Biopsy Difficulties

H Folks,
Will try to keep this short as possible. I'm a 57 year old truck driver.. about 8 years ago had my first PSA test taken simply because the Dr. thought I should, not because of any difficulty. Came back as 2.4. Sent me to a urologist who's first thought was that I needed a biopsy to check for cancer. DRE showed prostate swollen but smooth. Understand that my dad had just died that year from pancreatic cancer. I had helped take care of him at home his last 2 weeks and had been at his bedside when he died, so I was well aware of cancer, scared of cancer, and didn't asked any questions or check any farther. I went along with everything the Dr. had to say and scheduled a biopsy. From what I came to find out afterward, would have never gone along with this so willingly.

My first surprise came as I was getting on the table for the procedure and it was explained to me about the EIGHT! samples he was going to be taking. (Says something about how much had actually been discussed about the procedure to begin with.) Being anxious, ignorant, and scared I thought "a" biopsy meant just that, not eight! Was assured by the Dr. from the beginning that he does "hundreds of these a year" and rarely, rarely has anyone that experiences any problems. The procedure was very uncomfortable, no local anesthetic. I couldn't wait to get out of that office! Nearly passed out about 30 minutes later on the way home. To make this saga brief, over the next 2 weeks I experienced extreme discomfort (aka pain) especially on the right side of the prostate, passed a lot of blood, passed numerous large bloodclots, and was in ER twice. Thankfully no infection. Took almost 2 weeks after that for me to begin having a normal looking color to my urine. For years after that if there was any discomfort in the prostate area it was always on the right side.

That whole episode caused me to change the way I was living. Had been living the truck driver diet. Immediately stopped the red meat and used very little dairy. Increased fresh fruits and veggies. As of a few years ago I even stopped the poultry and now eat only fish. Had dabbled with prostate supplements, but never got real serious with them. Had chest pain problems and have had some BPH symptoms for a while, so had blood tests last November. Found that in spite of my diet I have high cholesterol, and I had a PSA of 9.2. Intensified diet to lower cholesterol and began with supplements. Dr. set up an appointment with a urologist (not the same one) for a month later. Again DRE showed prostate swollen but smooth, wanted to do a biopsy. Explained to him the difficulties I had and asked that every other possibility be eliminated before I would consent to a biopsy. He agreed to a free PSA test. 2 months after the first, PSA down to 7.8, free PSA 11%. (Cholesterol also down 30 points). Urine flow and regularity has much improved. Urologist still insists on biopsy. Used the "hundreds of these a year" statement which, as you can imagine, didn't impress me a bit. His difficulty rate of .9% means nothing to me as I have a difficulty rate of 100%! He took a urine sample at my first exam and declared before I left his office that I do not have prostatitis. Since the DRE I have begun to experience what I believe to be prostatitis symptoms as far as pain and discomfort are concerned. Will not discuss any available options. When told him I was not getting a biopsy until he further examined other possibilities our conversation was over.

Needless to say I have an appointment with another urologist in a week. Also, just as needless to say, my opinion of urologists at this time can't be written in this forum. In my limited time of reading this forum I have not noticed any talk about problems with the biopsy itself. Sought out this forum this morning, joined and am sitting here in my prostatic discomfort entering my first post. My apologies for the length.

LPdriver

RB,
Thanks for your reply. I don't doubt the Dr. when he states rate of success. I just don't understand why he can't be more understanding of my experience and checkout other options that seem to be available to narrow down the probabilities of cancer before he sticks an already uncomfortable prostate with a dozen needles. I also don't understand his unwillingness to even discuss them. In what I've been able to find, there appear to be a few other options available. What would be the harm in pursuing these other than taking the risks of another bad experience with a biopsy? At this point, I have a lesser probability of having cancer and a greater probability of difficulty with biopsy.

I am glad you or the many others on here have not had the troubles I had. The fear I have of another biopsy is not fear of the unknown, it is fear of the known.

Lpdriver

LP,

I had a lot of pain from the biopsy as well. There used to be a number of discussions on biopsy pain, and maybe they're still here somewhere. But I can't find them even with a search. As I recall, there was something of a debate. One side wanted to make sure doctors offered local and general anesthesia as options. The other side said most guys have hardly and discomfort, and you don't want to scare people off from getting the biopsy in the first place.

