Since 2003, Paul has been an inpatient five times at hospitals in Thailand. All of his stays have been at international hospitals.
Prostate Gland Problems
A History of Prostate Gland Problems
Since January 1999, I have been afflicted with prostate gland problems. After a routine blood test ordered by a family doctor indicated an elevated prostate-specific antigen (PSA) reading, I started seeing urologists in 1999. While under their care, I had my first prostate biopsy performed in Maryland in July 2000 and a second in Thailand in December 2003. Following a diagnosis of an enlarged prostate or BPH, I have been advised since the first biopsy to have regular PSA testing and if necessary, additional biopsies.
The prostate-specific antigen (PSA) is a protein produced by normal as well as malignant cells of the prostate gland. A normal PSA reading is 4.0 or lower. If the reading is above 4, there is an indication that the prostate may have malignant cells.
After the second prostate biopsy, I have had periodic PSA tests through the present. Since 2015, however, my urologist in Thailand has prescribed a drug for me to take to shrink the prostate. Its growth and condition have been monitored through semi-annual ultrasounds and PSA readings.
In this article, after first stating the function of the male prostate gland and describing BPH, I discuss the need for biopsies. Then, based on personal experiences, I relate to what to expect after a prostate biopsy.
The Prostate Gland and Its Function
According to urologyhealth.org, the prostate gland belongs to the male reproductive system. Being the size of a walnut, it weighs approximately one ounce. The prostate is found below the bladder and in front of the rectum. You will also find the prostate going completely around the urethra which carries urine from the bladder out through the penis.
The primary function of the prostate is to make fluid for semen. At the time of ejaculation, sperm made in the testicles moves to the urethra. Concurrently, fluid from the prostate and seminal vesicles also moves into the urethra. This semen mixture passes through the urethra and out of the penis at the time of orgasm.
What Is Benign Prostatic Hyperplasia (BPH)?
In January 1999, a urologist in Maryland diagnosed me having BPH or Benign Prostatic Hyperplasia. This diagnosis was based on a digital rectal exam and the results of a prostate biopsy.
Based on an article in urologyhealth.org, BPH is an enlarged prostate. As men age, BPH often happens during the second growth state of the prostate which starts at about age 25. The first growth stage occurs early in puberty.
As the prostate gets bigger, it can squeeze down on the urethra. This narrowing of the urethra and accompanying urinary retention cause many of the problems related to BPH. Although BPH is benign, BPH and cancer can occur at the same time. About 50 percent of all men in their 50s have BPH. Over the age of 80, up to 90 percent of men suffer from BPH.
What Is a Prostate Biopsy and Why Is It Necessary?
According to an article from the Mayo Clinic, prostate biopsy tissue samples are usually collected by transrectal or transperineal means.
A transrectal biopsy is the most common way. In this procedure, a needle is passed through the wall of the rectum.
In a transperineal biopsy, a needle is inserted through the skin between the anus and the scrotum. After a small cut is made in the skin area between the anus and scrotum, a biopsy needle is inserted through the cut and into the prostate to get out a sample of tissue. An MRI or CT scan is usually used to guide this procedure.
Urologists generally advise a prostate biopsy when PSA readings over a length of time are high (above 4) and/or a digital rectal exam and ultrasound indicate abnormalities on the prostate. According to doctors, this is the only definite way to diagnose prostate cancer.
What to Expect During Transrectal Prostate Biopsy
In July of 2000, I underwent my first prostate biopsy. It was a transrectal biopsy conducted at my urologist's clinic in Maryland.
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Before the biopsy, it was necessary to have an enema so that my rectum was clean during the procedure. There were no other preparations in that I had to fast or discontinue taking certain medications.
After arriving at the clinic around mid-afternoon, I remember pulling down my pants and leaning over a high table. Following the cleaning of the anal area and the application of a gel, the urologist gently inserted a thin ultrasound probe into my rectum.
According to the Mayo Clinic, transrectal ultrasonography uses sound waves to produce images of the prostate. These images are used to identify the area that needs to be numbed with an injection to reduce biopsy discomfort. The ultrasound images are also used to guide the prostate needle into place.
After the biopsy device is situated, the doctor retrieves thin sections of tissue with a spring-propelled needle. I noticed sensations each time the urologist took a tissue from three or four places in my prostate. The whole biopsy procedure didn't take more than 10-15 minutes.
What to Expect After Transrectal Prostate Biopsy
I remember having no physical limitations after undergoing the biopsy.
While taking an antibiotic for a few days, I noticed the following.
- Blood in my urine for a few days
- A rust-colored tint of my semen
The rust-colored tint was caused by a little amount of blood in the semen. This condition lasted for about a month.
Some people feel slight soreness and have a little bleeding from the rectum. A few persons may have a fever, difficulty urinating, prolonged or heavy bleeding, and worsening pain. If this is the case, they should immediately see their doctor.
Fortunately, the pathology results indicated that I did not have prostate cancer.
What to Expect After Transperineal Prostate Biopsy
In December 2003, I had a transperineal prostate biopsy at an international hospital in Bangkok, Thailand. The biopsy was ordered by a Thai doctor who had received urology training in England. Because my PSA readings had been consistently high since July of 2000, Dr. Viroj decided to take tissue samples from 15-20 places around my prostate.
During the biopsy procedure, I was knocked out with anesthesia for about 90 minutes. When I came to inside the ICU of the hospital, I could not be discharged until after passing urine. When I finally passed urine, it was in spurts and there were blood clots in it. I foolishly made the mistake of signing the discharge papers and leaving the hospital with a friend who drove me home.
