At the end of November the UK National Screening Committee's (NSC) decision on the future of prostate cancer screening should be known. The latest newsletter from Prostate Cancer UK doesn’t sound particularly hopeful.
Not me, but stolen from a Facebook post. It is with a degree of trepidation that I broach the following; a delicate topic that nevertheless I feel must be aired among all who possess, or are thinking of acquiring, a prostate gland. Be aware that I will be going into considerable detail, but it’s all for your own good as the alternative could be a great deal worse. Back in July of this year, I approached my General Practitioner (GP), concerned that my urinary flow rate was not favourably comparable with, for example, the rains down in Africa. With appropriate permissions out of the way, an enthusiastic digital examination was performed, with commendable solemnity. Additionally, a blood sample was acquired; the latter to be expedited to a laboratory somewhere, to ascertain the prostate specific antigen levels (PSA) therein. Friends, I have to tell you that it was mildly elevated and a follow up blood sample was scheduled four weeks hence. As sure as Kilimanjaro rises like Olympus above the Serengeti, this too showed an elevated level of PSA. Now, 4.0 ng/mL is considered normal for someone of my tender years (66) - my result was 4.5 ng/mL. Being a sound and cautious medic, my GP duly arranged for an MRI scan at a popular local outlet, saying "Hurry boy, it's waiting there for you”, before bidding me adieu, godspeed etc.. A few days later, I received a phone call from my go-to Urology Department, cordially inviting me to attend for an MRI scan the very next day! This was borderline exciting, I can tell you. So, onward to the scan... I'm delighted to report that an MRI scan is an object lesson in utter dullness, notwithstanding the earsplitting acid-techno soundtrack that accompanies it, as magnets whirl and electrons flow. Lying in the belly of the machine for half an hour or so, thoughts of Nikola Tesla passed the time. The MRI procedure proceeded in two phases: the first under 'normal' conditions (normal, my @ss, though more of that later) and one following the injection of a contrast dye. I was expecting perhaps to turn an interesting colour, such as vermillion or cerulean blue, but then remembered that these are generally pigments, not dyes. I remained my normal, dull colour throughout and afterwards, which was a relief, as I'm sure you will understand. Two days later I was summoned, with little ceremony, to attend for a biopsy of my hitherto oft-overlooked prostate. It was a grey day with moderate rain and on arrival I was greatly assured by the sheer blandness of the Urology Department interior, designed, as it must have been, by exceptionally dull people with the express intent of minimising any tendency toward excitement among either staff or patients. Bravo! my inner voice cried. It turns out there's a reason for this level of blandness, as ‘urology business’ can rapidly escalate into the giddy realms of 'really very exciting', to which the following eludes: Quoting directly from the very informative NHS web page on the topic - 'an ultrasound probe (a machine that uses sound waves to build a picture of the inside of your body) is inserted into your rectum. This allows the doctor or specialist nurse to see where to pass the needle to take small samples of tissue from your prostate.' Some of you may struggle to comprehend the sheer excitement which this sort of thing can lead to. Before this could happen however, I was treated to a select 'mano a mano' preview of my MRI scan. Sitting, almost conspiratorially, alongside my consultant, I nodded sagely with the wisdom of the profoundly ignorant as we surveyed the digital miasma of barely differentiated shades of grey that, apparently, comprises my lower abdomen. It was reassuring to find that I'm also extremely dull on the inside. However, being a man of great experience and wisdom, and notwithstanding that he appeared to about 16 years old, he pointed out a couple of areas within my prostate that he considered to be ‘less than dull’, saying: "I know that I must do what's right" followed by: "I seek to cure what's deep inside". And so we crossed the corridor to the biopsy suite - in reality a small, almost featureless box room. Almost, but not quite. Adjacent to an elevated bed/gurney, stood a hybrid contraption - part low end LCD TV, part commercial grade kitchen appliance to which, attached by yards of visceral tubing, was mounted a probe which can best be described as sonic screwdriver meets 'marital aid' (Google it, but not on a work computer) meets bladed article (Offensive Weapons Act 2019). This, fellow travellers, is the fabled transrectal ultrasound guided biopsy probe, and what a marvel of medical technology it is! A stubby-stabby wand of penetrating insight, no less. Disconcertingly, it was wearing a condom. In an effort to minimise what might have been tense apprehension, mainly on my part I think, I thanked the good consultant for such consideration. In the spirit of reciprocal levity, he took this as his cue to regale me with his hilarious anecdote: toward the end of his training, he told me, he ordered luminous condoms through the NHS internal procurement portal, just to find out if his superiors were paying attention. It turns out they were and he had some explaining to do. Thinking on his feet, he told them that sometimes it helped to have the lights dimmed during a biopsy procedure and so a degree of luminosity was helpful. This is my kind of guy and I was clearly lucky to have him on my team. “It's gonna take a lot to drag me away from you” I thought. Anyway, with humorous anecdotes now out of the way, it was time to get down to business and following another, and I must say, vigorous digital examination, my hero declared “She's coming in”. And so, generously lubed, she did. As a welcome hors d'oeuvres, I was treated to a hefty dose of the finest lidocaine available, to anaesthetise the target area before expert thrusting commenced. This, I thought, is not your first rodeo, son. The probing was accompanied by a number of loud clicking sounds as the biopsy needle retrieves samples throughout the prostate. I did wonder, in an off guard moment, whether it’s possible to curl ones toes so tightly that a singularity might be formed, dragging the entire postcode into a temporal vortex from whence none may return. Happily, before that event horizon was reached, it was all over bar some light banter and looking for my shoes. I was told to expect results in 3 to 4 weeks, and only this week a missive arrived from the Denizens of Urology. This was conveyed to me not, as expected, by a phalanx of oiled Nubians, borne aloft on a palanquin of gold and emeralds, on a sumptous velvet cushion, but by the reassuringly dull medium of email. And to think, some of you doubted it would ever catch on! The first sentence read: ‘The result of your biopsy is dull’. The actual word used was ‘benign’, but I think we all know what they were really saying. Clearly this was a relief and my gratitude to the the NHS and all who sail in her is boundless. So the moral of all this is: get your prostate checked out, if you have concerns. It’s hilarious and you’ll love it, trust me. The foregoing is an accurate account, though some poetic license has been taken in order to incorporate the required number of Toto lyrics, thus ensuring at least tolerable levels of dullness. And finally, remember: “There's nothing that a hundred men or more could ever do”.