I compare it to having dental work. My dentist gives me some local before starting, and during the procedure, if we jointly decide the first amount wasn't enough, he gives me more. This makes me more inclined to visit my dentist. The dentists seem to have the pain issue much more in hand than a lot of medical docs.

Moot point for me now, since that prostate is gone. Hopefully, that is, I hope I'll never need a lung or liver biopsy.

DJ

LP,

I understand it all. The biopsy was shocking, mine was also eight cores.
You have a serious situation, your PSA is too high and your free PSA is too low. You do not have to be subjected to the same treatment as before with the biopsy, it can be done under what is called IV sedation and I think you should ask. More Dr.s should ask the patient before subjecting them to an office procedure.

Please get the biopsy but make sure that they do not make you hurt in doing so.

Scott

Zufas, got me curious now. Can you give a list of doctors that you have used and liked and thought were competent?

LPdriver,
You stated that you are about to see a new urologist. This is good, you can start with a clean slate with this one, and hopefully he will be better about disclosing and explaining things. One of my longterm habits with any doctor, is to go in with a written list of questions I want to ask or hear answered. Its too hard when I am in a long waiting room, or nervous with the doctor. Most doctors love it, because they are stretched for time to start with, and it makes it easier to stay focused instead of going off on rabbit trails.

With what you stated originally, with your psa numbers, and the fact that prostitis was ruled out (if I understood correctly), then a good biopsy is still needed. Some men here have PCa detected on the first one, me- took 3 spread over about 15 months, someone else here, I believe has had 13 biopsies.

Hopefully, your new dr and you can communicate freely and openly from the first visit. And if he/she does suggest another test, procedure, or even biopsy, then fire up your list of questions. If pain is an issue, most dr. will work with you, if it is anxiety, most will work with you.

Dear truckdriver, here are a couple of thoughts:

1.  Re your question about other tests, there was a lengthy discussion in another thread on this forum about the "PCA3" test.  I looked back and could not find which topic that was under but perhaps a moderator or other member will find it and let you know via this thread.  In the meantime, here is a link about the test:

http://www.prostate-cancer.org/education/preclin/Torres_PCA3.html

You can also google "PCA3" and find tons of info.  The test is non-invasive and being recommended by some docs (and some members here) as a test that should take place between PSA and biopsy.

2.  My biopsy experience was very similar to that posted by BillyMac in this thread.  IV sedation and no big deal...I had 16 samples taken.  My urologist did it that way for 2 reasons, (a) patient comfort and (b) so he could take his time and not worry about patients jerking and moving while the needle goes in.  It's not about being a wuss, it's just why suffer any unnecessary pain or discomfort when you do not need to do so.

Tudpock

Truck Driver, With your PSA and free PSA numbers you have to get a biopsy, the other alternative will be much less pleasent in the long run.

I've had a total of 13 biopsies, so I know a little about them.There are several possible ways you can go.

You can go to a doctor that will sedate you. In this case get as many samples as you can, at least 24.

You can find a doctor that gives a lidocane shot, this decreases the pain a lot. Also take a vicodine, this helps with immediate and post pain and won't cause bleeding. (Docs won't tell you this).

You can get a color doppler targeted biopsy. This is by far the best method as it is the most accurate; if there is no suspicious area no biopsies are taken. If a suspicious area is seen only that is biopsied. Rarely are more than 6 cores are taken. If nothing is found then a base line picture is established to compare changes. If cancer is found it can be accurately staged as to exact location and tumor size. A normal biopsy can't do this.

The only problem is there are only a few doctors that are skilled in it's use. Dr Fred Lee in Mich, and Dr Duke Bahn in Ventura Ca are two that I know of; there may be a couple more around. If anone knows of other good doctors that use this please let this forum know. 

After 13 biopsies I would only get another color doppler biopsy, even if it meant flying across the country. It's that much surperior to a normal biopsy.

JohnT

I had a 12 plug biopsy. No pain. It was a two person procedure. The Urologist and the ultrasound technician. The technician numbed me with a local injectable. I had little blood in my urine, but a lot of blood in my ejaculate, for 8+ weeks following. Cancer was found in only 1 of the 12 plugs.

