Friday 2 October 2015

Rog T's Cancer Blog - Everything you ever wanted to know about Transperineal Biopsy of the Prostate gland

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, in 2013 my test was 4.0, Jan 2014 was 3.8, August 2014 was 4.0,  February 2015 it was  up to 5.5  and my latest in August 2015 was down againg at 4.6.  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?

Firstly, a little warning. This particluar blog is not for the faint hearted. But I do believe that knoweldge is power, so I think this may help anyone facing this procedure understand what it is about, why you are having it and for me the most important thing of all, what you can expect.
So yesterday I underwent a Transperineal Biopsy of the Prostate gland. This is not the run of the mill prostate biopsy. It is a far more detailed and extensive version. Generally this procedure is used to get a "full picture" of just what is going on with the cancer in your prostate gland. A run of the mill biopsy takes 10-12 core samples from the prostate, mostly from the lower part of the gland. This takes 30-50 from all over. The transperineal biopsy gives a far more accurate picture. As I understand, if you live in the area covered by the Royal Free Hospital trust, this procedure is used when you've been on active surveillance for several years and they have some reason to want a fuller picture of just what your cancer is doing and how its developing. The booklet you get says "The reason this is done is because you have already undergone a number of biopsies (via the rectum) which have not indentified the coause of your elevated PSA; further transrectal biopsies would carry a significant risk if performed in this number.

The reason for the lower isk, is because it is a cleaner procedure. Wheras a regular old prostate biopsy involves poking a probe up your bum and snipping bits (cores) off your prostate for examination, the leaflet says of this procedure "The procedure involves using an ultrasound probe, inserted via the back passage, to scan the prostate. Biopsies are taken through the skin behind the testicles (the preinium) using a special grid. The sampling is targetted and and the number of samples taken depends on the size of the prostate, usually ranging from 30 to 50."

It is a procedure done in the day care unit. The leaflet you get tells you it is an overnight stay procedure, but this is not the case in Barnet. Personally I'd rather be in my own home. I am sure the Royal Free Trust do this to save money, but I personally am more than happy to be at home.

You are given anti biotics to take the day before the procedure. As it is done under general anaethetic, you also get a pre assessment in Barnet, a couple of weeks before. They take urine samples, blood pressure and check your medical history, so if you have to pay for prescriptions, don't forget to take your wallet!

So on to the day itself. What can you expect. Initially my letter told me to present myself at 7.30am, to eat nothing after midnight and to drink nothing but water after that. On Weds (the day before), the unit called me and told me that I ddn't have to arrive until 9.30am, as I was third on the list. I was quite happy with this. So at 9.30am, my wife dropped me at the day unit. I was advised to bring slippers and a dressing gown. I was shown to a bed. The first assessment was a nurse, who checked my blood pressure and pulse and ran through details of allergies, metal implants etc. Then I had the anaesthetists. They asked pretty much the same questions. They told me I'd have an oxygen line into my lungs, a catheter inserted and an ultrasound probe inserted into my rectum, so I may feel a bit sore in all three areas after.

Then another nurse came down. She told me the process of what happens when I wake up. Basically they'd ask me my postcode and date of birth to assess just how with it I was. Then my doctore arrived. He explained the procedure. He told me that after the MRI I had in January, the triage team (wwho manage my care) had decided that it was time for this procedure. Whilst my cancer and PSA has been fairly stable for the best part of fpur years, they felt they needed a better understanding of its aggressiveness and size across the whole prostate gland. He ran through a few "normal side effects". These are (according to the sheet)

Common side effects (greater than 1 in ten people)
Blood in urine for 10 days
Blood in semen for up to six weeks (apparently harmless and no risk to your partner)
Bruising in preineal area
Urinary infection (10% risk)
Discomfort due to bruising
Haemorrhage preventing passing of urine  (1 in 10)

Occasional Side effects 
Blood infection and septicaemia needing hospitalisation (2%)
Haemorrhage needing hospitalisation (1%)
Inability to pass urine.
MRSA (0.9%)

So these were the side effects I new about. In his talk, he added another one. Apparently it is common to be unable to get an erection for up to four weeks.  I asked when it was safe to have sex, to which he replied, more or less when you feel like it. He added that I may wish to wear a condom as it is likely to be very messy for a few weeks.

