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Posted 5/20/2009 9:37 PM (GMT 0)
Ok I need a little advice   My PSA is normal, everything is working normal and the doctor (urologist) even asked why are you here?   During my last exam they felt a small "bulge" and the urologist suggested that I have a biopsy.   I am supposed to go to do the biopsy on 05/27/09.   Should I be concern, should I even do this if my PSA is normal? Any advice is helpful to me. Thanks  
Posted 5/20/2009 9:41 PM (GMT 0)
WEDsr,
What is your PSA? Also what is your age?

Tony
Posted 5/20/2009 9:46 PM (GMT 0)
Well...my .02 cents worth would be depending upon age and PSA score and it might well be a good idea anyway. A small bulge is not something to ignore in my opinion. Did your urologist confirm the "bulge" and also recommend having a biopsy?

By the way...welcome here. Hopefully you don't have cancer, but if you do there is a wealth of information here to answer any questions you might have.
Posted 5/20/2009 9:46 PM (GMT 0)
Also Wed,
I deleted a duplicate post. This way we'll keep things together for you. Welcome to HealingWell. This is a great site for those who have or suspected to have prostate cancer. We'll be happy to answer any questions. the DRE or Digital Rectal, Exam is capable of finding lumps that could be cancerous. But not lumps are cancerous. So until a biopsy confirms cancer, you don't have it and should not worry too much. If you do have it, then after the initial shock of it, you will need to learn about it. You will find that this diagnosis is seldom a terminal condition. But it is life altering, and it can be distressing. But hang in there and stay positive.

Tony
Posted 5/20/2009 10:03 PM (GMT 0)

If you would tell your current psa and any change in psa over the past few years that would be helpful.  Your age can also allow for normal psa range to be higher.  If a bulge was discoverd from a family physician DRE, he would probably send you to a Uro for specialty followup. 

I was not concerned with my psa, even at 2.5.  A DRE by the Uro was "maybe a nodule".  At that time I was given the option to wait and monitor psa in 6 months or to have a biopsy.  For peace of mind I decided to have the biopsy.  If there was something there, I wanted to find out.

After diagnosis, I realize that percentage change from year to year or a certain point change in one year may be an indicator.  Please, be aware that psa or DRE do not necessarily mean cancer.  Just as a negative biopsy does not necessarily mean cancer-free. 

I wish you all the best.

You have found a great place.  I didn't find this forum until post-surgery.

DS

Posted 5/20/2009 10:08 PM (GMT 0)
Wow! am I glad to get a quick response.
I am 59 (August)
PSA was real low (from DR. will get acutual numbers tomorrow.)
My urologist confirmed the "bulge" and he is the one who recommend having the biopsy.
Scared? Very much so I seen what my wife went through she survived breast cancer this past year, both breast removed, chemo & Radiation. She is now doing awesome.
Again thanks
Posted 5/20/2009 10:16 PM (GMT 0)
I hope the very best for your wife,
And I hope that you do not have cancer. There have been cases here where the PSA is in a normal range for the general public, but you can't rely on PSA alone. After you have the biopsy, about a week later you will get the results. When you do, ask for a copy of the pathology report. This will very useful when deciding what to do next. Remember to stay calm about things. What you don't know about prostate cancer can be scary, but most of us here have learned that we can do well with the disease. I am a rare case of being diagnosed in the low forties and having an advanced case. But I am doing well. And with a low PSA you would likely have a very small tumor should it come back positive. This is a good thing.

Do you have any family history with prostate cancer?

Tony
Posted 5/20/2009 10:19 PM (GMT 0)
Hi Tony

No history with prostate cancer in the family.

Thanks for you time and I wish you well and will keep everyone in my prayers.
Posted 5/20/2009 10:23 PM (GMT 0)
You are very welcome. And for my part, your prayers are very welcome as well. Thank you.

Tony
Posted 5/20/2009 10:27 PM (GMT 0)
WEDsr...fully understand the scared part...but don't compare this to what your wife went through...not the same thing at all.