My brother-in-law has BPH so they give him annual biopsies, but his doctor doesn't numb and he had me so afraid of the procedure that I was reluctant to go through with it. Find a Urologist that will use medication to stop any pain. Good luck.

LPdriver,

It does sound like your biopsy recover was more difficult than average. I wonder if that could be a factor if you ever decide to have surgery. The rule of thumb (stated by my surgeon) is that you wait 8 weeks after a biopsy, to let the tissues heal, before surgery is performed. In your case, maybe a longer wait is called for.

DJ

truckdriver says:
It was the damage done by the biopsy that most concerns me. It's the complications caused as a result of the biopsy that I would like to avoid. I have no reason to believe the first biopsy was performed by an unqualified doc. My complaint with him was that he did not fully inform me about the procedure not that he did a shoddy job. I would have still gone through with it, anyway. He is a recognized doc in the area. The results of the test were negative in more ways than one.

If I can be convinced that I have a greater chance of having cancer than I do of having difficulty with the biopsy it would help. With what is known now I have a greater chance of not having cancer than I do of having it. All I am asking is that a few more tests be conducted that demonstrate my likelyhood of cancer before I take the rixk of having the same problems or worse taking a biopsy of that can still miss the cancer. There are other non invasive tests that can be performed before taking a non definitive biopsy.

Truckdriver, I understand your hesitancy to go thru another biopsy. Mine wasn't any picnic and I did have 'issues' with pain and discomfort for several weeks afterwards. However, I think that you are dreading the wrong thing here. Yes, it may be painful, yes it may take a longer time to heal, but your stats that you presented really does override your worries about the results of a biopsy. You want assurance that the chances of cancer is greater that the difficulty of another biopsy. That seems easy to answer, using your stats. IF you do have prostate cancer, (and your stats lean in that direction) discomfort from the biopsy to find it out and to treat it is gonna be much less than if you don't find it out and treat it, or you delay discovery and treatment. Prostate Cancer, if of the aggressive type and left unchecked, will ruin your whole world, in a manner of speaking. As to how to determine if you have it and avoid another painful biopsy, there's been a couple suggestions that may or may not be feasible with you. The color doppler imaging sounds promising, but is not readily available locally to most of us, I suspect. The PCA3 test is another, new weapon in our bag, we have found out this week. Whatever course you choose, I would suggest to you that with your stats, you need to do something to determine your cancer status, if any, and soon. I hope and pray that it is something other than cancer and that you can continue your life uniinterrupted.

LPdriver, it is not wrong of you in any of your choices in dx. and treatment, it's your choice(s) clearly. With my 3 biopsies prior to the PCa dx, I reacted to each one differently. The 3rd and final one was actually my best, hardly bled in the the urine, just barely pink, nothing really in the ejaculate, and the pain was the least afterward. The news I got about having PC from the 3rd biopsy made me instantly forget about any of that part, trust me. The only way you are going to know with certainty is to continue the biopsy path, I believe that is what James in the post above was making the point. Your stats are already way too iffy to delay much, if at all. Someone on this site once quoted or said, the best time to have PC surgery is one day before it spread outside the prostate capsule. It can make all the difference in the world once it begins to spread and is no longer contained. That's something to think about. My own dr/surgeon was not hard up to do another open RP, he knew with my stats, there was more of a chance of agressivness, and when we did decide on surgery, I was actually bumped way up on his schedule, and he re scheduled some lower psa/gleason operations so that he could do mine sooner than later. It is all about your choice, brother, wishing you only the best, and hope you get the answers soon to make the choicesy you need to make

david in sc

I had 2 biopsies 7 months apart. I was sedated for each one and I experienced a little blood in the urine and blood in the ejaculate. The first biopsy said "atypical cells" meaning that they couldn't be sure if it was PCa. The 2nd biopsy confirmed PCa. I had PCa less than 5% of 2 cores out of the 16 samples. My surgeon said that I should wait another six months. I opted for surgery immediately. Sure glad I did. The pathology report came back Gleason 7 (3+4) with a positive margin. My only regret was that it wasn't caught on the first biopsy and I could have had surgery that much sooner. PCa is nothing to mess around with, believe me.