Philippine Medicine: Prostate Biopsy

I’ve had a couple semi-major medical procedures (both outpatient) in the past couple weeks. I’ll describe them here, since my experiences may be of assistance to others having the same procedures – especially if they are having them done here in the Philippines. To make them easier to find, I’ll post them separately, starting with the first of the two, a biopsy on my prostate.

I had the biopsy on Wednesday Sept 18. First the really important thing -- no cancer, I have fibroglandular hyperplasia with chronic prostatitis.

I’ve been aware of the hyperplasia (meaning my prostate is enlarged) for a year now. The effect of BPH (benign prostate hyperplasia) that most guys complain about is that it involves waking up during the night to pee and/or needing to pee often and urgently, and/or other things going wrong with the peeing function. My GP (Dr Mejia at Chong Hua Medical Arts) had put me on some medication to shrink the prostate, which worked in terms of gradually getting it back to about the size it should be, but without a lot of improvement in the symptoms. So in early September she sent me to a urologist, Dr Catipay (same building). He did a digital rectal exam (meaning he stuck a finger up my butt), and said my prostate had some rough spots on it – which could mean cancer, though it could also mean some kind of infection, such as prostatitis. Since my father had prostate cancer (and died from it) he thought a biopsy was in order.

In case you’re wondering, I have a very low PSA (1.8), but with two indicators pointing toward the possibility of cancer, I think it was a good call on his part.

So I had to go through a bunch of tests and get a clearance from a cardiologist and a hematologist to undergo the procedure. This took almost two weeks because I initially flunked the bleeding test (I kept bleeding longer than I should after a small cut in my arm). The hematologist said it was probably because I take ibuprofen regularly after workouts. This was new to me – I was aware that aspirin works as a blood-thinner, but didn’t know the same is true of ibuprofen. I had to re-take the test after laying off ibuprofen for a week, and then my blood behaved itself.

Anyway, I finally had a ‘trans-rectal ultrasound-guided needle biopsy’, which consisted of the doctor shoving a tube containing ultrasound equipment up my butt and using the ultrasound to guide him in shooting needles into my prostate to get samples. It’s exactly as much fun as it sounds like.

The process takes about twenty minutes or so. It hurts a bit, despite a local anesthetic, when the needles are shot into the prostate, but it’s nothing terrible. There was no pain afterward. Dr Catipay gave me a prescription for pain pills, and I took one shortly after getting home. I don’t know if I needed it, but I forgot to take the next one, which will tell you how badly I was hurting.

I was warned that there would be blood in my urine for a couple days, and there was; initially a good bit of it, but it gradually diminished. By Thursday afternoon, it was mostly gone. I was also warned there might be blood in my feces, but that seemed not to happen (I didn’t examine my poop closely, I assure you). I didn’t poop at all until Saturday – I had taken laxatives Tuesday night and pooped up a storm Wednesday morning before the surgery.

If you think that paragraph was gross and qualifies as Too Much Information, I strongly urge you to skip the next three entirely, because it gets much worse.

Shortly after I got home, I took a leak, which contained some blood, as expected. I sat around afterward and drank some tea while I read; I was feeling fine. About an hour later, I felt the need to pee again, so I went into the CR to do so. HERE COMES THE GROSS PART (FINAL WARNING): As I began to pee, I felt a large amount of liquid squirt out my butt. It felt somewhat like diarrhea would (although that is always accompanied by stomach pains of some sort). I looked down and saw that the stuff dripping off my legs was red, not brown, and there was a puddle of blood on the floor.

I felt a moment of panic, thinking that there was something seriously wrong. Except that I felt fine before it happened, and I still felt fine after. My guess (I forgot to ask the doctor when I saw him) is that blood from the biopsy had collected in my rectum and was released when my sphincter relaxed while I was peeing. Or something like that.

Anyway, I decided to wait and see. I cleaned myself and the floor, threw my shorts in the garbage, and returned to reading. The next few times I needed to pee, I did so sitting down as a precaution, but there was no repetition.

END OF EXTREME GROSSNESS: I apologize, but I included that bit because someone may have a similar experience, and I hope you will be reassured that it may not be a big deal, as it wasn’t for me.

So then I waited for the test results.

Allow me to rant a bit about Philippine inefficiency. As you might imagine, I was pretty nervous the week and a half that followed. According to the American Cancer Society website, the results of a prostate biopsy should be available (in most cases) in 1-3 days. Here they say 7-9 days (and it took nine). Some people think that Filipinos’ refusal to hurry about anything is charming. I don’t.

Overall, it was not a terrible experience – the doctors were competent and professional, the facilities were good, and other than the extremely slow work by the lab, I was pleased with everything. And, of course, very pleased with the results.