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Tales from a prostate biopsy

Absolutely necessary to diagnosing cancer, a prostate biopsy is not quite the cakewalk that some sources would have you believe.'s Mike Stuckey describes his experience.
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There is no delicate way to describe what is about to happen to me. Wearing only two thin hospital gowns and lying in a modified fetal position in a cramped room in downtown Seattle, I’m waiting for a doctor to grease up an ultrasound probe and stick it where the sun don’t shine. But wait, it gets better: One at a time, a dozen needles will be inserted alongside the probe and through the wall of my rectum to snatch bits of tissue from my troublesome man gland.

You can read a lot about the procedure that is technically known as a prostate biopsy in the many good books that have been written about fighting and treating prostate cancer. Most of them will tell you that it “doesn’t hurt much,” that it’s “not so bad.” 

But for me, “doesn’t hurt much” and “not so bad” are stunning failures at describing the awful cocktail of fear, anxiety and misery in which I find myself drowning on the day of my procedure.

The straw that stirs such a drink, of course, is the unknown.

It's April 25, 2006. In three days I will be diagnosed with prostate cancer. But I don't know that yet. Right now, I'm thinking about those needles.

Other than brief, clinical descriptions of the prostate biopsy, I have only this reflection from a fellow patient: “This is the worst you’ll have to go through, unless you like having needles stuck up your butt.” He’s a very nice man who only means well, but his dark synopsis rings in my ears on the afternoon drive to the medical center.

I arrive having begun the three-day course of antibiotics I was prescribed to ward off a potential infection that could be caused by all those needles passing through the poop chute and into vital blood-bearing tissue. Contrary to some of the reading I have done, I have been told not to bother with an enema. There were no restrictions on what I could eat or drink.

I am shown into a standard exam room by an efficient but very kind nurse who checks my vital signs and goes over a list of questions about my medical history. Concerned that I haven’t eaten for several hours, she fetches orange juice and crackers for me.

A reassuring primer
Then she explains everything that is going to happen from that point forward. Her calm, deliberate, two-minute speech drains away much of the fear that has been swirling faster and faster amid the mystery of what comes next. I thank her profusely.

The nurse leaves and I get naked. I put one gown on so it opens in the back and the other so it opens in the front. I crack the door to show that I am ready and am led to a bathroom to take a final leak. Then I am shown to the biopsy room with its instruments and monitors. The nurse helps me onto the table on my left side and has me draw my knees up toward my chest. She positions pillows for me, the last one between my legs. Finally, she gives me two little foam anatomical models of prostate glands to squeeze during the procedure.

“Good afternoon, Mr. Stuckey,” says the urologist with a little pat on my shoulder as he reviews a chart. “How are you feeling?” I smile weakly and bluff: “Not too bad considering the circumstances.” He sees right through it and gives me another pat.

He begins by applying a numbing gel to my rectum and performing a digital exam of the prostate. Then he inserts an ultrasound probe “about the diameter of a roll of nickels” to help guide the biopsy needles. So far so good.

Next come a couple of shots of Lidocaine, what you’d get at the dentist, right into the prostate. The doctor’s assessment of a “little pinch” from each injection is pretty accurate. But I find my anxiety growing instead of fading.

As the moment draws near when the biopsy needles will do their work, my body is approaching full rigor mortis. I squeeze the little prostate balls, breathe deeply and try to ignore the technical exchanges between the doctor and nurse.

'Another little pinch'
“OK, Mr. Stuckey,” he says, “you’re going to feel another little pinch.” Doubting that I can tense any more, I manage to. “Schtick!” The spring-loaded needle makes an odd little clicking sound. Oh. My. God. I am being sodomized with a knitting needle. Eleven more times? Hah! I manage to avoid screaming, probably only because I am busy trying to find the words to tell the doctor and nurse that I obviously can’t handle the rest of the procedure without large doses of morphine and Valium.

“Another pinch,” the doctor announces before I can beg him to stop. I become a beam of steel. “Schtick!” It’s a miracle. Maybe it took just that much longer for the Lidocaine to kick in but the second biopsy sample is nothing like the first. It’s not exactly pain-free, but it is, in fact, a “little pinch” instead of a knitting needle. As are the third, and fourth, and all the rest. I begin to breathe easier. By the time we are done, 15 specimens have been collected, three more than planned, because the doc was unhappy with the size of the first three.

When it’s over, the nurse has me get up slowly and watches me to make sure I don’t pass out, which I am still far too tense to do. Back in the first exam room, I wash antiseptic and numbing cream from the scene of the crime and change into my own clothes. By the time I step off the elevator in the lobby, I am halfway alive again.