Being that your urologist made the recommendation, then I would move forward with the biopsy. Ask him about how he will perform the procedure...normally it is not very painful but if your are the anxious type, have him give you a sedative to relax you during the procedure. I think I have read that some have had it done under a local. For me the preparation was the worst part...I am not the type to let probes be put where they normally shouldn't go....but it wasn't all that bad. The mind made it alot worse than what it really was...just so you know.

Hang in there and if you have more questions...let us know.
Posted 5/20/2009 11:29 PM (GMT 0)
WEDsr,

I would consider getting a second opinion or if you like another DRE, from different urologist to see what he feels, if he feels a lump or a ridge, then I would definately be getting a biopsy. 

Posted 5/21/2009 12:29 AM (GMT 0)

I don't know if this will help you or increase your worries more.  If you have a biopsy, you stand a good chance of finding something because a lot of men have a trace of cancer by this age.  What is unknown is whether you should do something about it, because in many cases it will be slow growing and you will shake off these mortal coils from some other cause at a ripe old age.  The Gleason score provides some information, but most men end up with a 6 or 7, which doesn't fully answer the question because it is midrange.

I also had a slight abnormality in a DRE, so I had a biopsy (and by the way, if you have a biopsy, ask how many cores they are going to do, 6 was old thinking and nowdays 12 up to 18 is thought to be better.  The more the better chance of finding something if it is present, like 'searching for the seeds in a strawberry' is how I heard it described.).  The abnormality turned out to be nothing, but to make a long story short they found a trace (less than 5% on one core out of 18) of possible cancer (2 out of 3 pathologist's opinions).  I eventually went the route of robotic prostatectomy, and am 'on the other side' with little after effects except still waiting for my sex life to pick up more (but it is headed up).  My post operation pathology report still showed very very little involvement.

Would I change what I did?  Probably not.  But like other replies, I don't think what I faced is in the same category as a woman facing breast cancer.  I think I got caught by the improved early detection systems, and that the concern to me was not whether I would die, but whether I would have the same quality of life (sex and incontinence issues, as you'll read about here).

Posted 5/21/2009 5:37 AM (GMT 0)
Greetings, WEDsr. Someone earlier asked about your family history. That was the final test for my urologist. PSA was relatively low, DRE slightly abnormal but when he asked about family history and I told him my father, his twin brother and their older brother all had prostate cancer he said we need to do a biopsy.
Hang in there - please do keep us posted on how things are going. David
Posted 5/21/2009 9:52 AM (GMT 0)
Question

I will have my biopsy next Wednesday. Can I go to work on Thursday and Friday or will I be in "pain" / "disconfort"?

Thansk
Posted 5/21/2009 10:26 AM (GMT 0)
Everybody is different. I had no pain afterwards, so could have gone to work immediately. The only after effects were slightly pink urine for a few hours, and very obvious blood in the semen for about 6 weeks after. And no, even if you have it, your partner cannot "catch' cancer from you -- that was a concern I had.

Good luck for Wednesday.
Posted 5/21/2009 11:05 AM (GMT 0)
WEDsr,

I too had a normal (for my age) PSA but an abnormal DRE. As the stats show below, my biopsy came back positive and I had a RRP in 01/09 and, so far, aside from Mr. RD hanging around, all is well. My next PSA is in June and I'm keeping my fingers crossed. As to the biopsy, my urologist gave me a pill to take 45 mins before the procedure (can't remember the name) and by the time of the biopsy, they could've cut off my head and I wouldn't have cared. Good stuff! :-) He then gave me a shot of a local anaesthetic right where it counted so all-in-all the biopsy was unpleasant and somewhat uncomfortable but not as bad as I anticipated. Not fun but not bad. Make sure you ask for both the pill and the shot. They're well worth it.

Welcome to the group and sorry to see you here. Good luck on the tests and keep us informed.

