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[SEX] [TMI] Caution: What follows deals with subjects that may make some people uncomfortable. Various body parts and their function are discussed in plain language.
If your urologist has reason to suspect that you have prostate cancer, probably based on the results of a digital rectal exam in which he felt a lump in your prostate or based on an elevated Prostate Specific Antibodies blood test (PSA), he may recommend a biopsy. Medically, it's a pretty good test. It provides useful information, is fairly simple, and if your doctor says you should get a biopsy then you should man up and get it done. The procedure is approximately as uncomfortable as having a tooth filled at the dentist -- it's a bit worse than having your teeth cleaned but not nearly as uncomfortable as having a tooth extracted or being fitted for a crown.
Here's what to expect based on my experience:
Before you go in your doctor will give you a prescription for an antibiotic which you are to start the day before the procedure and continue taking for several days after. He will also probably prescribe an over-the-counter enema to be self-administered right before you go in. He may prescribe a second, antiseptic enema as well. If he does you'll have to pick that one up from your pharmacist. I have had three biopsies over the course of a couple of years and only for the third biopsy did Dr. Cavernosa call for the second enema. I don't know if that is because it is a new thing that he has added to his routine, or because he had decided to take a lot more samples the third time and wanted to ensure that the extra punctures didn't raise the risk of infection. In any event, the over-the-counter (Fleet) enemas are no big deal but the antiseptic (Betadine) enema, although tiny, gave me cramps that lasted for twenty minutes after it was expelled.
Your doctor may also prescribe a sedative (often Valium) to keep you calm during the procedure. The best time to take it is in the waiting room after you check in. If your doctor prescribes the sedative you will have to have someone come with you to drive you home after the procedure. If he offers the Valium as an option my advice is to take it, and if he doesn't offer the option you might inquire. I had my first biopsy without Valium and the next two with it. My experience with the procedure is that it is not so much painful as extremely annoying and that any pharmaceutical detachment I can get is all to the good.
When you are called back they will take you to a room with an examining table and some equipment on a cart. They will tell you to remove your pants and sit on the table. They will give you something to drape over your legs while you wait for the doctor. While you wait you can look at the machine. Depending on whether or not you have taken the Valium it will be interesting or it will make you nervous. Here's what you will be looking at and what it does:
The machine is a "prostate ultrasound system." It has dials and buttons and a small screen like a television. It will have a cable coming out the front that runs to a device shaped a bit like a sexual novelty item with a reassuringly non-anatomical design. That dildo-looking thing is an ultrasound transducer. It sends out a fan-shaped burst of sound waves that bounce off parts of your prostate and are reflected back to the transducer to produce a black and white image that shows, basically, a slice through your prostate. By moving the probe back and forth your doctor can see the whole organ. He will look for abnormalities and will also use the image to aim the small metal tube that runs along the side of the probe where he wants it. Through that tube he can insert a needle to inject Novocaine (which he will probably do first) or a device called a biopsy gun which is spring loaded to shoot a hollow needle out the end and then pull it back quickly taking a small amount of tissue with it.
When the doctor come in he will have you lay on your left side facing away from him and pull your knees up slightly towards your chest so he can get at your butt. He will smear a bit of KY Jelly on your anus and poke the probe up your behind. By this time you are probably used to his finger but the probe is a bit bigger and more uncomfortable, especially as he grinds it around looking at the various parts of your prostate with the ultrasound. There is a bit of a metal-on-metal sliding sound when he threads the syringe through the tube so he can inject the Novocaine. The stick doesn't feel sharp, it's more of a sudden ache. Then it's gone.
The actual biopsies are more annoying than painful, although the do hurt a bit, especially when the doctor is taking samples of the apex of the prostate gland -- the part farthest from your bladder and closest to Mr. Happy. Also, the biopsy gun makes a noise like a mousetrap going off. My best analogy for the sensation, if you've never had a prostate biopsy, would be to lay on your back with your legs spread and have your wife push your balls aside so she can stretch a stout rubber band tight across the base of your penis just behind your scrotum. Then over the course of the next fifteen minutes she should snap the rubber band without warning, six to fifteen times at random intervals, being sure to pull it back far enough so the noise alone would make you jump. Something like that. Then try it again with the Valium. You'll see the difference.
When the doctor is finished he will let you sit up and hand you a box of tissues to wipe the goo off of your butt. Don't be surprised if the tissue comes away bloody. That threw me a bit the first time. I'm sure Ethel would have found the experience familiar -- a once a month event -- but for me it was new and unnerving.
If you are observant after the procedure you may notice some bits of absorbent material lined up on a tray beside the machine. On each one is a small smear of blood and something that looks like a grain of rice. Those are the biopsy samples the doctor took. They will be packaged up, labeled, and shipped off to a pathologist who will stain them, slice them up and look at them with a microscope to see there is any cancer. It will take about ten days to get the results back.
Those can be a very nervous ten days, waiting to find out if you have cancer. After my first biopsy I made it three days before I called my regular doctor to get something to calm me down a bit. Xanex works well for that if you need it and, often, just to know you have a pill or two in your pocket that will help if you start to freak out is enough to calm you down and you don't have to take them.
The paperwork your doctor will give you will tell you to expect to see some blood in your stools, in your urine or in your semen following the procedure but that it should mostly be gone in a week. In my experience that is a bit optimistic. They are easily right about blood in the stools. There usually isn't much and it tends only affect your first bowel movement after the procedure. After that there is no blood in your stools... not exactly. We'll get back to that. As for blood in your urine, it will mostly be gone after a day or two for stand-up peeing. But, if you have some sit-down work to do at the same time, the pressure when you defecate will often force out a drop or two of blood from your prostate which will tend to drip out of your penis with your last bit of urine. So, no blood in your stools, technically, but there may be a bit of it in the toilet nonetheless.
As for blood in your semen, that's where I think they are just lying about the week. For the first four or five days your semen will be bright, vampire-movie blood red. Then it will darken to a chocolate syrup color for about a week. (If it stays red for more than a week you should probably tell your doctor.) Then, gradually over the course of five or six weeks, it will fade through cafe latte colors then tea-with-cream, and gradually back to normal. With me it is about two months before I feel sufficiently normal to resume the usual business of pestering Ethel.
I suppose, medically speaking, I could start earlier, but there are times when it's just hard for a boy to feel pretty.
