First Post — Not A Tech Post

In which we examine PSA levels, not Primary-Secondary-Arbiter Replica Sets

I’m Eric. I’m 62, live in Michigan, USA, and am a Consulting Engineer for MongoDB, Inc.

I always imagined my first Medium post would contain words of great wisdom about MongoDB, or at least databases. Tech, for sure. OK, maybe drones or playing bass trombone or some disaster with my Oculus Quest 2 headset.

Nope. Prostate health, and more importantly, prostate cancer. Because it’s important. Today it became more important to me because I underwent a prostate biopsy.

Wait, what?! Dude, No! Not what I came to Medium to read; I want interesting, topical, insightful things! Keep it light!

And for the love of all that is decent, Keep it to yourself [emphasis mine]…

If you feel like moving on to a less serious stop in your internet travels tonight, men, I understand wholeheartedly, but I also challenge you to stay for a bit longer if you are a man over 55 years of age. The rest of you can get back to reading about NFTs…

Because this post is more about taking care of ourselves and resisting urges to ignore or downplay the risks, often due to self-shame or lack of knowledge or “not having the time to deal with it”.

As a late Baby Boomer (“you kids get off my lawn NOW!”), I see my elders facing certain health challenges. One of these is prostate cancer in men. First some facts, courtesy of the America Cancer Society, before we move on to my story:

1. Other than skin cancer, prostate cancer is the most common cancer in American men
2. About 1 man in 8 will be diagnosed with prostate cancer during his lifetime, but it is rare in men under 40
3. Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 41 will die of prostate cancer.

No, I’m certainly not here to doom-and-gloom you, but I am hoping I’ve gotten your attention, fellow men-of-a-certain-age. Because this is serious stuff. The good news is that there are many things we men can do to lessen the risks.

If we listen. If we trust. If we let go of stigma. Of shame.

This stuff shouldn’t be whispered anymore. Not the condition, not the diagnostic tools that can be used to detect, not the treatments.

Five years ago, my physician remarked “oh, that’s a mighty big prostate!”. Oof. I mean, thanks. I mean… oh, who knows what I mean. So I had PSA my levels measured [method: simple blood test], and they were indeed elevated, but not excessively so. Fine. We’ll keep a watch on it.

Last fall, the numbers were to a level where just watching them wasn’t enough. A second test confirmed this. Next stop on the prostate crazy train: prostate biopsy [method: ultrasound probe up the rectum, 10–12 little ‘nips’ taken via attached cannula (super-needle), 15 minutes max].

At that point, I’m all:

Muppets who fear prostate biopsies

My five phases of reckoning with this impending procedure were (and your mileage may vary):

1. NOPE NOPE NOPE NOPE NOPE NOPE NOPE
2. I should research this!
3. No way in Hell I want to research this!
4. I’m not really digging what some male friends are saying about this (“I’d wished I’d been under a general anesthetic”, “Feels like little punches”, “NOPE NOPE NOPE NOPE NOPE NOPE NOPE”)
5. F*** it, just take the damned thing out

But guess what, guys? It ain’t that bad. At all. It ain’t a day at Disneyland (wait, I’m burned out on Disneyland — it ain’t a day on the Maui Coast), but it’s precisely because of the stigma / shame / lack of knowledge that caused me to really ratchet myself up over the past few weeks.

I slept for four hours last night, which I consider a miracle.

Nonetheless, this morning, before leaving for the appointment, I downed an antibiotic, gave myself an enema (to the “NOPE NOPE NOPE NOPE NOPE NOPE NOPE” crowd, I say that colonoscopy prep is 20X worse), and placed aside all mental images of massive robotic pincushions insinuating themselves in the general vicinity of my rear flank.

There was another antibiotic given by the nurse [method: intramuscular injection in the hip area]. Vitals taken, pants to ankles (somehow more immodest that removing them, IMHO), gown over shirt, into the room, lay on side. My urologist and two helpers are in the room, where our conversation steers toward talk of the NCAA Tournament. We’re all masked (because these days, we’re all masked). Some lube, a smear of lidocaine gel on Ye Olde Massive Glande, wait 60 secs, and I barely felt the needle sticks (no, really!). Then on to the Main Event.

The biopsy probe, though we were only somewhat formally introduced, still strikes me as a pretty cool little device. Finger-sized, it contains enough ultrasound transducers and other sensors to give my doctor a somewhat visual tour of Mount Prostatius, and guides him in deciding where to ‘sample’.