While all of this is not good news, I am of the opinion that as cancer is a life threatening condition, it is necessary and prudent to manage the condition, making these risks worthwhile.

I was asked to change into a hospital gown and paper undies. I was then given stockings to reduce the risk of clots in the legs. I must state at this point that I've been under the treatment of this team since 2011. When I started, the hospital was run by the Wellhouse Trust and this suffered a financial failure. The hospital was taken over by The Royal Free trust. It appears to me that the process and procedures, to my casual eye, seem to be more efficient and better run. There are all manner of minor things I noticed. On my last biopsy, I had the pre assessment, then had to fill the whole thing again with a different nurse on admission. This time, they simply gave me the previous form and asked me to check it. It gave me a degree of confidence that the place was being properly run.

So anyway the time came for the procedure. Previously a porter had come, put me in a chair and wheeled me t theatre. As I was perfectly able bodied, this seemed OTT. This time I walked in under my own steam. I was rigged up to a machine which monitored my pulse, blood pressure and various other sensors attached to my head and chest. A line was put into my right hand and I was told I was being given something which would make me feel a bit light headed. I felt a cold sensation in my vein. I was then told I was being given some anti biotics and pain killers. Then I fell into a lovely warm sleep.......

I awoke in a recovery area. The clock said 12.35am. I was busting for a pee. I felt as if I'd awoken after a heavy night out. The nurse came. I asked if I could have a bottle as I despwrately needed a wee. She must have decided I was with it, as I wasn't asked my postcode or date of birth. I was given the bottle and then started to wee. Oh lord. I realised my mistake. It felt like I was peeing battery acid. I was unprepared for this. When I finished, the nurse was quite happy. She said it showed everything was working.  She said they'd put 200ml in and I'd pee'd it out again which was good. I didn't think so. I was then taken back to the ward and given tea and biscuits. I promptly threw up. I was starting to worry, but the nurse said this was just the effects of anaesthetics. I had a drink of water and started to feel much better. Then I had to pee again. This was agony.

Then the nurse took my blood pressure and temperature and told me she'd call my wife and I could go home. By 2.45 I was back home. I had some lunch and then decided to go to bed and read the papers. Another couple of painful trips to the loo and I was feeling rather sorry for myself. Then I got  a text. A friend of mine contacted me to tell me that a good friend of mine, who plays five a side football with us, and who had lost his son in a tragic accident on Saturday was going up the pub for a deink with our five a side football boys. I had planned to have a quiet night in, but felt I should make the effort (strictly no alcohol though). As I was advised to avoid driving for 24 hours, I arranged for a friend to pick me up. I then had a sleep.

The human body is a wonderous thing. I suspect that had I stayed in I'd have felt rotten all night. As it was, I went to the Three Hammers, had three bottles of mineral water and a memorable evening. As a group, we turned out en masse to give our friend support. I cannot imagine anything worse than what he is going through, but he was telling us how his sons friends had rallied. He said he felt great pride in the fact his son was living life to the full. None of us know the future or when our numbers up. We can hide away, scared or we can live life to the full. I rolled in at half past midnight. My wife thinks I am mad, but in a funny way, I think it was the best thing I could have done. I think my friend appreciated the support and I was just pleased to see him out and perhaps having some of what will pass for normality. As my friends were aware of the procedure I'd had, a few of them were keen to discuss. I turned out another squad member had a similarly horrible procedure on Wednesday and another the week before. I guess we are "at that age".

I woke up this morning, had a pee. It hurt but it wasn't as bad as it had been. I will take it easy today and await the results with a degree of trepidation. So far, the side effects of the procedure seem on the mild side (apart from the battery acid wee wee effect). If you have this procedure, do ask if there is anything that can be done to mitigate this, as you've heard it isn't very nice, that is the best advice i can offer. I didn't and in hindsight I wished I had.

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