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Before I get the second biopsy in May, I need to get an MRI of the area to help better direct the samples for the next biopsy. This is new for me, but not a huge deal. The biggest issue I've heard of people getting an MRI is getting claustrophobic in the tube. And while I can get that way, due to the fact that I'm getting my nether regions scanned, my head never went into the machine. The results were as expected. It showed where the cancer was on the prostate. This would help guide the next biopsy and get a better idea of how much cancer I have and how aggressive it is.

A few weeks later, I do a bowel cleanse the day before the biopsy. This is similar to the preparation for a colonoscopy, which I have had before. Like the first biopsy, I'm prescribed an antibiotic starting the day before the procedure through the day after.

Unlike the traditional biopsy which was done in the urology clinic, this procedure was done at a hospital. I am sedated for the procedure and leave a couple of hours later with a bandage on my perineum and sent home the same day. While the procedure itself was easier since I was sedated, the recovery was different. One of the definite differences was as the site was healing it, along with my butt, itched for about 2 weeks. I wasn't expecting this, but from Internet searches, it's normal and the usual treatment is petroleum jelly (like Vaseline) on the affected areas. That helped, but it was still really annoying. The rest of the healing process was similar with blood in the urine and semen, the latter lasted for about a month.

Also, like the last time, I got the biopsy results several days before my appointment to review them. Again, it was 13 samples. This time, though the results were quite different:

So, that's not good but I'm not sure how bad it is. On the one hand, there are definitely more samples that are cancerous or pre-cancerous, however it's reasonable to expect that since this biopsy was concentrated on a known area. I see this going one of two ways: either we continue active surveillance or surgery. For some reason, I'm thinking it's going to be active surveillance but I realize it might not be that. Internet searches are good for giving you basic information, but what I lacked was the real-world application of the information. But that's why I have this appointment.

Appointment day comes and my doctor comes in and the first thing she does is make sure that I have her business card in case I need to contact her. Ok, I'm a bit suspicious. Next she asks if I've ever had abdominal surgery before. I haven't, of course, but I now see where this is going. She wants to cut out my prostate. My heart sank a bit. I knew this was a possibility, but I had convinced myself that it was the less likely of the outcomes. She explains that if I do have the option of radiation and that she can set up an appointment for me to speak with those folks if that's what I want, but that I'm just over the line of taking action vs surveillance and she believes that surgery is the best option at this point. It's not urgent, but she suggests getting it done in the next few months. She tells me that if we do this there is a high probability that I will be cured, although we'll still have to do some follow-ups to be sure. She cited a study showing that 70% of patients who get the surgery are still cancer free 10 years later.

Now the flip side: surgery is not without its own consequences. There is a reason we started with active surveillance. Because of swelling, I will have a urinary catheter for about a week. As a result, after that is removed, I will have little bladder control until it heals up from being forced open for a week so I will initially wear adult diapers, eventually going to pads before, usually, going to nothing. Much like women who have had babies, it could be common to pee a little with a big laugh or something similar. Regular Kegal excercises are suggested to help strengthen the muscles to better control urination. I have a new appreciation for the ladies and what they have to do. Then there is the sexual side. It is very common to have erectile dysfunction for the first 18-24 months after surgery, perhaps longer. She has a “penile rehabilitation” program involving drugs (cialis), devices to try to increase blood flow and, if needed, injections that can cause erections as needed. As a married man who is only 52 years old, this matters to me quite a bit. One thing in my corner is that my urologist had a fellowship in robotic assisted surgeries for the purpose of minimizing nerve damage. So, to a laymen like myself, it sounds like she knows how to do this as well as anyone. She wants me to start the cialis two weeks before the surgery to try to get the blood flowing as well as possible at the time of surgery. Of course, a vasectomy is typically done as well since post surgery, I can't generate semen as that's the primary job of the prostate. In my case, I had one years ago, but I wanted to include this for completeness. I will likely spend one night in the hospital then be sent home with several post-surgery follow-ups (I have 4 of them currently scheduled, between September and December of 2023). After a very good explanation, she answered all my questions and told me that her scheduler would call to set up a date. I left with a 20+ page paper on the procedure and the recovery process. It doesn't look fun, but doable.

About a week later, I get the call from the scheduler. We settle on September 8. I have some trips I'd like to take this summer and that's well within the time frame she gave me. This way I'll have the surgery on a Friday and, as I usually work from home, I should be able to start working again on Monday. My job does involve a good amount of travel, but I informed my manager and team that I'd need to be home for the week after the surgery (at least until I can get catheter out).

For someone who hasn't had much in the way of health issues, this is a lot of absorb and process. It was around this time that I came up with the idea of this blog. It's a way for me to process things and, hopefully in doing so, I can help other men going through this as well.

One more point, and this is specific to the US medical system. As I mentioned earlier, I will be on cialis for erectile dysfunction daily for quite a while. Most medical insurance in the US do not cover this drug (including mine) so it can be potentially expensive. However, there is a service called GoodRx that can help find it at an affordable rate. By shopping around on that site I was able to get a 90-day supply for about $15. But it's worth shopping around because the prices can vary a lot, some as high as several hundred dollars for the same prescription. I had to drive about 30 minutes to this particular pharmacy, but the savings was well worth it. So for other men going through this in the US, take the time to find a good price.

NB: At this point, my blogging has caught up to the current point in my journey. This means that new entries will be as they happen so they may be a bit more irregular. But as new developments happen, I will update them here. In the mean time, feel free to reach out with any questions or comments as this is one of the reasons why I'm doing this.

Please note: This blog is based on one man's experience and is for educational and support purposes only. Nothing in this blog should be considered medical advise. Always consult a physician to properly evaluate your particular health issues.