After returning to my apartment at around 8:30 p.m., the horror story began. I started to have extreme difficulty passing urine and most of it was clotted blood. Upon returning to the emergency room of the hospital where I had the biopsy, I was seen by a doctor, given medicine, and sent back home.
About an hour and a half later after being back in my apartment, I was in terrible pain because I could not urinate. When I returned to the emergency room, a catheter was inserted into my urethra and I was sent back home.
The catheter did not do much good because I noticed big clots of blood that could not pass through the tube. Since I was in agony not being able to empty my bladder, I returned to the emergency room for a third time at around 4:00 a.m. At this time, my urologist, Dr. Viroj, was notified. I remember staying in the emergency room until around 7:00 when the doctor arrived and I was finally admitted to the hospital.
Upon seeing Dr. Viroj, I learned that the biopsy had brought on excessive bleeding which happens in only about seven percent of patients. While in the hospital for two days and two nights, I was given medication intravenously to stop the bleeding and antibiotics for an infection. In the hospital, I also had occasional great pain trying to empty my bladder until the medication started to work. To me, this experience was worse than death.
The catheter was removed on the morning of the day I was discharged from the hospital. I had no further complications after leaving. As for the good news, the results of the biopsy indicated that I did not have prostate cancer.
Dealing With BPH Since 2003
Based on my experience of 2003, I will never again have a prostate biopsy. Since having my left cancerous kidney removed in April 2015, the condition of my prostate has been monitored by more PSA tests and semi-annual prostate sonograms. My new urologist has me on the drug Avodart containing dutasteride to help shrink the prostate and another, Harnal containing tamsulosin hydrochloride, which makes it easier for me to urinate during the night.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Questions & Answers
Question: My prostate biopsy had a reading of 3.9, and my urologist recommended 53 radiation treatments. Was this normal?
Answer: I can only answer this question as a layperson based on my personal experience. PSA readings in the range of 0-4 are considered normal if you are not taking any drug to shrink the size of your prostate. For many years I had PSA readings that were over four. My urologists scheduled me for two prostate biopsies but never recommended radiation treatments because the results of the biopsies showed that the prostate was benign and I had BPH. Has your urologist diagnosed you with prostate cancer? If he has, I can understand recommending the radiation treatments. If you don't have cancer, this doesn't seem normal to me. Please remember that I am not a urologist.
© 2017 Paul Richard Kuehn
Paul Richard Kuehn (author) from Udorn City, Thailand on December 29, 2019:
Thank you very much for your comments. I am fortunate that my second prostate biopsy did not kill me. There has to be a better way for early detection of prostate cancer.
Paul Richard Kuehn (author) from Udorn City, Thailand on November 14, 2019:
Thank you very much for this useful information. The biopsy was done at an international hospital in Bangkok Thailand by a Thai doctor educated in England. Yes, it was done 16 years ago and I should have considered other options before undergoing this blind biopsy.
Jim on November 14, 2019:
A 12 or 18 core blind biopsy, holey prostate! One million dangerous prostate blind biopsies are performed in the USA each year and they should be banned: Men with a high PSA tests result are often sent to a urologist for a blind biopsy. This technology is (obsolete) 30 years old. Would you use a cell phone or drive a car that was designed 30 years ago? Blind prostate biopsy cost in the USA is at least $3 billion annually. False positives and false negatives can occur. Men should be told about other options; Percent free PSA test, 4Kscore test, PCA3 test or a 3T MRI test before receiving a blind biopsy. These tests can often eliminate the need for a risky and invasive blind biopsy. Unfortunately, sometimes insurance companies may not pay for other tests. Insertion of 12 or 18 large hollow needles through the dirty rectum into a gland the size of a walnut, a blind biopsy can result in pain, infections, a risk of temporary or permanent erectile dysfunction [22,23]. Biopsies can cause, urinary problems, 6.9% hospitalization within 30 days from a complication, sometimes even death from sepsis (About 1.3 to 3.5 deaths per 1,000). There is also debate that a biopsy may spread cancer because of needle tracking. A blind biopsy is degrading and can also increase PSA reading for several weeks or months, further frightening men into unnecessary treatment. Blind biopsies are almost never performed on other organs. One prestigious hospital biopsy information pamphlet states: semen color has a rust tint. Another well-known hospital describes semen as: reddish or brown. These statements can be an extreme exaggeration (mostly lies). After a biopsy, a man's semen can turn into a jet black goo. This could be an unpleasant surprise for a man and especially for his unsuspecting partner. However, if a biopsy is performed before Halloween or April Fools’ day this may be of use to a few men. If some prestigious hospitals are not factual about the color of semen, what other facts are being misrepresented?
Paul Richard Kuehn (author) from Udorn City, Thailand on May 20, 2018:
Yes, I should have stayed in the hospital longer after the biopsy, especially when I noticed blood clots in my urine right after the procedure.
Peggy Woods from Houston, Texas on May 20, 2018:
So sorry you had those complications after your biopsy. It does indeed sound terrible. As you now know (hindsight is always 20/20) you should probably have stayed in the hospital longer after that biopsy. Thanks for sharing your experience. It may help others in the future who may need that procedure.
Paul Richard Kuehn (author) from Udorn City, Thailand on January 22, 2018:
No, Jim, I have not received your narrative yet. I am longing forward to reading it.