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PSAs, pistols and probes

It all began with a routine flight physical. My doctor discovered that the prostate-specific antigen (PSA) level in my blood was a bit high, and he calmly suggested prostate cancer screening. My brain, of course, translated his routine words into, “DANGER, SEEK SHELTER IMMEDIATELY!”

Since many of you men will face prostate cancer screening yourselves someday, let me help prepare you for what’s ahead.

1. I am convinced that digital rectal exams (DREs) of the prostate are only slightly less uncomfortable than what women experience during childbirth. I have tried everything I know of to get out of these exams. I even replaced the box of medical gloves on the counter in an examination room one day with a makeshift sign that read, “GLOVES ON BACK ORDER.” When the doctor entered the room, however, he just looked at me and said, “I hate it when I have to do this barehanded.” I returned the gloves. Unfortunately, guys, there is no way out of the DRE.

2. If you become a candidate for a prostate biopsy, the doctor will normally use a transrectal ultrasound probe as a guide during the procedure. According to a brochure that I was given, these devices are — and I quote — “barely bigger than a thumb.” Yeah, right! Whose thumb? The Jolly Green Giant’s? Don’t let anyone fool you: these things are HUGE! Even though I have never actually seen one, my considerable experience with these probes leads me to say with some certainty that they are approximately the same length and diameter as a baseball bat.

3. The prostate biopsy gun, on the other hand, is actually not as bad as it sounds. It really causes very little pain or discomfort. Still, if you want to keep your anxiety level somewhat under control, I would recommend that you avoid gazing around the procedure room. If viewing all of the medical paraphernalia doesn’t bother you, I would think that seeing the extra nurses, medical students, janitors, the receptionist and her daughter’s kindergarten class, the UPS guys, etc., who have wandered in to observe your procedure just might. I know. You are thinking that I’m embellishing the size of the crowd…and you’re right. Because of their demanding schedules, the UPS guys seldom get to stick around.

4. I have experienced prostate biopsies both with a sedative and without, and the procedure is completely tolerable either way. If you are going to receive a sedative, however, your doctor will probably tell you — as did mine — to be sure to bring a driver with you. That’s why I walked into my last biopsy appointment with my graphite-shafted #1 wood in hand. I take my doctor’s instructions seriously.

Well, that’s some of what I have experienced during my prostate cancer screening journey. And, although I may have exaggerated some of it (okay, most of it) to make a point or two, the whole process — even the biopsy procedure itself — is really not a big deal. The important thing is this: although recommendations vary, the prostate cancer screening process — while not foolproof — could quite literally help save your life.

And remember, you can gain something beneficial out of almost any situation. I am now so familiar with the whole biopsy thing, for example, that I am writing an informational brochure about it. I’m calling it “The Prostate Biopsy Procedure: A Guide to Understanding the Tools and Tactics Used by the IRS during Your Tax Audit.” It occurs to me that there are an amazing number of similarities between these two events.

— Jerry Tobias

Jerry Tobias is an aviation writer who flew everything from supersonic military aircraft to Boeing 747s during a 40-year career as an Air Force, corporate and airline pilot. He also speaks as an aviation safety specialist and as a motivational speaker discussing life lessons learned through aviation. Jerry is a cancer survivor. Reach him at

Reflections of Erma