One of my closest and dearest friends is having a prostate biopsy today (“Prostate Cancer – It’s All The Rage!”), so in his honor and now that your breakfast is done, let’s discuss a procedure that many men will reluctantly…submit…to – and should, if the need arises.
Honestly, it’s not that bad, but there are some things a man should know before the urologist goes exploring. (Hang in here – there’s a cool reward at the end.)
Until fairly recently, “exploring” really was the appropriate term. If the urologist conducting a digital examination (use your imagination and see the reward below) felt a bump, well that was bad – but it also was good, because at least he or she knew where to poke the guy with the biopsy needle.
Most of the time, that is not the case. A rising PSA without any other information left the urologist/explorer with little choice but to, I don’t know, hunt and peck. Usually, with 10 to 12 excavations.
Hit or miss.
Maybe the procedure would discover malignant cells that could be studied and staged, maybe it wouldn’t. Maybe that meant the patient was cancer free; maybe it meant that the urologist understandably guessed wrong and missed the mark.
Now, there’s a better way.
It’s called an MRI-guided prostate biopsy, and this is what a patient should request, if the need arises. In layman’s terms, an MRI scan is generated to search for suspicious lesions. Using that data, the urologist has a much better chance of focusing the procedure and finding a malignancy or, with greater confidence, ruling out malignancy.
Either way, the biopsy itself is not a big deal. The doc generally goes in from the rectum, injects the patient with the urological equivalent of novocaine, waits a few minutes and then extracts 10 to 12 samples of tissue. The patient feels the injections of pain killer, but little else after that. (Pro tip: Never refuse the local anesthetic. Another friend once did that. He won’t do it again.)
If the suspicion is particularly strong, the docs will conduct a “saturation biopsy,” which merely means that they are extracting about 20 samples rather than 10 to 12. Hey, the more the merrier, right?
Information from actual experts at the Mayo Clinic about risks, side effects, etc., can be found here:
In my case, the initial biopsy – a 12-plug event in April 2015 in response to rising PSA scores – came up empty. Good news! Or so it seemed.
But the PSA kept rising, so we did it again – this time with an MRI-guided saturation biopsy in May 2018 that focused on a suspicious lesion identified by the scan. Pay dirt. Damn it. That led to treatment then and more intense treatment now to deal with the more serious recurrence.
Bummer, but much better to know than not to know – survival and/or longevity are very much in play here. So…keep an eye on that PSA and don’t duck a biopsy if the experts recommend it.
That’s today’s lesson boys (and girls) about prostates and biopsies. Since you’re been such a good class, here’s a brief clip of actors Danny Devito and Michael Douglas (in real life, great buddies) doing the deed, so to speak. It’s from the terrific Netflix series, “The Kominsky Method.”