Hi. My name is Chris and I'm a 47 year old male. I live in a middle class neighborhood with my wife Anne, and my youngest daughter Allison. My oldest daughter, Stephanie, is 27 and has a beautiful family of her own (husband Clint, daughter Madisyn and a boy on the way). My son Chris, almost 25, is soon to be married to the lovely Becca. He's also training to become a Fireman. How cool is that?
This process started about three months ago, June 2008. I suspected that I had a hernia in my groin so I went to my regular MD for a check. She gloved up, I coughed and she had all she needed to verify it was a hernia (properly known as a "inguinal hernia"). She referred me to a surgeon and while I was there she ordered your basic blood work panel. What I didn't know then was that she also ordered a test called a "PSA". It test for the presence of "Prostate Specific Antigen". In brief, the prostate puts out this antigen when it is under attack by cancer. I get the blood work done a day or two later and don't think much about it after that.
At the surgeon
A few days after getting my blood work done, I'm at the the surgeon. He examined me and found three more hernia's. That was surprising in itself. He explained "open" versus "laproscopic" procedure and it's pretty obvious that I am going to do the laproscopic method. During this process he also explains what exactly is going on - the muscle wall is torn and the intestine is bulging through that wall. It's putting pressure on that cord/vein/tube/whatever that runs from somewhere inside me down to my right testicle. So that's why I have those occasional pains out of seemingly no where! Just for fun, any pressure in my abdominal cavity will exacerbate the problem (sneeze, cough, etc).
He asks if I have any other questions... Over the past year I'd noticed that I was having a more difficult time starting to urinate, and when the flow would stop, I still felt like there was more. I'd wait a few minutes and then be able to finish the job. I ask him if this hernia thing could be why I'm having that problem (thinking that the intestine is pressing on some part of the "plumbing"). He looks at me oddly, says "No" and offers to check my prostate.
I'd never had a prostate check, but I had a good idea of what that meant. I was right. He gloves up, I drop my pants, get on the table, lay on my left side and curl up into a semi fetal position. The doctor tells me that I will feel a "bit" of discomfort. I'm not sure what I expected, but I sure didn't expect him to start digging around in there like he was trying to fish a class ring out of a drain pipe. Thankfully this only lasted about 15 seconds, although it did seem like 15 minutes.
While I'm dressing he tells me I have an enlarged prostate and that I will need to see a urologist before we can do the hernia surgery. I'm somewhat surprised by this news and almost miss the chair while sitting back down. "Enlarged Prostate"? What is
that? He explains it can become enlarged for a variety of reasons, but the only one I hear is "cancer". It's damn hard to think straight when you hear that word...
Anne finds and makes me an appointment at a urologist. They request blood work, but as you will recall, I did that recently. They explain that I will also need a "PSA" test - Anne informs them that the blood work I did a few days ago had this test requested and that makes them happy.
Back to the MD
A few days later, my MD calls and wants me to come back in. The blood work is back and there are problems with my blood sugar levels and with my PSA level. That's a little scary - I've never been called back in to the doctor for anything. They do some other blood test (A1C) and that clears me on the blood sugar front. Cool. However, my PSA is 7.6 and she wants me to see a urologist about it. I tell her what the surgeon found and that I already have an appointment with a urologist. She asks me to keep her updated and that ends that.
Google is your friendWhile I'm waiting for my urologist appointment date, I google PSA and learn enough to really confuse me. A PSA of 0 almost certainly means you do not have cancer, but 7.6 means you may or may not. In other words, an elevated PSA value can be a indicator of cancer, but it doesn't mean you do have cancer. I ask some guys I know and most have had an elevated PSA at one time and never any issues with cancer. One even had a PSA of 11 at one time, no cancer. My uncle regularly has a PSA of 6.5 and never any cancer. This looks promising.
The UrologistThe day finally comes that I get to see the urologist. He seems nice enough, a little young maybe (mid thirties I'd guess), but about right if you want a doctor with experience, but is also up to snuff on the latest and greatest. He tells me what I pretty much already know about the PSA value. He tells me he doesn't like it that high in my age group - he'd like to see it below 2.5. He suggests a two week regiment of some super-duper antibiotic in case I have an infection in my prostate. I didn't know you could have an infection localized to just the prostate, but that's why he was wearing the doctor garb.
I take the antibiotics for the two weeks, wait one week, get new blood work for PSA and go back to urologist for a "flow" test.
Flow TestA flow test is simple and (almost) painless. You show up at the doctor with a full bladder (you drink 32oz of water 1 hour prior) and urinate in a fancy bucket that measures A) how much and B) how long it takes. After this test, the tech tells me I did "great". They needed about 100cc and I did 300+cc. The only "bad" part is that the first time I showed up at the doctor for this test, the machine was broken and after 40 minutes I couldn't hold things any longer.
Back to the UrologistA few weeks later, I return for the follow-up at the urologist fully expecting good news. In general, I "feel" better than I had in a while, and, my urine flow had dramatically improved since the antibiotic regiment. I was certain that all I had wrong with me was a simple infection.
