Urologists Take Note – The Real Truth About A Prostate Biopsy!

November 10, 2008

At first I thought I was just a “wimp.” At the urging of my family doctor I went to a urologist for a prostate check. She (my family doctor) said my PSA was a bit high for my age – 4.58 PSA and I was 47 years old.

Now let me state…I didn’t even know what a PSA was until she forced the test when I was having routine blood work done. Something I hated as I had a fear of needles.

The urologist did the “bend over boy” routine finding nothing with his “DRE” – Digital Rectal Exam. Now I have to be honest, that wasn’t the most exciting exam, but all in all it didn’t cause me any great pain. But, as the urologist said, “Better to be safe than sorry. Let’s schedule you for a biopsy.”

Now let me be frank…I had no clue what to expect other than what my doctor told me. He said there wouldistock_000002146611small be some minor discomfort but mostly I would be annoyed by the sound of the instrument when the sample was taken. “Other than that,” he commented, “most men don’t really feel much.” I do recall asking if there was pain, and again, my urologist stated, “Most men feel very little. Nothing to be concerned with.”

I have been interviewing men from all around the English speaking world who have been diagnosed with prostate cancer. With few exceptions everyone reports the same thing. The damn biopsy hurts! When they report this, I ask a follow up question: “Did you tell you doctor this?” Their response – “Well, no, I just took it like a man.”


In Dr. Sheldon Marks book, “Prostate and Cancer” he describes the biopsy as follows:

In a biopsy of the prostate, multiple tiny sliver-like ppeces of tissue are obtained for microscopic analysis to see if cancer is present. These pieces are obtained through a long but very thin needle, specially designed to open inside the prostate, take the sample and then close.

For most men, biopsies can be done as an outpatient office procedure without anesthesia and with usually only temporary discomfort. Now we can get a good representative sampling of the entire gland with minimal trauma to the gland.

He is right…it is done outpatient most of the time. Where I beg to differ is on the pain issue. Thus far, well over 70% of the men I have talked with have reported that their urologist misled them when it came to what to expect and the pain. All but two men interviewed would, in retrospect, have desired pain medication before the biopsy. One man reported that had he known it would have hurt as bad as it did…he would never had submitted to the test. (Although the test might have saved his life).

Several men stated that they felt that ALL UROLOGISTS should have a biopsy on their prostate so that they would know exactly what their patient was going through. In that way, the urologist might be willing to volunteer provide some local anesthesia to reduce the pain and trauma.

Urologists…do you get the picture. What is reported to you is inaccurate (men don’t want to admit to their pain) and it (the biopsy) freekin…hurts – SO GIVE US SOMETHING TO TAKE THE EDGE OFF.

WHAT ABOUT AFTER THE BIOPSY? For most men normal functions – exercise, work, activity will all resume as normal either the next day or day after that. Now, when I say normal functions…that also includes sex.

I’ve scoured the Internet and seldom do I see PRACTICAL ADVICE that men need to know – so here’s some. A few days after your biopsy you may engage in sexual activity. Be prepared! When you achieve orgasm your ejaculation will be bloody. Guys I don’t mean a trace of blood, but bright red bloody. And, gentlemen, if you are unprepared for that, it can cause alarm. That alarm may be to you and/or to your partner. Nothing can change the mood of an intimate evening of sexual play than to achieve an orgasm and find that you look like you just hemorrhaged.

GUYS… The biopsy is necessary so in no way take this entry as anything other than solid information. Have it done, and more than once if necessary. My personal advice is – request pain medication.

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Male Erections and Ejactulation Following Prostate Cancer Treatment – What’s the Real Deal?

November 6, 2008

chuck-web-photoI must admit it is a bit unusual when taking on the task of writing a book about a subject that – through personal experience – and now research – I have become a subject matter expert. I have to be honest and say up front, I never really wanted this knowledge – for that matter I didn’t want to find out that I was diagnosed with Prostate Cancer at age 47. But, everything happens for a reason…and I guess that mine role is to be open about the experiences and provide a reality check for men and their families.

Now…some three years later as a Prostate Cancer survivor, I am conducting interviews with men from all around the world about their experience with prostate cancer. My goal…to produce a book and perhaps CD or audio recordings that will explain the realities about Prostate Cancer – what options are available and what you can really expect when it comes to treatment and side effects.

