3. Biopsy and Ambience
On December 5th of 2017 Juli and I went to meet Dr Wang for another physical exam. It was with a certain amount of dread that we walked in together, hand in hand. No matter how we tried to explain the possibilities, there seemed to be no way around a PSA number of 26.1 that did not include a cancer diagnosis. Clues were spoken but cancer was never explicitly stated as the probable cause. Nobody wanted to say the word until the results of a biopsy made it a fact.
Without calling it what it is, one doctor said "I've seen some good outcomes even with a number this high." That certainly had an ominous opposite implication. With the DRE performed by the urologist came a quick and decisive opinion that there is a tumor on the prostate that felt like it had spread beyond the prostate. That would not be confirmed without further tests but the hope was that it was contained within the prostate itself.
The reason we hoped for containment is that prostate cancer limited to the prostate gland itself can be removed in its entirety along with the complete surgical removal of the prostate. The side effects are significant. Men who undergo a prostatectomy have several permanent challenges associated with this surgery, but generally speaking, the cancer is completely eliminated, the patient cured. Juli and I were preparing to embrace surgery, plan for a 6 week recovery period along with the long term process of living with its side effects.
Dr Wang scheduled a biopsy for the following week and the tension ramped up another level. On the day of the biopsy, Juli and I again walked hand in hand into the clinic, signed in and waited for me to be called back.
Once in the exam room it got a little awkward as the nurse and doctor prepared equipment and started what turned out to be a pretty uncomfortable process. Another DRE, and then an ultrasound probe was introduced to my anatomy to guide the punch biopsy tool and determine the tumor size and precise location. Then, right in the middle of it all the lights went out. Literally. After a few seconds, the lights came back on and the doctor said "What was that?" The nurse suspected (correctly as it turned out) that someone in the main part of the office had inadvertently doused all the lights in the entire office. Juli worried that it had effected my room as well but other than startling the doctor, progress continued. As he got back to work I suggested that the darkness had served to improve the ambience of the room. They laughed and perhaps felt less concern about how their patient might perceive the biopsy experience.
After retrieving 12 samples, I was left alone to dress and exit for a day of recovery, which itself was pretty uncomfortable, including nausea and the feeling that this doctor had not just built a Lego ship inside my colon, he'd actually built a fleet of them. (Might that explain the fleet enema prescription?)
Within a few short days, we were called back to discuss the results of the biopsy, replacing speculation with the fact that we were not only dealing with prostate cancer, but it had metastasized and was beyond the reach of surgical correction. Cure was no longer possible, containment and control were now the goal. It only remained to discover how far it had spread and what could be done about it.
With that in mind, Dr Wang scheduled a bone scan and a CT scan at the hospital and also began the referral process to send me to specialists at UC Davis in Sacramento.
The scans were scheduled for the day after Christmas.
I cannot leave this post without talking about my mother and my sister who were both lost in 2017. My mother passed away at the age of 96 in March. She had suffered from breast cancer in the last few years but died simply of old age, a long and full and beautiful life. My sister Darlene was diagnosed with Leiomyosarcoma during the Summer and was ravaged so quickly by the cancer that she was lost the week I was diagnosed. Her memorial service was in Portland the day after my biopsy. Someone always has it worse. I miss them both.
Without calling it what it is, one doctor said "I've seen some good outcomes even with a number this high." That certainly had an ominous opposite implication. With the DRE performed by the urologist came a quick and decisive opinion that there is a tumor on the prostate that felt like it had spread beyond the prostate. That would not be confirmed without further tests but the hope was that it was contained within the prostate itself.
The reason we hoped for containment is that prostate cancer limited to the prostate gland itself can be removed in its entirety along with the complete surgical removal of the prostate. The side effects are significant. Men who undergo a prostatectomy have several permanent challenges associated with this surgery, but generally speaking, the cancer is completely eliminated, the patient cured. Juli and I were preparing to embrace surgery, plan for a 6 week recovery period along with the long term process of living with its side effects.
Dr Wang scheduled a biopsy for the following week and the tension ramped up another level. On the day of the biopsy, Juli and I again walked hand in hand into the clinic, signed in and waited for me to be called back.
Once in the exam room it got a little awkward as the nurse and doctor prepared equipment and started what turned out to be a pretty uncomfortable process. Another DRE, and then an ultrasound probe was introduced to my anatomy to guide the punch biopsy tool and determine the tumor size and precise location. Then, right in the middle of it all the lights went out. Literally. After a few seconds, the lights came back on and the doctor said "What was that?" The nurse suspected (correctly as it turned out) that someone in the main part of the office had inadvertently doused all the lights in the entire office. Juli worried that it had effected my room as well but other than startling the doctor, progress continued. As he got back to work I suggested that the darkness had served to improve the ambience of the room. They laughed and perhaps felt less concern about how their patient might perceive the biopsy experience.
After retrieving 12 samples, I was left alone to dress and exit for a day of recovery, which itself was pretty uncomfortable, including nausea and the feeling that this doctor had not just built a Lego ship inside my colon, he'd actually built a fleet of them. (Might that explain the fleet enema prescription?)
Within a few short days, we were called back to discuss the results of the biopsy, replacing speculation with the fact that we were not only dealing with prostate cancer, but it had metastasized and was beyond the reach of surgical correction. Cure was no longer possible, containment and control were now the goal. It only remained to discover how far it had spread and what could be done about it.
With that in mind, Dr Wang scheduled a bone scan and a CT scan at the hospital and also began the referral process to send me to specialists at UC Davis in Sacramento.
The scans were scheduled for the day after Christmas.
I cannot leave this post without talking about my mother and my sister who were both lost in 2017. My mother passed away at the age of 96 in March. She had suffered from breast cancer in the last few years but died simply of old age, a long and full and beautiful life. My sister Darlene was diagnosed with Leiomyosarcoma during the Summer and was ravaged so quickly by the cancer that she was lost the week I was diagnosed. Her memorial service was in Portland the day after my biopsy. Someone always has it worse. I miss them both.
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