Saturday, August 31, 2019

Prostate Cancer

My former approach
NOTE TO READERS: The subject of this blog is prostate cancer, written from recent personal experience. While still maintaining a humorous approach to the subject, this material is written in an honest manner. Some readers may find the subject and the manner in which the material is presented indelicate. If you might fall into that category, please do us both a favor and skip this blog.   

“I’m not worried about prostate cancer. There’s no family history. Besides, I don’t have any of the symptoms.”

Those words, almost verbatim, had been repeated every year at my annual medical humiliation since I turned fifty. Like most guys, I wasn’t enthused about the possibility of the dreaded “digital rectal exam.” (More commonly referred to as a “DRE” because that sounds much less unpleasant.) For those of you who may not be familiar with a DRE, that’s where the examining medico tries to reach a male patient’s tonsils by inserting his index finger into the patient’s rectum. Along the way, the patient’s prostate gland is given a cursory mash, or two.

Just as an observation, it is interesting to me that the female health providers I’ve had over the years seem much less inclined to perform a DRE than their male counterparts. That strikes me as being unfortunate as their fingers are, as a general rule, much smaller. Personally, I think male providers – particularly those with massive hands – have no compunction about preforming a DRE because they see it as shared misery and a way to bond with their patient. Just guessing.

The alternative to the DRE is a lab test called the PSA test (for prostate specific antigen). Use of the PSA test for diagnosing prostate cancer has been under debate and study for quite some time. There are times when the test can show cancer where there is none, and the test can also falsely indicate no cancer. For those reasons I never had a PSA test until I had a female physician in New Mexico. In April of 2018 she insisted I get the test (see above paragraph about aversion to DRE). The results showed an elevated number, and the doc suggested I wait a month and retest. The second test showed a significant increase. Time to go see a urologist – AKA the plumber – which was a two month wait.

Picture of DRE in action
 Urologists delight in performing DRE’s. The guy I saw in Las Cruces had hands only slightly larger than those of the Incredible Hulk. He also was pretty blunt in his assessment: “Well, the good news is that you’re not going to win any prizes with that thing. However, I want another PSA run in two months.”

You guessed it; the numbers were up again. Unfortunately for Dr. Hulk Hands, when he started talking about a biopsy appointment, I informed him Mrs. Poynor and I had already decided we were moving to South Dakota. The doc seemed somewhat disappointed – I’m guessing over lost revenue.

Fast-forward to Rapid City, SD. New primary care physician, new plumber, more DRE’s, more PSA tests, same results (only worse on the PSA). By May of this year, everyone (including myself, finally) was in agreement: time for a biopsy.

The procedure for a prostate biopsy is performed in the doc’s office. It’s a simple matter of being mechanically violated. A probe called a TRUS (for Trans Rectal Ultrasound guided) is inserted into the victim’s… er patient’s rectum. The probe has hollow needles that are injected into the prostate gland, through the rectum wall, to take very small core samples for pathological examination. That’s the textbook explanation.

Biopsy sample - 2.5 cm equals 1 inch. Not big.

From a boots on the ground perspective, it’s quite a bit different. The biopsy thingy feels to be the size of a Trident submarine. While the doctor plays Captain Nemo, twisting and maneuvering the submarine, the nurse acts as navigator, calling out coordinates for the missile strikes. 

“Left anterior proximal section,” the nurse directs.

“Firing missile one!” the doctor responds, and a click is heard and felt, then the next target coordinates are called out.

Roughly halfway through the procedure the Captain Nemo remembered there was someone else in the room besides himself and the fire control officer. “You doing okay?” he asked.

I couldn’t help myself; had to be honest. “This is definitely not going to make my list of things that make for a fun Saturday night.” For that, I got a sympathetic pat on the butt.

Rare picture of a TRUS being prepared for a biopsy
All in all, twelve missiles were launched.

It wasn’t the worst office procedure I’ve ever experienced, that’s for sure. I will say, however, there are some side effects. The worst of which is feeling like you’ve jumped on a bicycle only to discover its seat has been removed.

After the procedure I was scheduled for a follow-up appointment in two weeks to discuss the results. I’m just going to toss this out there: the health care system we use is set up so that one can check test results online as soon as they get back from the lab. To the people who run said site: NOT posting the results lets the patient know immediately things ain’t good. Just sayin’. You might as well put out the facts.

Check back for part 2.