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Thursday, July 31, 2008

SATURATED PROSTATE BIOPSY

When my PSA went up again after this year's physical, Dr. William Burnett, my GP, strongly encouraged me to get a biopsy. The fact that my Free PSA had dropped from 25 to 16 percent decided the issue for me. I made an appointment for a biopsy at the UT Southwestern Medical Center.

At the physical with Brad Hornberger, Dr. Claus Roehrborn's Physician's Assistant, I agreed to an office procedure. But later, at home, I had second thoughts. A urologist had done a DRE (also known whimsically as a "finger wave") on me last year and said I had a "huge" prostate (nice to know that something down there is huge). An office prostate biopsy would take maybe 12 core samples. If my prostate was very enlarged, wouldn't it make better sense to take more samples to reduce the risk of a false negative. Many men have successive biopsies when the first 12 sample biopsy is negative and I didn't want to have to turn around next year and do it again should the results turn out negative. Plus, the thought of not being sedated while a mini-nail gun was inserted in my bottom and fired off 12 times made me a little queasy. So I emailed Brad with my concerns and he asked the staff to make an appointment with me for a saturated prostate biopsy to be done by Dr. Roehrborn in the operating room of Zale-Lipshy Hospital on the UT Southwestern campus.

The procedure went very well. I had a little bleeding afterwards but in the normal range and that stopped within a day. I was up and down the night of the biopsy because if I didn't drink lots of fluids it burned a little to urinate but that also ceased by the next day.

Everyone, from the nurses to the valet parking guy, were friendly and kind at UT Southwestern Zale-Lipshy Hospital; it's a very well run and professional organization from top to bottom. Dr. Roehrborn, the head of urology at UT Southwestern, came in and gave me a short briefing. One of Dr. Roehrborn's assistants, who came by before Dr. Roehrborn, spent a lot of time with me explaining what would happen (he said they would take 30 samples) and answering my questions.

Before the procedure, a nurse gave me an injection to numb my hand and then when she put the catheter in I didn't feel a thing. When the time came for the procedure, I was told they were going to give me something to "relax" me. As I was being wheeled down a hall on the gurney at what seemed a rather excessive, possibly even dangerous clip (had the drugs kicked in??), I remarked to the nurse guiding the gurney next to me that I was feeling something cool in my hand where the catheter was. She said that was normal. (I never did feel euphoric or relaxed, darn it!). We turned a corner and started down another long corridor, presumably heading to the operating room, and I noticed one of those iconic bright red coke machine on the left. That coke machine was the last thing I remembered; the next thing I knew I was awake in the recovery room and two cheery nurses were asking me how I was. I said I felt great, like I could run a hundred yards. (Always the jokester, that's me.)

The anesthesiologist had said I would be kept awake long enough to turn over on my side in the op room but I was asleep flat on my back still moving on the toboggan-gurney run before we even got there. I didn't even make it past the soft drink machine, which was a shame because I could have used a cold coke at that point, not having anything to drink since 8:30 PM the night before.

My sedation cocktail included versed and propofol (sedatives which induce sleepiness, reduce anxiety and cause loss of memory of the procedure) and fentanyl (a pain killer). This is a very similar mix to what is given for a colonoscopy as far as I can tell.

Before the biopsy, I had been particularly concerned about the possible complications: infection, bleeding, and acute urinary retention. But I needn't have worried. They kept me at the hospital unitil I could urinate, and as I mentioned, I had a little bleeding but it stopped in a day or two. I was given levaquin, an antibiotic, to take before and after the procedure and had no infection. The burning on urination stopped the next day.

The pathology report came back negative which was a great relief. Since 30 core samples were taken, the chance of a false negative should be pretty low and I wouldn't think I would need to undergo successive biopsies unless my PSA takes off or I get a positive DRE on a future physical. At this point, all I am sure of is that I have is an enlarged prostate. Recently, I became aware of a drug called finasteride, which not only shrinks the prostate but studies show it reduces the risk of getting prostate cancer by 30 percent. Finasteride was originally marketed under the names Proscar and Propecia, the latter being the hair-growing product for men, so I might get some of my hair back in the bargain.

Men over 50 or with prostate cancer in their family should get a prostate cancer exam every year.