The Prostate Biopsy That Missed My Cancer

Due to continued rising PSA levels, my urologist recommended a prostate biopsy. I’ll never forget the solemn tone in his voice and the serious look in his eyes. My heart started to pound, and the hair on the back of my neck stood up.

Hoping to avoid a biopsy

I had read about this procedure and was hoping to avoid it. The doctor may recommend a prostate biopsy if they feel lumps or other abnormalities during a digital rectal examination. Or, as in my case, PSA continues to rise without explanation.

A prostate biopsy is the only way to confirm prostate cancer. The doctor will insert an ultrasound probe and a biopsy gun with a spring-driven hollow needle into my rectum. Once fired, the needle pierces the rectal wall to retrieve tissue samples from the prostate.

A pathologist will examine the tissue under a microscope to determine cell abnormalities. If cancer is present, the pathologist will assign a Gleason score that indicates cancer growth rate and likelihood to spread. The lower the score, the better.

Worried about the results

My urologist warned that the procedure has a few potential risks. These included bleeding at the biopsy site, blood in semen, blood in urine, difficulty urinating, and infection.

As a precautionary measure, he prescribed a three-day supply of antibiotics. They were for the day before, the day of, and the day after. Therefore, I was quite concerned. Not about the prostate biopsy itself, but of the possible results.

A few months later, it was time for the appointment at the hospital. I found myself wearing a gown, walking down a long hallway, escorted by a nurse to the biopsy room. At the time, I didn’t realize the prostate biopsy was going to be random or blind. Meaning, the doctor would take tissue samples from areas in the prostate where cancer is most likely to be found.

As a patient, we learn as we go, and sometimes we learn after the fact. In this case, I was also blind, walking into a procedure that I didn’t fully understand.

How the procedure went

The nurse asked me to hop onto the table and lie on my left side in the fetal position. A few moments later, a doctor entered. He introduced himself and explained the procedure. He warned me to expect a loud bang when he pulls the trigger and not to worry.

Despite the warning, I still jumped at the loud noise! The doctor continued to reposition and fire the biopsy gun several times.

Overall, the prostate biopsy was not too painful. But it took several days to recover. About a week later, the urologist confirmed the biopsy was negative. I jumped for joy, hearing the news and assumed I was clear of cancer. As a precaution, my doctor recommended continuing with regular PSA testing.

More needles and bangs

Over the years, my PSA continued to rise without explanation. Even several DREs by different doctors reported everything to be smooth and normal. However, I did have an enlarged prostate, but it was considered typical as men age.

Since I had a previous negative prostate biopsy, my doctor recommended an MRI. The doctor explained that an MRI produces three-dimensional imaging of the prostate. The idea is to identify any abnormalities to target in another prostate biopsy. Just what I wanted to hear, more needles and loud bangs.

Bad news

The MRI was a cakewalk compared to the prostate biopsy. However, the results were not good. It identified a significant anomaly and suspicious of high-grade cancer, found in an area that was out of reach of the DRE.

Once again, I found myself in a gown at the hospital, escorted by a nurse to the biopsy room. However, this time, it was reassuring to know that the doctor wasn’t shooting needles blindly into my prostate.

The missed tumor

The pathology report confirmed prostate cancer with a Gleason score of 4+3=7. The tumor was the size of about two golf balls. And more importantly, my cancer was in the final stage before breaching the prostate.

I couldn’t help but think that the previous blind biopsy missed the tumor. Until now, it continued to grow undetected.

I’m grateful my doctor recommended to continue with regular PSA testing. Without the PSA test, I would not have had an MRI targeted biopsy that confirmed cancer. However, I could have done without the blind biopsy.

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