The urologist comes in and after some brief small talk he informs me that my PSA hadn't changed significantly (7.4) and that something called the "free" PSA is too low at 14%. The logic is this: the PSA cells/molecules/whatever "attach" to cancer cells in the prostate. If the PSA level is high, but the "free" PSA is also high, then there's a better chance it's not cancer (lots of antigen harmlessly floating around in your blood). However, a high PSA coupled with a low "free" percentage can mean that the prostate is pumping out antigen and that most of it is hooking up with cancer cells in your prostate.
He tells me that we have to do a prostate biopsy. Given my expectations, this news was quite shocking. About this time the room began to slowing spin. Everything moved in slow motion, even the doctor. I could hear him talking, but I can't remember what he was saying. I recall that my eyes watered up and was overcome with emotion. It wasn't fear, or sadness - I don't know what it was, but it was intense for a few moments. Apparently I was visibly shaken because, bless his heart, he tried to assure me that this didn't mean I had cancer. Just that the odds weren't real positive for someone in my age group with a PSA that high. Thanks doc.
I gather myself and begin to ask coherent questions. He gives me the quick overview of a prostate biopsy. One of the things I distinctly remember him telling me was that the biopsy wasn't that "bad". He said I'd feel a few small pinches, and a few "thumps". He demonstrated the "thump" on my thigh. It won't be that bad at all he assured me.
At the conclusion of the visit, he walks back up to the front desk with me. I've never had a doctor walk back to the front desk with me for any reason, so I'm impressed. The woman behind the desk comes up with some date that is about four weeks out - he tells her "no, get me something early next week, even if it means overbooking". Again, I've never had a doctor do something like that.
The BiopsyFirst, you don't just go get a prostate biopsy. You have to prepare for it. The device used to perform the biopsy will be poking holes in the lower intestine (specifically the colon) in order to get to the prostate gland. In order to prevent infection from this procedure, you have to take antibiotics (I had Cipro) the day before, the day of and the day after. Further, and less thrilling, are the enema's. You have to have an enema the night before, and 2 hours before the appointment. Somehow, in 47 years of living I'd never had the need for an enema - again, I had no idea what to expect. Not fun is as best as I can do.
I arrive at the urologist for the biopsy. A few minutes later I'm told the machine is broken and could I come back next week. I couldn't believe it. I'm all "prepped" for this biopsy now I'm going to have to do this all over again?!?! I leave, pick up Allison from school and head back home. The phone is ringing as I come in the door. It's the urologist - they got a another machine from another office and they want me to come back in an hour. Sure. Great - lets get this over with.
I show back up for the biopsy. A few minutes later I'm being lead though a labyrinth of hallways to the bathroom. If you visit the urologist, you pee in a cup - it must be some rule. I do, place the cup in the "secret passage window" and exit the bathroom. I'm then lead to another room where there are a lot more people standing around than I expected. Two men and three women.
The doctor is not "my" doctor - it's one of his partners, but he seems very attentive. After a brief exchange of difficult banter, he instructs me to drop my pants and get on the table, on my left side in a fetal position. I notice that my hands are slowly starting to unbuckle my pants, but my brain is preoccupied with wondering when those women are going to leave. It takes me a few seconds to realize they weren't leaving - they were part of this process.
I get on the table and attempt to position myself in the manner instructed. They move me around a bit and they drape some cloth with a hole it over me. A few minutes later the good doctor is telling me I may feel "some discomfort" as he inserts the biopsy device. If you haven't figured it out, this device goes up your bum. Well, "some discomfort" doesn't quite cover it.
He pushes this thing up me what feels like four or five inches and tells me that he is about to inject the site with anesthetic. I feel a few pinches, but it's not too bad. While he waits for the anesthetic to take effect, he goes on a tour of my lower intestine. Doc, I assure you, there's nothing lost up there - stop digging!
After a few minutes of this fun, he tells me he is about to start the biopsy procedure. He tells me I will feel a "slight" pinch and then a "thump". Then he asks if I'm ready and I give the thumbs up.
Allow me to digress for a moment - I think that I've figured out a life rule:
Any time a doctor asks if you're "ready", do not believe what they told you a few minutes ago about it not being "that bad".
He pulls the trigger on the first sample. Yep, a "pinch", but not that bad. About 1 second later the "thump". WOW. That felt weird. Sort of a shock wave that I could feel in my pelvic bones, thigh bones and all the way down the urethra to the end of my penis. I no longer remembered or cared that there were women in the room. Sample number two. Same small pinch, but this time that "thump" felt like a lighting bolt shooting out the end of my penis. It takes your breath away. By the fifth or sixth sample, the pinches were starting to be more than a "pinch". It was starting to really hurt. I was soaked in sweat by this time. I had sixteen samples taken.
I could not move at the end of the procedure. I was a sweat soaked pile of goo. Everyone was very kind and helpful, but I was wasted. After a few minutes, I was able to sit up and put my cloths back on. One or more of these fine folks held onto me at all times, but I kept assuring them that I was OK. They finally let go of me and as I turned to leave the room, the room turned with me and I started to fall. They were smarter than me, because one of the guys was ready for me to fall and caught my dumb butt.
They sat me down in a chair and made me drink some juice and eat some candy. Two or more stayed with me for at least 15 minutes until I had "color in face" and was really OK to leave.
The WaitI had the biopsy on 9/2/2008 and it's going to be three weeks before I get the results...
