My Prostate Biopsy Horror

It was supposed to be a routine test, but it nearly cost me my life. I am a healthy, 45-year-old male and a former competitive swimmer who exercises regularly. But there is a history of prostate cancer in my family. At 74, my great uncle died of complications related to it. My father succumbed to it at 81, and a cousin was diagnosed at 47.

When my father's prostate cancer metastasized six years ago, I decided to undergo regular prostate exams. For the past six years I have routinely had digital rectal examinations (DREs) and PSA tests.

PSA stands for "prostate specific antigen", a blood protein. PSA is measured in nanograms (a billionth of a gram) per milliliters (ng/mL). I also had a sonogram, in which a tube is inserted a few inches up the anus, producing sound waves that are bounced off the prostate. The sound waves form a picture on a screen, which is then examined.

My DREs and sonograms have always been normal, but my PSA has ranged from a low of 2.3 ng/mL to a high of 3.4 ng/mL. According to an article in WebMD (http://www.webmd.com/content/article/45/1688_50828.htm), a reading of less than 4.0 was traditionally considered normal, but that was recently revised downward to 2.5 for men under 50.

According to the National Prostate Cancer Coalition, about 25 percent of men with a PSA of between 4.0 and 10.0 have prostate cancer. Approximately 67 percent of men with a PSA above 10.0 have the disease.

Because my last reading was 3.0, my urologist wanted to schedule a prostate biopsy. I wanted additional opinions.

Through a college friend of mine, Anthony, who is an M.D. instructor at a major hospital, I consulted several more physicians. The consensus was, that to be absolutely certain I was cancer free, I should have the biopsy.

I then got a referral from my internist to a board certified urologist with over 30 years' experience. He had an office ten minutes from my home. I made an appointment the next day.

After putting me through a battery of tests, including measurement of urinary flow and sonogram, all of which were normal, this new urologist echoed the view that, in order to be sure that I had no lurking illness, I should have the biopsy. I agreed.

Prior to the biopsy, I was told that there were risks, the most significant of which was infection. However, the doctor explained that the risk of infection is negligible if antibiotics are taken before and after the procedure.

He gave me a shot of Cipro and a six-day supply of tablets to take home. I also had to sign a consent form indicating numerous possible complications: fever, urine infection, retention, and bleeding. A good overview of the risks and benefits of a prostate biopsy can be found at http://www.webmd.com/hw/mens_conditions/hw5468.asp.

A prostate biopsy involves administration of an anesthetic, after which a long needle is inserted into the anus six times to get microscopic tissue samples of the prostate. I felt a dull poke, followed by a clicking sound, each time the device was withdrawn. It was all over in a couple of minutes.

The nurse told me that there is almost always some rectal bleeding, and that I shouldn't worry about it. So when I saw the first bowlful of red, I ignored it. My casualness almost cost me my life.

After dinner, one red sea after another began appearing in the toilet. I began to think something was very wrong. I was told that there would be "some bleeding", but not of biblical proportions.

I thought I could sleep it off, but the bathroom trips continued. Around midnight, I was returning to bed in the darkness, when I saw a rainbow cloud. I awoke horizontal. For the first time in my life, I had fainted.

Panic-stricken, I jumped up, ran to the phone, and dialed 911. After explaining the situation to the ambulance dispatcher, I propped open my front door and lay down on my bed, waiting for paramedics to arrive.

The paramedics were a man-woman team consisting of a ruggedly handsome, blue-eyed fellow of about thirty-five, and a slim, leggy brunette in her late 20s. I told them what my usual vital signs were, and, after taking my blood pressure and pulse, the male para told me that I was within normal range. With oxygen going up my nose, I began to feel better.

But that feeling was short-lived. When I was wheeled into the emergency room, I again became disoriented.

I was transferred to a hospital stretcher and was parked in the ER's intensive care area. A stocky black male nurse couldn't understand why my vital signs were falling. I looked at the monitor and noticed that my systolic blood pressure, which is usually about 110, was down to 79. My body began shaking, and my teeth started chattering. I could only speak in short phrases.

I told a slim, bespectacled female nurse with salt-and-pepper hair, "If I need… transfusion…my blood type…O positive."

The male nurse returned. "Don't worry. You're going to be all right," he reassured.

The paramedics had started an I.V. of saline solution. The nurse added epinephrine. I started to warm up, and my systolic reading rose to 125. A young physician inserted a hard pressure bandage up my rectum to stanch the blood flow. It hurt like hell for about three seconds and then became a dull discomfort.

