Men's things - III

Gibbering not to the wreck

I suppose it was in a flux of apprehension that I forgot my notes, notepad, and pen as I made for my early consultation. Fortunately, I had printed out the Canadian paper that gave a cautionary note on avoidable biopsies and that was my reference document as I boarded the luxury Uber BMW that dropped me off in the maze of the Manchester Royal Infirmary buildings unsure of where I needed to go, until a nurse gave me directions.

At the reception, I was asked to give a urine sample which might well have been under duress as I waited to see the consultant. He had decided I must have a Transperineal Prostate Biopsy, but I had questions, his approach was quite paternalistic even as he implied there was no pressure to go ahead with the biopsy. It was my decision to make, only if I had the essential data, for that purpose.

Decision time truncated

However, my PSA reading was high, increasing dramatically over a 7-week monitoring, the DRE (Digital Rectal Examination) suggested an enlarged but smooth prostate organ, the next thing I needed to know was the PI-RADS (Prostate Imaging Reporting and Data System) score pertaining to the mpMRI (multiparametric MRI) scan I had, just over two weeks before. On a scale of 1 to 5, with 1 being benign and 5 suggesting cancerous lesions, the assessment was 4. [Radiopaedia: PI-RADS]

With that conclusion, I guess I had no other alternative than to go ahead with the biopsy. No time to waste with that kind of assessment. I opted for the biopsy even as the life-or-death implications dawned on me with the sudden realisation of the loneliness that accompanies decisions like this. Your mortality becomes a smorgasbord of conflicting thoughts, you seek a resolution and a determination, with no time to reflect on the import of the moment.

Let’s do this thing

Soon, I was with the doctor who was to do the biopsy, his computer was acting up, and his pen not inking the paper. I lent him my pen that the receptionist had given me to take notes of the questions and points I needed to assess my understanding of the situation, and he explained through drawings what was to be done.

I still had the option not to go ahead with the biopsy, I asked to see the MRI scan, and he zeroed in on the T2 scan explaining the abnormalities on one side that presented the need for a biopsy. [Radiopaedia: Prostate MRI - T2 Weighted Imaging explained here.]

Then, I was prepped for the biopsy, I changed from shoes into my slippers and only had to take off my trousers and underwear to wear a hospital tunic gown.

Ouch! And much else

I swallowed 3 antibiotics Ciprofloxacin 250mg tablets and about 15 minutes later, I was invited into the biopsy room. splayed out as if to be examined by an obstetrician in the most vulnerable state in stirrups, a digital inspection, then an ultrasound probe, a cold antiseptic wipe, and an icy cold spray even so painfully close to beyond endurance, a light introduction to discomfort as I looked up at the scenery of a tropical beach, psychology that was good for the imagination, but I felt better closing my eyes.

I grimaced and let out a shriek, once or twice as the local anaesthetic was injected, I was probably given 6 injections.

Again, the ultrasound probe was inserted and then the doctor began taking the biopsies, I felt much unease and on two occasions pain, the biopsy needle sounded like a stapling gun, and that happened about 9 times.

All done for now

I did not feel at all woozy, and when it was done, my blood pressure was taken with what looked like an old mercury sphygmomanometer with a dial and a stethoscope; the memories of the traditional ways flooded back, before I was chaperoned back to the dressing room.

As I left the biopsy room, I was offered tea and biscuits. I had my first urination which was clear, dressed up and filled in a survey. Results in 2 to 3 weeks, an ordeal in some way and probably a lifesaving act of catching something early.

My advice is not to be too coy about men's things, better to be under medical supervision with knowledge of what needs to be done, than leaving it out of fear or machismo.

It may not be a rite of passage, but I was first at the urology department this morning, and then more chairs were set up, it was like the Church of the Prostate Screening, many men come to worship there, in silent contemplation of what life ahead might be. I had humour to offer that made some laugh. God help us all.

Reference

Diagnosis of prostate cancer: the implications and proper utilization of PSA and its variants; indications and use of MRI and biomarkers [Canadian Journal of Urology] February 2020. (PDF)

Blog - Men's things

Blog - Men's things - II