling teeth came up and looked me in the eye. I say she was short, because her face standing up was about even with mine lying down. Now this may actually have been the time I had my colonoscopy, but I'll claim it was the fourth biopsy, just for the sake of a good story that hangs together with fine narrative complexity.
"Is there anything I can get for you?" she asked. "Yeah, sweetlheart," I replied. "Can you get me some Viagra? I'm afraid of rolling off this gurney" "Oh, you need a little kick stand, do you?" she shot back, with a twinkle you couldn't miss through those coke-bottle lenses that sat just a couple inches above all those chuckling teeth. She may have nodded her head enthusiastically, as well.
I figured I'd have to wear Depends someday, but not so young. But after 50 jabs I ended up passing blood in two directions for a while. As with any surgury, this was not a drive-yourself-home day this time. A male friend delivered me up to the condo, but I was fine to be alone overnight.
None of the samples showed a hint of cancer. Not only that, my PSA score fell. We must have put the fear of God into that little organ. Slapped it up-side the head. It calmed down.
For a while.
Biopsy the Fifth--five years later
This occurred this last spring. My PSA is now 19. It had been 16 early in the year, prompting a closer monitoring of the growth. A second blood test showed what appeared to be this further growth spurt in the PSA. This time the urologist probed from two directions -- through the intestine, and from beneath, in order to reach parts of the prostate that were not accesssible for the earlier biopsies. And this time, taking 24 samples and less than 1 percent of the prostate's tissue, they found the cancers we are now keeping an eye on.And what does it mean? Well, they are not aggressive, and probably half the men in my age category have a cancer of some sort growing in their prostates. Nothing unusual there. So the procedure now is to take more blood tests, monitor the PSA, and continue to keep a watch, with options for another MRI and perhaps annual biopsies.
Metaphorically, it's probably a lot like living on the frontier. You know there's carnivores out there, and you keep an eye out for them, but you don't worry about them until they give you a reason.
Nurse wanker
Oh, by the way, there's another nurse story to share. My prostate was a few years older and didn't take this second saturation biopsy lying down. In the recovery booth, I had a great urge to pee, along with a urethra that was just not cooperating. (I think my prostate had a get-even choke hold on it.) After two trips to the bathroom with that fancy robe they give you which insults everyone who's behind you, I started hearing disconcerting terms being thrown around -- one term actually: Catheter. That motivated me. I tried and tried, while the nurse held the bed pan. Somewhere in the course of events, she used the endearing term, "wanker." I was shocked. SHOCKED! She explained that she had grown up with five brothers. Well OK, she had established the parameters of our discussion, so in my frustration and discomfort I asked her whether, instead of using a catheter, there might be some nurse on the staff who had grown up on a farm. She took the question in good cheer.However, no such luck. They called in Nurse Catheter. "Does your mother know what you do," I asked, as she coaxed Monsier Wanker into eating the catheter. "My mother's dead, she said. For some reason she whispered that quietly into my ear. She didn't sound malevolent . . .
Love,
Dad
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