Let me caution – I am not a doctor, not involved in the medical community and don’t represent any drug company that may be trying to persuade you or someone you love to seek a certain option. I am a professional speaker who, just by chance, found out he had prostate cancer.

So, the purpose of this blog is to provide up to date information to men and their partners about Prostate Cancer and the emotional issues that you may face. You may not want to hear what is written, but I promise that it will be practical, useful and accurate. That said…let’s talk about prostate cancer, erections and sex.

Before I began tonights blog I was on the phone with Richard S. – he gave me permission to use his name – although I can’t begin to imagine how many Richard S’s there are in the world. Sorry, I digressed! Anyway, Richard was diagnosed less than a year ago with Prostate Cancer and in May had his treatment of choice – HIFU (High Intensity Focused Ultrasound) a treatment I considered.

Like most of the men I’ve interviewed for this book (I am still conducting interviews if you would like to share your experience contact me), if nerve sparing techniques were used and the prostate cancer was localized, the ability to gain an erection was reasonable. The problem is very few will define for you want an “erection” is after surgery. Now I can hear some folks now saying – “What’s he talking about, I know what an erection is?”

FACT: Not that my research is complete, but thus far no one I’ve talked to has told me that the erection they achieved following treatment was as satisfying of substantial as before their treatment. I ask this question: “On a scale of 1 to 10 with 10 being an erection like you had when you were 17 years old, what number would you assign as erection strength before treatment?” Most men answer between 8 and 10. Then I ask the same question, but this time assign the number after treatment. The answer from Prostate Cancer survivors who have had nerve sparing treatments varies between 3 and 7. Rarely do I find any one who will suggest that they are able to achieve an erection like before.

REALITY CHECK: It is true, an erection can be achieved, but more than likely it will take more stimulation to achieve and maintain or it will take medication or pumps to enhance the erection effort. One does not have to have a #10 erection in order to achieve an orgasm or to achieve penetration during sexual intercourse. However, it is practical to say that while an erection may be possible, do not expect things to be the same – based on my research they generally are not.

SIDE NOTE: As most will tell you the ability to achieve an erection is as much psychological as it is physical. As a Prostate Cancer survivor, if you are stressed about sexual performance, you will find that stress, anxiety, and other emotional strains will hamper your ability to perform and hence challenge your healing. For that reason, I elected to use Hypnotherapy and it worked. If you have questions about that, feel free to contact me – I’ll be happy to share the details.

EJACULATION: Gentlemen – after surgical or, in some cases HIFU, treatment you will not have a ejaculation – you have an orgasm, butA latex condom with reservoir nothing generally comes out. Richard S. shared with me that no one told him nor did he find out this fact on the internet. I suppose I was luck as my Doctor prepared me for that fact. He said that orgasm was likely but that it would be a “dry orgasm.” I asked him what that meant…to which he replied nothing would come out. It would feel the same, but there would be no semen released.

Guys…prepare for this. Some men have reported that it was not an issue for them. Other men have shared that they have yet to get over the lack of an ejaculation. I understand that. Now I am quite confident that some will be less than happy with my next comment, but I have made a commitment to be frank and candid in the entries I write. For all our lives since we reached the age of sexual maturity, we have had a ejaculation when orgasm was achieved. Whether that orgasm was released internally (through sexual intercourse) or externally, it was released. Some have said that the release or ejaculation was like “marking one’s territory.” It is quite natural. The inability to continue to “mark the territory” is disconcerting to many and something to prepare for.

In other words guy – you won’t need one of these (unless you are using it for other purposes).

CAUTION: I have reported in other blog entries that some men experience the release of urine during sex. This may occur before or during orgasm. It seems, from my research, to be limited in scope – most men are not reporting this issue. But there are some of us, myself included, that have experienced this – and I am told from the Doctors that it is not that unusual. Interestingly enough, most women that I have interviewed were not put off by that – the issue with urine release was more a problem for the man. If this is a problem, one practical thing is to avoid heavy drinking immediately before sex and certainly empty one’s bladder before sex is practical.

As always…these entries are intended to stimulate discussion. Please feel free to comment as your comments will certainly help others.

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