PSA test for prostate cancer

Can you say a little bit more in detail about the biopsy for men who might be worried about it?

Oh I see oh well yes this is the least pleasant of the things that happened to me but I'd never had any pain or anything like that throughout any of the procedures that happened in the next few months. This was the first time, as I say, all the women present said, 'Well we've been interfered with since we were teenagers, it's about time you men had, you know suffered the same fate.' And they stick a thing, it's just like a, just like a large finger up your bum. It was an enormous finger as far as I was concerned and then they put a needle through the wall of your rectum into the prostate and they take, under guidance from an ultrasound cinema screen, you know television screen, they carefully select places that look dodgy. And I think six out of ten or nine out of, or five out of ten or something like that of these turned out to be cancerous and they take a samples. Having taken them through the wall of the rectum they obviously can introduce dirt into your system and therefore they stuff you full of antibiotics, a huge injection and all this sort of stuff which is not something that that one wishes to do voluntarily really, you know we try and avoid antibiotics if we can. But that was probably the worst procedure I had throughout the whole of the exercise, but it wasn't that bad, for heavens sakes it wasn't that bad at all.

So did you have any local anaesthetic for that?

Oh yes, yes they gave a local anaesthetic yeah, yeah. You couldn't see the screen, that's the only thing that they could improve, put the screen so you could see it but yes local anaesthetic certainly.

So you'd liked to be able to see what was going on the screen?

It would be nice, it would be nice, for an engineer it would be nice.

Did you have any side-effects of the biopsy?

I don't think so no. A bit tender and that sort of thing but not no, no nothing serious at all.
 

Can you explain in some detail what it's like to have a biopsy?

Yes well that's what I was just coming to yes it [laughs] it's, it didn't hurt, I mean it was uncomfortable, I mean you have to lay there, I mean it was all done properly and you put a gown on and you lay there and the nurse like talked to you about things which you want to talk about like holidays or whatever it was. And then you had like this, they greased up, like a, well I take, I take it was a, like a clipper sort of affair or something which they take, they only take like little clips out. And then they just inserted that and then...

In the back passage?

Yeah in the back passage and then they actually took, I think it was 12 they took and I mean to explain what it felt like it, it was alright in the back passage because you know you could, you could stand that alright but it was like as though they was firing, every time they done it, it was like a paper clip going into you, as though they was firing a paper clip in. So anyway that is what I had done, I had 12 and after that it was, you know it's quite alright. I mean I've talked to other people who's had it and like they all said it's nothing really to worry about, it's a bit uncomfortable but I mean that is all.

Did you have any side effects after that?

No, no, no they say that you, you could turn round and pass a bit of blood or something like that but no I had nothing at all, no pains, no nothing and everything was fine.

So when I went back now to have the, the biopsy [laughs] that was painful. However, but he explained to me what was, how it's going to be and I went and I lie down on the bed and the doctor, he explained to me that I would hear like a little 'Pouf' going off, 'But it's not painful and it's nothing, it, it's just discomfort.' 

That's what he said?

That's what he said. But to me, when he started it wasn't discomfort, but it was painful. On the outset he said they wanted eight samples. So I said, 'OK.' But when he started, and when he reached, he got his six samples, I said, 'Hang on a minute doctor', I said, 'I want to go to the toilet.' Because I couldn't stand that any more. But when I go to the toilet I was passing blood, you know, I see the, set of blood. So I got some paper, the tissue paper and pat myself with it. And when I went back in he said, 'Right, two more pieces.' I said, 'No you ain't.' I said. 'You've got six pieces of samples, whatever tests you're going to run, that's enough.' I said, 'There's no way I'm going back on that table for you.' And he started arguing with me. I says, 'You can talk until doomsday, I'm not going back there.' 

Because it was so painful?

Because it was so painful.

And how did you feel after the biopsy?

I was in, I was in some pain. Because imagine you've got like a claw, snipping these bits of flesh from you, it leaves you sore inside.

Right.

Inside sore. And the, the blood, I was passing blood for about a day and a half or so. And in the meantime it was uncomfortable.

Yeah.

