Transrectal Biopsy Delights

Such a wonderfully descriptive phrase, transrectal biopsy. In my five year journey to my current PSA-out-of-bounds stage, I have learned some interesting things about transrectal biopsies of the prostate gland.

My consultant and specialist nurse discussed the possibility of a biopsy with me in the early stages when my PSA level was bouncing around in the 2’s (2 – 3 ng/ml), still within specification but higher than they’d have liked for a man of my tender years. [Ed: yeah, right!] They explained the procedure. One assumes the same position as is required for a DRE (Digital Rectal Exam) – bare your backside, lie side down on the physician’s couch and draw your knees up to your chest. Very elegant! Your backside thus correctly presented, instead of the now familiar gloved finger of the physician, a rather more impersonal ultrasound probe is then inserted through your anus into your rectum. The ultrasound probe enables the doctor to “see” your prostate on a monitor and to position the probe accurately for the taking of tissue samples using the same probe. It’s obvious when you think about it but worthy of note that the probe is inside one’s rectum but the prostate is hiding sneakily on the other side of the rectum wall. So, once correctly positioned, the probe’s needle must be fired through the rectum wall into the prostate to snag the required samples. All this rectum wall puncturing leads to the slim possibility of infection so prophylactic antibiotics are prescribed.

In my original discussions, eight tissue samples would have been taken, four on either side of the central line of the prostate. The procedure could probably best be described as uncomfortable, naturally enough. What I was very surprised to learn was that the medical folks actually expected to get about 30% false negatives; that is a third of the biopsy results finding no cancer would actually have missed cancer cells that were, in fact, present. This little gem was instrumental in my deciding against a biopsy during those early stages; there seemed little point going through that level of relative discomfort only to be left wondering if I was the 1 in 3. Monitoring my PSA level would be fine until readings dictated otherwise.

In April this year, that pesky PSA level had hit 5.1 ng/ml. As expected, the consultant suggested biopsy time had now arrived. I agreed. He shovelled me off to the specialist nurse to make the arrangements and explain the procedure once again. A couple of significant details had changed while we’d dallied for a couple of years on blood tests.

1. 14 samples would now be taken. It seems most European countries had been taking 16 samples so maybe peer pressure upgraded the UK procedure. Quite why we’ve now settled on 14 instead of 16, I know not but it’s an attempt to reduce the instances false negatives.
2. Local anaesthetic would now be administered before the needle was fired thru’ the rectum wall into the prostate. Patients had apparently reported that things were more comfortable with a local anaesthetic. Surprise, surprise! For this revelation, we need seven years of medical school?

Both sounded like excellent modifications to me.

My biopsy date duly arrived and I returned to the scene of my earlier ultrasound scans, the x-ray and radiology department. My biopsy doctor turned out to be a rather attractive lady. I assumed the position. Under more normal circumstances I would have been delighted by this lady’s taking an intimate interest in my prostate. Regrettably, I was not in a particularly good position fully to appreciate her attention. I was however, in a good position for her to stick the ultrasound probe up my backside.

I had originally, sadly incorrectly, thought that the probe might be armed with as many intercontinental ballistic needles, multiple warheads as it were, as were required to take all the samples in one fell swoop. Not so; the probe has but one warhead and takes 14 samples individually. Oh joy! The taking of each sample made quite a loud click and, despite any local anaesthetic, I felt a shockwave very slightly. Given the situation, I figured it wasn’t a good idea to flinch. Part way through the harvesting of my samples, Mr. Senior Radiologist, disturbingly called Dr. Savage (I kid you not), appeared before me and began chatting as though nothing were happening. Clearly this was a classic distraction tactic. I trust that you have painted an appropriately colourful mental picture. There is something decidedly surreal about nattering with another guy while an attractive young lady continues rummaging around inside your rectum playing with your prostate gland. Weird!

Eventually we were finished with tissue harvesting. Not only is there a very slight risk of infection, hence the antibiotics, but, with more new holes in your rectum wall than there are in a colander, there is a distinct chance of some bleeding. I was presented with something akin to a large sanitary towel to wear on my way home. So this is how the other half lives.

Time to await my biopsy results.