Saturday, 14 September 2013

Rog T's Cancer Blog - Important information if you are having a Prostate Biopsy

For those of you who are regular readers and have read the previous posts on Cancer, you can skip this first paragraph.This is the latest installment in my occasional series about how I'm adjusting to living with a big C in my life.  For those of you who aren't, here's a quick summary. I'm 51 years old and in October 2011 I  had a prostate biopsy following two "slightly high" PSA tests - 2.8 & 4.1. The biopsy took ten tissue samples and one of these showed a "low grade cancer" which gives me a 3+3 on the Gleason scale. I'm now on a program of active monitoring.  In early February, I got the results of the a PSA test - down to 3.5 and an MRI scan which found absolutely nothing, two more tests in 2012 were at 3.5 and 3.9. My latest PSA test in August was not quite so promising,  back up to 4.0, in other words the downward trend has stopped. I've no symptoms and sadly for a few people, if I'm gonna die soon, it won't be from Prostate cancer. Got the picture? 

So yesterday I had a prostate biopsy. This was the second time I've experienced this procedure. I wrote about the first one here - - back on the 25th October 2011. Before writing this article, I reread this. When I wrote the blog, a week after the procedure, I didn't know I had prostate cancer and didn't expect a positive result. In fact I was convinced I was Ok and the whole thing would just be a a passing fancy in a midnight nightmare. Sadly, for me at least, it wasn't and I have had a lot of things to get my head around. Perhaps the most important thing I wrote in that blog was the key questions to ask your doctor

So what should I have asked?
a) Can I be knocked out or at least doped up?
b) When is it safe to have sex/masturbate?
c) How many samples will they take?
e) What happens if the test comes back as negative. What happens then?
f) How much fluid should I drink (I've been drinking as much water as possible)?
g) What should I avoid?

Yippee, I thought as I reread this. A strange response you may think. Well no not really. You see I learned one thing as a result of the first procedure. Question a). I asked this time. The doctor said I could have a general anaesthetic, but advised against it. Well let me tell you something very important. When I had the first procedure under local anaesthetic, I found the experience as disturbing as anything I've ever experienced. It has confirmed something I knew since I was given a suppository when I was four years old, having my tonsils out. I don't like having things shoved up my bum. As if that wasn't bad enough, as each of the ten samples was taken I had the sensation of someone flicking my testicles from the inside. By the time the procedure was over I was traumatised. I discussed the issue with my brother in law, who is a doctor in the USA. He informed me that they would never perform such a procedure under local anaesthetic. So this time I insisted on a general.

So what happened yesterday. I arrived at the day procedure department at Barnet General hospital at noon. I'd brought the Guardian and the Express to read during the wait. At around 1pm, I was called through. A nurse took my BP 128/88 and pulse - 51. All was good to go. Then I saw the anaesthetist.. I was asked a whole stack of questions. My name, date of birth, allergies etc. I was told that if it went wrong, I'd loose a few teeth (a bit like a bad night at the Bald Faced Stagg in Burnt Oak). Then the surgeon came down and started the consults. Each patient had the curtains drawn. There were four of us. Rather bizarrely, the curtain is drawn, but you hear every detail. One guy was having his forskin "eased", another guy was having a circumcision, the third was having a vasectomy. Then there was me. Now tell me if I'm wrong, but I was not impressed. We were all able to walk. Why on earth should our deepest medical secrets be discussed in earshot of other people, strangers? There was no earthly reason why we couldn't have the consult in a room with privacy. I am the worlds greatest defender of the NHS, but such matters should be dealt with in a manner that gives respect to the patient.

I was told I'd be the last patient to be treated. The doctor explained that they always started with the most problematical patient. The diabetic with high BP was clearly in front of me. I took the opportunity to read and have a snooze. The anaesthetist commented that I was extremely calm and relaxed. I replied that I relished the chance to chill out and relax. I think he concluded that I was a lunatic. A nurse fitted a line into my hand, through which anaesthetics would be administered.

Eventually I was taken to theatre. I walked down. I was asked to lie on my side. Monitors were fitted and then the anaesthatist announced they were giving me a gin and tonic to help me relax. I replied "Good". I looked up at the monitors and thought "this is having no effect at all". The next feeling I was aware of was one of warmth and comfort. I felt great. Then I woke up. I was back on the ward and it was all done. I felt absolutely fine. A nurse came up and asked if I wanted a tea. I asked for a bottle to relieve myself. I got a nice cup of tea, had a couple of biscuits and did a wee. The surgeon then came up and said "It all went well, your prostate was normal sized. You'll get the results in 3/4 weeks". I had a rather odd feeling in my nether regions, but apart from that I felt absolutely fine. The contrast with the first biopsy could not be more marked.

In 3-4 weeks, I will get the news. I am hoping and praying that this will be good. Whatever happens, I know that opting for the general anaesthetic was the right decision for me. I have been dreading the procedure. I can imagine that many men simply refuse to go back. The down side of that is that you will not know whether your cancer is developing and you are putting yourself in grave danger. Here is the answers to those questions as best I can find out

a) Can I be knocked out or at least doped up? Yes - the procedure can be done under  a general anaesthetic
b) When is it safe to have sex/masturbate? The consensus seems to be 3-4 days
c) How many samples will they take? At my hospital ten, don't know if this is standard. 
e) What happens if the test comes back as negative. What happens then? They monitor your PSA
f) How much fluid should I drink (I've been drinking as much water as possible)? At least an extra litre of water
g) What should I avoid? Vigorous exercise for 1 week

Of course we are all different. Some of the people I've spoken to have taken the biopsy procedure in their stride under local. If you genuinely think that it won't bother you, then have it under local, there are far less risks. People have asked me why I choose to share this private information on a public blog. The reason is quite simple. I was never offered the option of a general anaesthetic and I was discouraged from having one when I asked. Given the feelings of dread I had about the procedure, I had put it off for nine months. Having had the procedure under general anaesthetic, I now know that I have nothing to fear from it. The idea that anyone may not be getting necessary treatment out of the same fear chills me to the core. Our health is the most important gift we have. Cancer robs that gift from us, therefore anything which can help in the fight is the right thing to do. The reaction I've had to this series of blogs has been overwhelmingly positive. I believe that we should respond to cancer as a community, not as scared, frightened, lonely individuals, overwhelmed with fear.

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