But it had to be done, so it had to be done. When I went back to the hospital I saw a different consultant and he told me well the prostate gland is cancerous.

The biopsy, I went to the local hospital to have. And I was very, very nervous before I went there, because I'd heard already that it was unpleasant. And, and, and it didn't disappoint me. It was unpleasant. It was done under, with just some GTN cream and, and some gas and air. And it was very painful, or very painful for me for the ten, fifteen minutes, twenty minutes that the biopsy was taking place. However I must admit that even though it was painful that twenty minutes, two hours later I was fine. I was very shaken up to start with, but two hours later when I got back home I was fine.

So they, did they use a little bit of local anaesthetic? You mentioned a cream?

They used some GTN, glyceryl trinitrate cream, which they applied rectally, and gave me some antibiotics when I had it. But to be fair that, that didn't, that didn't ease, ease the procedure. Then they gave me some standard gas and air, which I could take while I was having the procedure. Which I did take. However the procedure I found very very unpleasant.

Do you know how many samples of tissue they took?

I think it was either six or eight. I, I could have told you at the time because it seemed to be very vivid. But I think my mind's blocked it out since then.

Did they tell you to expect that sort of level of discomfort?

Perhaps they didn't warn me as much as that, you know, as, as much as I thought it was going to be. But from what I understand of talking to other people, it, it just depends on different people as to how painful they find it. I found it particularly painful.

The biopsy was worse than the operation [laugh]. The biopsy was more painful than the operation. 

Well, you're the first person that's told me you had gas and air during the biopsy. Was that easy, was that on hand, or did you have to ask for that?

I said, 'What op?' Well, I said, 'What painkilling can I have?' And they said, 'Well, you can have this gas and air'. So I said, 'Right. Get the mask here. Let's get that mask in my face'.

Did that make you feel a bit queasy afterwards or not?

No, not really.
 

Whilst I was in hospital then they did, they asked, or they told me that it would be wise to have a biopsy. Small pieces, very minute pieces of the tumour taken away. The idea of it frightened me to death and then it was explained that it was not going to be painful, a little bit uncomfortable but certainly not painful, it wasn't even necessary to give me an anaesthetic, but I did have to sign consent forms because I went into theatre. But the nurse was very supportive, the surgeon was very supportive, nothing to be frightened of and it was true. So it he took I think it was about seven samples, seven or nine samples by going in through the anus, into, into the prostate gland and removing tiny little pieces. And it was just as if a ballpoint pen had been pressed on my hand, it wasn't even sharp, but there was a click each time it was done and then went back to the ward and recovered very quickly, nothing to worry about whatsoever. If I was told I as going to have it tomorrow it wouldn't worry me at all, and far less, far less traumatic than going to the dentist.

Do you know if they used any local anaesthetic or anything?

No they didn't use any anaesthetic at all, it wasn't necessary.

And were there any side effects of the biopsy?

Noyes I was, just afterwards I passed blood in the urine for a short while, a few days and a little bit uncomfortable when I went to the toilet, when I passed stools, it was just that little bit sore. But after that no problems at all.

I went for the biopsy, I had ten biopsies and basically what happens is they will give you a local anaesthetic, but it's all, obviously they access your prostate through your back passage so you actually have a local anaesthetic injected up through there. They then put this bit of kit up inside you which grabs bits of your flesh, whatever. And I didn't find it that unpleasant, I mean it certainly wasn't pleasant, the whole thing is quite undignified and quite difficult but it wasn't that unpleasant although obviously I did react to it because when I got home I was sort of pale and looked as if I'd been through a bit of an experience. But it was fine and later in the day I was fine and went back to work and what have you. 

But at the time of having the, the biopsies the consultant said to me, 'By the way,' he said, 'Obviously we're going into your prostate and we're taking samples from your prostate, it is going to have an impact on your insides and you may find that there's a little blood in your urine over the next little while.' And I said,' Well what do you call a little while?' And he said, 'Well may be a month, 6 weeks or so.' And then that was that so off I went home and all the rest of it. 