I’ll spare you the picture I was first considering adding to this post, so just trust me that it’s fascinating.

When he pulls a trigger of some sort, the spring-loaded cannula snaps forward, bites, and retracts in a flash, with sample. He chooses 10–12 sites (which went to 15 for me, because the first few ‘samples’ weren’t substantial enough for his liking — pffft!). Each ‘sample’ proceeded as follows:

1. (First couple only) “Now, don’t move!” (note: I was striving not to, but shaky legs made it a challenge)
2. “Ready?” “Biopsy!”
3. There is then a “snap” sound (think ‘Perseverance rover laser on Mars’ sound), accompanied by pressure somewhere down there. Over in 0.1 seconds.
4. My thought bubble now reads “Hey! That wasn’t bad at all! Oh, wait, not done yet…”
5. Rinse, repeat

Done in about 10 minutes.

Are there to be some after-effects? Sure. Are they especially bad or painful? Nope. How do I feel nine hours hence? Pretty darned normal, if I do say so myself.

I’ll get my results in a week. As somewhere between 70–80% of all biopsies return negative results, I’m not terribly concerned, especially because my doctor didn’t see anything particularly noteworthy, visually as well as on the ultrasound.

So, this was, to put it mildly, a revelation for me. Today wasn’t anywhere near as nasty as I had led myself to believe it would be. So, yay for that.

But, then, why did I put myself through all the work-up leading up to today? Why is this whispered about, when even discussed at all? I have some thoughts, and I’ll throw ’em out here:

Perception One: It’s Dirty Stuff

Yeah, we’re talking penises. Prostates. Rectums. Not dinner party-level chat for sure. On the other hand, this is not 1960. These are health and quality-of-life issues, not shameful secrets. These things happen to us, not because of who we are or (most likely) not because of something we did. Shame doesn’t belong here. Judgement doesn’t register. Plus, knowledge is power for the patient and their loved ones.

And I do get it, gents. Objects in the rectum are usually frowned upon. Biting, snapping probes even more so. It isn’t on guys’ Bucket Lists. It was never on mine.

And, yes, it’s sex stuff. Loss or impairment of the prostate means perceived loss or impairment of one’s sex life. But not really, and not always. Plus, again, penises. Plus, the source of semen. So yeah, we don’t chat up someone next to us on the Uptown Bus about it. Unless they’re my urologist, and likely then only once he’s done with his stuff.

Perception Two: It’s Painful and Scary

Well, kids, it’s scary because:

1. It’s the unknown — true dat.
2. It’s inside us — also true, also unknown territory. And squishy and alive and blood-filled and the like.
3. And, yes, it’s dirty sex stuff — but please see above.
4. But worst of all, ouch, right? — yeah, no. Not so much, really. There is no whirling robotic porcupine of doom laying waste to our lower GI tract. It’s pretty darned civilized if you ask me. And, because U of M has made the Sweet 16, I didn’t really get a chance to fret on the table. Good times.
5. And, yes, of course, looming over all this is specter of cancer — buddy, I’m with you there. But things like these can keep that specter at bay; denial doesn’t, and it never, ever will.

Perception Three: Doctors and Their Tests Can Be Wrong

Sure, they can be. So can I in my job. So can you. Not because we’re quacks or slackers. Not because the underlying science is quackery (or slackery?).

It’s because everything in this universe is inherently imperfect. The human body, the practice of medicine, as well as the practitioners of medicine. PSA tests are imperfect. Cancer treatments are imperfect. My prostate is imperfect. Interestingly enough, Cancer might be the least imperfect member of our cast in this little drama.

But our society is striving to make things better. And we can strive to do the right thing and throw off the shackles of shame and lack of information.

Some are unwilling to take on such additional knowledge of their bodies, and that is fully their right. For me, I wish to know. I want to fight something like this if need be. I know my loved ones want me to.

So think about it. Just think about it. And know that it’s just a little outpatient medical procedure that involves a dozen snaps and a ‘was that it?’ at the end.

Good health to you all.

References with links:

• “Key statistics about prostate cancer” [American Cancer Society]
• “Men, It’s Time for Real Talk about Prostate Health” [United States CDC]
• “We’ll Say It So You Don’t Have To: PROSTATE CANCER IS NOTHING TO BE ASHAMED OF!” [Prostate Cancer Foundation]
• “Prostate cancer screening: Should you get a PSA test?” [The Mayo Clinic]