PSA tests and Prostate biopsy - The blog you don't want to read

November the 8th. On that day I will either drink a lot of alcohol to celebrate or my life will presumably fundamentally change. That is the day I get the result of a Prostate biopsy. It has taken me from last Tuesday, when I was told I needed it, until today, to get my head around it. Some of us keep these things private. That was my first inclination, but hey, I'm a blogger - loud and proud. It would be a cop out to say nothing. It's not in my nature. I was in my favourite cafe, having a cup of tea and some advice my Dad gave me many years ago came to me. "Everything happens for a reason, if a bad thing happens to you and you can make a good thing happen to someone else, then you have a moral responsibility to do it". It seems that there isn't a wealth of information on the subject out there. The doctors always say "Do you have any questions" but generally you haven't thought of the most important ones at the time. I'm writing this in the hope that

a) It helps a few people understand whats happening
b) Anyone who has anything useful to add can leave a comment
c) Answers a few of those questions that you forgot to ask

So how did it start? In May I went to see the doctor because I had a problem with my knee and needed a referal for a consultant. He commented that he hadn't seen me for a while and suggested that as I was 49 an "MOT" would be a good idea. So I rolled up and had a plethora of blood tests.

When I went back for the good news, he said the PSA test has come back slightly raised. What is that, I asked. It is a new test which can indicate Prostate Cancer. At your age, it should be under 2.1 and it's 2.8. We discussed it and he advised a trip to the Urology department. He went on to explain that generally people with Prostate Cancer would have a far higher PSA, but it is best to be cautious.

So I went to see the consultant,w ho advised that the usual course of action is a course of anti-biotics and a follow up test. He advised that the test is pretty unreliable and can vary on a day to day basis. So in August I took the Anti Biotics and gave some more blood. The appointment was changed a couple of times and I eventually went back last Tuesday. The consultant said "Well the urine test was clear, but your PSA has gone up to 4.1. As this is on an upwards curve, I'd recommend a Prostate biopsy." We discussed the options and he advised that this was a logical next step. His advice was that it was unlikely given the state of my prostate and the relatively low reading that I'd have anything requiring radical surgery, but the earlier these things are caught, the better. He said that for many people with early stage prostate cancer all that happens is that it is monitored. I must admit I was shocked. I had expected the test to come back as OK. I was phoned later in the afternoon and the procedure was booked for last Saturday.

I'd not given any thought to what it entails and I'd not thought  to ask. I'd had a leaflet that explained "afterwards there may be some blood in stools, semen and urine". I certainly hadn't thought how this might affect me. It also said it would be done under local anaestic (ie I'd be awake). So on Saturday I rocked up for the appointment at Barnet Hospital. I changed into a gown and was told that they were running late. I sat in the waiting room, watching the saturday cooking show. Quite surreal really. A certain gallows humour amongst the other poor mugs pervaded. I suspect that the British have a fundamentally different approach to such problems than most nations. Bad jokes was order of the day and a general mood of mutual support "Don't worry, I've had four of them, it's horrible". I felt like a condemned man.

Into the treatment room. Again, I hadn't realised what the treatment consisted of. They stick something that looks like one of the spark machines that lights gas hobs up you bum and snip bits off your prostate. It makes a similar noise as well. The local anaesthetic is applied first. You still feel something. It is far more unpleasant than it is painful. After the fourth click, I asked "how many do you actually take?" I'd thought they took 1. The answer came back "10". This didn't make me feel happy and I wished I'd been given the option of something to dope me up. I will most certainly ask if that is an option if I ever have to have another one. After the 10th snip, they said "Now we'll adminster an anti biotic suppository". After that I lay on my back and got the good news about the side effects. "You'll be peeing blood for a few days and there will be plenty of blood when you do a poo. You'll also find clots and fresh blood in your semen". How long for? "For some people a few days, for some people several weeks". It's now Tuesday and so far I get a small amount of blood maybe 50% of the time when I pee. The blood in the stools was bad on the first day. As to the semen? I've been too scared to even think about that so far. I didn't ask how long you should leave it before testing the equipment. The consensus on the internet seems to be 3-4 days. I must say so far I'm not ready to cross that bridge as it is bad enough with the blood in the pee (even though it is a small amount).

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?

In answer to g) The doctor told me not to play football or go to the gym for at least a week. If they had told me before, I could have cancelled my training session today a little earlier. Fortunately I had cancelled our Sunday night five a side already, but they should have notified me before.

Whatever happens, I'll be glad I had the tests. The earlier that anything is found the better. If there is nothing, then they have a baseline to monitor my levels going forward. I've found out that approx 1 in 5 people with a PSA between 4-10 have Prostate Cancer. As I'm at the bottom end of that, the odds are not too worrying. The examination said it was normal sized, so again that makes me cautiously hopeful.

If the news is bad then if nothing else, I've caught it far earlier than if I'd waited till  I had symptoms. As I've a family, even if the news is terrible, it means that I can sort things out in an orderly fashion. Sadly many people believe that burying their heads in the sand is the answer. It isn't. It just makes a bad situation worse and reduces any treatment options that may crop up. I hope to God that the tests come back all clear. If they don't then that bridge will be crossed at the time. I'm not worried right now although it is a bit of a black cloud on the horizon.

My advice? If you are approaching (or older than) 50 and you've not been to the doctor for a few years, get yourself an MOT. I really did not enjoy any of what I described above, but statistically you should be fine. I have no symptoms of anything, so don't assume that because you feel OK everything is OK. We live in an age where medical science can sort many things out. We live in a country where sorting it out won't bankrupt us. We are lucky. God Bless the NHS !