Needle, needle on the wall

I had a long awaited date with the above item today. For reference, that sucker is about 14 inches long. 

No trip through Hades would be complete without the specter of some kind of life-threatening situation, or at least life-altering. In this case, elevated prostate specific antigen, chronic prostate-related symptoms and no amelioration from a 30 day course of Cipro. 

It's not the greatest moment in one's life, sitting across from a doctor, and having them say "You need a biopsy."

So I delayed 3 months, hoping the PSA levels would go down to normal. The reading did go down, from 4.5 to 4, but that is still *half a nanogram per milliliter* too high for a guy my age. 

But the biopsy couldn't be set up until today, even though the appointment where we all agreed it would be a good idea was back at the end of June. I was on the road for July and my pee doc, Shapiro, was on vacation in Alaska. 

"I'm going to use my finger first," Shapiro said, although I had read in the latest recommendations that digital examination isn't recommended anymore. I decided not to argue though, since he had that long needle next to him on the table. "Then I'm going to use this transrectal ultrasound gadget to see what the hell I'm doing." Okay, that sounds great, it's good you'll be able to see what you're doing. "Then I'm going to give you two numbing shots on either side of the prostate." Ouch but yes. "Then I take 12 pieces of the prostate out with this biopsy needle, going in through your rectum, and then we're done." Well that all sounds just swell. 

The numbing shots hurt like hell. The 12 snags of prostate hardly hurt at all. "You know some guys come back to get this done for recreational purposes," Shapiro joked, probably sensing that I was getting a little queasy around snag number 9 or so. "I bet you charge extra for that," I joked back and he said "Listen anybody crazy enough to want to do this, it's on the house."

When it was over, the nurse told me to clean up using the tissues, put them in the biohazard bin, and take it easy. Shapiro said "You did great, you hardly bled at all, and now we'll get to the bottom of what the hell is going on with your prostate. Haha, get it? Get to the bottom?" I had developed a dizzy, cold sweat, nauseated pallor by this time but chuckled weakly, that's a good one doc, a good one. 

The excruciating pain set in later, after the lidocaine wore off. No ibuprofen or aspirin, due to the risk of increased bleeding, so I had to take Tylenol, which never works all that well for me. I ate a big lunch and tried to sleep, but the pain wasn't having it. 

After a few hours, it all settled down and I did manage to fall asleep. The prospect of the biopsy had been weighing on me a lot more than the possibility I have cancer. I have a thing about needles (which probably saved me from being a junkie) and I have fairly low trust in doctors. If I do have prostate cancer, there's a huge range of possible options, depending on the Gleason score. Outcomes range from watchful waiting, to radical prostatectomy, which usually renders someone either partially or completely sexually dysfunctional. So I have that going for me, which is nice. 

I don't feel like I have cancer, which I know is a weird thing to say, but my intuition is telling me something else is going on. Prostate stuff is very common for men in their 50s and beyond, and there's a couple other conditions that can lead to elevated PSA, Especially a chronically low level elevated PSA-- I had it measured three times over a year and it was 4.8, 4.5 and 4, in descending order. These levels are often more representative of benign prostate hyperplasia or chronic non-bacterial prostatitis, or even the somewhat more mysterious chronic pelvic pain syndrome. 

But now I have to wait two weeks to find out what's up.