Soon I was moved to an observation area, where I stayed until morning. I didn't sleep a wink because there is always someone screaming in an emergency room. When that person leaves, another yeller moves right in.

A nasal cannula pumping oxygen up my nose began to itch, causing me to take it off and repeatedly sneeze. Actually I didn't need it. My lungs were as good as ever.

Although I wasn't eating or drinking, the water being pumped into my veins gave me a strong urge to urinate. I asked for a plastic bottle.

My urine was tinged with blood. This is a harmless side effect of prostate biopsy, but the thought of bleeding from both ends made me nervous.

Around 7 a.m. I was offered breakfast, but fearing increased rectal bleeding, I only drank milk and orange juice, which quickly prompted me to ask for the pressure bandage to be removed so I could defecate. I grabbed a bedpan and produced a dark, bloody stool. The attending physician applied another bandage.

By mid-morning I was transferred to a semi-private room. I finally dozed off.

The doctors said I could not eat or drink. I continued to receive saline, dextrose, and antibiotics intravenously. I had lost between two and three pints of blood.

Massive rectal bleeding is a known complication of prostate biopsy. It affects one in a hundred patients. I had the misfortune to be among the one percent.

After borrowing a cell phone from a nurse, I called my Uncle Jerry and Anthony, who called others. Soon I was speaking with multiple well-wishers. Several cousins visited. I was no longer cut off from the world.

I was having doubts about ever getting out of the hospital. Initially I was supposed to stay overnight. Then I was scheduled to stay two more days. First I was scheduled for one procedure, then two.

I received visits from a dizzying array of medical personnel. One told me that if the bleeding did not stop, I would need surgery.

I was poked and prodded with multiple IV's. For two days I was not allowed out of bed. Leg warmers were attached to my calves to maintain circulation in the lower legs. I had seen my father in this condition during his final days, and the similarity was very much on my mind.

My spirits were low, and I made a brief farewell speech over the phone to my college friend. "You'll be fine," Anthony comforted.

Light headed from blood loss, I was wheeled into a GI clinic for bowel irrigation, a distressing process in which my lower digestive tract was suctioned and flooded with water to remove any stagnant blood. Numerous dark clumps began appearing in a device that resembled a small water jug. The doctor performing the irrigation said that this would reduce my discomfort. He applied a lighter pressure bandage that would come out the next time I went to the bathroom.

But I wouldn't have a bowel movement for some time because I was only now being allowed liquids. This was quite frustrating since I hadn't eaten for two days. Still, the worst was over.

Around 3 a.m. the next morning, I was woken by a senior resident who announced that he had come to do a rectal examination. My blood count, ordinarily 15-plus, had fallen to 10 at admission, increased to 11 over the next 24 hours, and had now plummeted to 9. The doctors were concerned about new bleeding.

I was astonished. At this point, I felt stronger than I had since my mishap. Color was returning to my palms, which had been chalk white. Mercifully, when the resident saw that I had a pressure bandage, he agreed to spare me additional pain. I would still have blood tests every four hours to make sure that I wasn't losing any more corpuscles.

By the third day, I was able to move around with IV's in tow, eliminating the need for leggings. I reluctantly consented to a colonoscopy to ensure that I wasn't bleeding anywhere else. I hesitated because I was in the hospital because of another invasive procedure, the biopsy. But unlike a biopsy, which involves poking holes in the prostate, in a colonoscopy, a tube is simply inserted several feet into the large intestine for examination.

The night before the colonoscopy, I was moved to a six-bed facility. I had to drink a one-gallon-plus saline solution to clear the contents of my bowels. It had to be imbibed slowly to avoid nausea and vomiting. After numerous trips to the bathroom, I finished the moonshine at 3 a.m.

I counted my blessings. Everyone in my room was much sicker than me. Mr. Yee, a retired Chinese cook, had prostate cancer. James, a strapping six-foot African American in his mid-30s, had just had a kidney removed. Another patient had a leg amputated; a fourth looked like he had just been released from Dachau.

The colonoscopy took about 15 minutes. The procedure was uneventful, except for one moment when I felt a sudden tightening in my abdomen and moaned, prompting a heavier dose of painkiller, which left me placid until the tube was removed.

Back in the ward, I got the best possible news. Not only was the colonoscopy negative, but so was the biopsy. At long last, I had gotten the peace of mind that I had sought.

Never again will I take health for granted. With it, you can do wondrous things; without it, your world is very limited.