Went along for the results on the Friday and he explained that 9 of the biopsies were clear but one of them had very suspicious cells and the, the operative who was looking after this kit was saying, 'We must do some more biopsies around that area.' So he gave me a little rest and the following Monday, that is a fortnight after the first biopsies, I had another 12 biopsies. That obviously was quite difficult, and I know that, for instance in America, my brother-in-law is a surgeon in America, they would never give you 22 biopsies in your prostate in a matter of 2 weeks. But anyway I had, I had 12 biopsies done and went back for the results a few days later and he pronounced that they were clear. But by that time I was suffering from extremely bad cystitis which is an infection I'd got probably from the first biopsies. It took a little while for that to be sorted, in fact they thought that they might have to take me into hospital and put me on a drip because the cystitis was so very, very bad.

But actually what I want to say about the biopsies is something which was very, very much more important to me and that was this, this remark about you may have some blood in your urine. Probably the most traumatic thing about the whole experience for me in terms of the PSA testing and the biopsies and visiting the consultant and all the discussions, quite apart from the difficulty with the, 'Having sex in a coffin' comment was the fact that I was not prepared for the effect of the biopsies on my sex life. And what I mean by that was the consultant said, 'You may find that you pass a little bit of blood in your urine.' In fact it isn't blood in your urine which is the most significant thing it is the fact that when you have a sexual experience and you ejaculate it is a bit like the film 'The Alien' if you're not expecting it. What happens is that you ejaculate what looks like very florescent strawberry jam. And I actually, according to my wife, was traumatised by this and subsequently suffered elements of post traumatic stress for several weeks. 

And it was very, very difficult and it was very, very difficult because, mainly because I wasn't prepared for it. If I'd been prepared for it I could have dealt with it, I would've expected it and I could've dealt with it but it mean that we didn't have full sex for about 6, 8 weeks, it meant that I was wearing a condom which I hadn't worn since I was in my early twenties and basically I had a very, very difficult time which was quite shocking for me because I'm a very forthright confident person in my life, I'm a very, or always had been very confident in terms of my sexuality and I had some difficulty with that for some weeks and months after that and the whole thing seems rather bizarre to me because basically I went for a PSA because of my symptoms which were to do with restriction of urine flow. 

Right the two things that I feel now with the wisdom of hindsight. One, I would never have nagged my husband [laughs] to go for a PSA test, and I think that everything that happened after the PSA test had a slight air of panic and hysteria to it and so that I, I regret that, I regret that I was part of that. I didn't appreciate how very hit and miss the PSA test was, so that's the first thing. And the second thing to me was, and may be this is even more important is that it seems such a sin of omission on the part of the consultant, on any medical person, not to explain to a lay person what happens to you when you have 22 biopsies to your prostate and that you do ejaculate blood. And for a lay person, especially for a man I think who's not used to bleeding, it had an incredible effect on my husband and, and it subsequently obviously had an effect on me because I love him very much and it took us about 18 months to get over that [coughs]. So I feel why on earth didn't someone say something so simple as 'put a condom on', so the first time you ejaculate you are containing the drama as it were and also preparing. And so for me as the wife, I've been dealing with trauma, I've been dealing with my husband being sexually traumatised and so that I've had, a lot of; my regret is about is that; and I'm really glad about, I suppose about my job I'm a psychosexual therapist and I felt quite confident about us having a very good sexual relationship and being able to play my part in reassuring him but we should never have been put in that position. So that's really what I want to say that if there are any medical people that are going to watch this, think, can you please think of what consequences are to people in their sexual relationships and, and the negative ripples that it sent out for us for months and months.
 

We were talking about the biopsy again, and you mentioned...

Yes.

...one other worry you had?

Yes.

Can you talk about that a bit?

Yes. It only occurred at the time I got the results from the biopsy, when having been expecting it to be benign, it, it turned out to be positive. And my wife and I had made love a couple of times during the interval between having the biopsy and the results. And it suddenly occurred to me after leaving the doctor who told me about this that I might in some way have contaminated my poor wife with semen which was, it had cancer cells involved. And so fortunately I was able to phone my GP, and spoke to his wife, who was also a doctor. And she put my mind at rest, because she said it could not contaminate a woman in any way, prostate cancer cells. Which was a great relief.