See ya...
Garth
Posted 5/21/2009 11:06 AM (GMT 0)
Correction: make that Mr. ED, not Mr. RD which makes no sense. :-)
Posted 5/21/2009 1:46 PM (GMT 0)
I had six biopsies before they found it. They are really not as bad as it sounds. My doc also gave me Valium and antibiotics before the procedure done under local anestetic. I had 24-core ones, so there were a lot of blood in the semen, but no other side effects. After the biopsy I felt tired/sleepy (probably due to Valium), but no significant discomfort. I went to work next day every time with no problems. My view is that it is better to be vigilant and watch it. My Dad has died from PCa. His DRE and PSA were normal. They found mets before they found the location of the cancer. So, early detection is key. Good luck!
Posted 5/21/2009 3:41 PM (GMT 0)
I had no trouble working the day after my biopsy. The day of I didn't even chance it. It took it off.

Tony
Posted 5/21/2009 7:02 PM (GMT 0)
I had my biopsy with an injected local anesthetic. Uncomfortable, but not nearly "chew off your own leg" kind of pain. Do note that people on this board report a wide range of pain levels so be prepared if it is worse than some report. I took the commuter train home and was fine for work the next day. The worst part was blood in urine and semen -- I had sort of forgotten the biopsy and there was just a moment of pure panic before I remembered.

Let me offer a slightly contrarian view about testing. Some recent and very extensive studies suggest that PCa is over diagnosed and over treated. That is, people are treated who are unlikely to actually have any effects from the cancer for the rest of their lives. It would be a rare event if your biopsy showed anything very extensive. So, whatever the outcome, remember that you have a lot of time to learn, think things over, and choose. As others have said, this is very different from breast cancer.
Posted 5/21/2009 7:55 PM (GMT 0)
Thanks to everyone.
geezer where did you get the Robotic surgery?

From what I hear that is the best way to go.
Posted 5/21/2009 9:12 PM (GMT 0)
Back when robotic surgery was new, people would travel long distances to be treated, but by now almost every metropolitan area has several very good surgeons. I just asked my internist and then interviewed his top two (who had also come up in other recommendations.) Doctors are used to having patients talk to several surgeons before deciding. I ended up at Bryn Mawr hospital in suburban Philadelphia.

Others on this board have asked how much robot experience a surgeon should have and the answer seems to be at least hundreds. Some of the most experienced are over 2,000 robotic surgeries.

I went for robotic because of its reduced chance of blood loss and faster recovery, but the differences between robotic and regular do not seem all that much -- as the experiences of some on this board show.

To me the most important thing was finding a doctor that gave me confidence. Among other things that made it easier for me to ask questions.
Posted 5/21/2009 9:24 PM (GMT 0)
All right I just talked to my Dr.

He gave me a prescription for valium for the Biopsy.
He said he will take 10 - 12 cores
PSA is 2.0
Small "bulge" he just wants to be sure

Walt

--------------------------------------------------------------------------------
Age 59,
PSA 2.0
Biopsy schedules for 05/27/09 10 - 12 cores, ??? positive (none I hope)
Posted 5/21/2009 9:52 PM (GMT 0)
Walt,
I had DaVinci robotic surgery at the City of Hope near Pasadena California. But you can get it at many places with great surgeons. But let's not get the cart in front of the horse. Good luck with your biopsy. May it be negative...

Tony
Posted 5/23/2009 4:21 AM (GMT 0)

WEDsr

I had my biopsy in the afternoon with a local anesthetic.  I could feel a bit of a zing each time they took a core sample.  They asked me how I was doing after the first few samples so I told them I would say "OUCH" if it made them feel better.  The biopsy "gun" does make a popping noise when it takes a core, don't let that bother you. 

I was able to work the next day.  I did experience an occassional zing of pain for the next week or so.  I had a bit of blood in my urine for a couple of days and blood in my semen for at least a couple of weeks.

Try to enjoy the weekend,

DS

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