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Posted 6/7/2010 2:27 PM (GMT 0)

Biopsy or no Biopsy

 

I just had a PSA test come back at 7.6. I did another 2 weeks later and it was down to 7.2. This is the first time I have ever been screened. I am 62 with no symptoms.  Went to a doctor and he wants a biopsy. I have no history to determine if PSA is going up or down. I want to wait awhile and see how my PSA levels look.  I do not want someone poking needles and scraping tissue just to be safe. What do you think? I know it’s my call and that you folks aren’t doctors.   I have no family history of cancer. Troy

Posted 6/7/2010 2:37 PM (GMT 0)
Welcome to HW, Troy. Its a good first step just to join in here, shows there must be some concern going on there. Your PSA is high, even if you age factor it. It could be elevated because of prostate cancer, or even from an infection. Did the doctor talk about or check or give you anything to take to see if an infection has caused it to be at that number? Also, did the doctor do a DRE (digital rectal exam) on you, you know, sticking his hand up your bum? If so, he would have been feeling for lumps or anything unusual that could warrant a prostate biopsy.

While the biopsy is no walk in the park, most men get through them fine without any serious complications or pain. And a good doctor can give you something on the pain front, and some men are put under when they have their biopsy done. So don't let the fear of pain stop you if one is needed. I had 3 done before my cancer was diagnosed.

And keep in mind, we have plenty of men here, with lower PSA then you have currently, and never had a positive DRE (no lumps), any sign of prostate problems, and none in the family, and still have full blown prostate cancer.

This is where the gamble lies. Right now, the only way to fully rule out prostate cancer would be to undergo at least one biopsy, this is assuming your doctor has ruled out benign causes of your PSA number. If there is cancer now, and you keep putting off a biopsy for reasons of your own, the cancer is only going to grow over time. What you don't want to have happen, if you had prostate cancer, is to let it grow outside the prostate itself and spread.

And of course, if you have uncertanty with this doctor, get a second opinion.


David in SC


Good luck, and please report back often, let us know what is going on. I hope you aren't dealing with prostate cancer, but if you are, this is a good place to be

Posted 6/7/2010 2:38 PM (GMT 0)

Welcome to the site..Sorry you have to be here.

My PSA never got over 1.3. But I had nodules and the biopsy confirmed I had cancer.

So, you either have cancer or you don't. The biopsy will tell you for sure idea

Posted 6/7/2010 2:47 PM (GMT 0)
Would it be inappropriate to request a general anesthetic for the biopsy.
Posted 6/7/2010 3:04 PM (GMT 0)
Would it be inappropriate to request a general anesthetic for the biopsy. I know I sound like a wimp.
Posted 6/7/2010 3:19 PM (GMT 0)
I don't know how many uro's do biopsies under general anaesthetic, although it is not inappropriate to ask. For me, other than being terrified at what the pain and discomfort may be, it turned out to be easily tolerated with only a local anesthetic on the prostate. I even went back to work for the rest of the day, and had only minimal discomfort. Each man is different - and, as you can see in my signature, my PSA was about 3.5 when diagnosed.
Posted 6/7/2010 3:20 PM (GMT 0)
 inappropriate -> Nope

general anesthetic -> would require you to do it in a hospital and would be much more expensive.

I think some guys here were given something like valium...

I thought my root canal was worse (cause it took a lot longer)  then a biopsy.

Posted 6/7/2010 3:24 PM (GMT 0)
Waitman

From reading accounts of biopsies on this forum, I think there is a difference in how the different urologists manage the pain during a biopsy.

I had my biopsy in April with just a local anesthetic and it was very manageable. Really no worse than getting a shot of novacaine at the dentist.

The doctor put some lub with lanacaine (or lidocaine?) on the probe and inserted it--uncomfortable, but not painful, let it numb the rectum wall then injected 3 or 4 shots to the nerve. It stung just a little bit, but not bad.

Then the doctor took the ultrasound pictures while the anesthetic did its thing, then took the 12 samples.

Virtually no pain when the samples were being taken, but there was a snapping noise that sort of startled me each time (even though I knew it was coming).

There was a small amount of blood that came out of my penis during the procedure (which was normal)

Afterword, my penis had a mild sting for about two hours, then no pain at all.

I drove there and drove home myself no problem

Overall, I would rate the whole thing as a low 2 on a pain scale of 1-10.

I would inquire with your Uro on how he manages the pain during the biopsy and go from there.

I am not a tough guy when it comes to tolerating pain and it wasn't that bad.

I have a friend who had a biopsy in 2003 and the Uro didn't use anesthetic and he experienced a lot of pain, but I just assumed things progressed since then and all Uros were managing the pain better now.

Good luck

Dan
Posted 6/7/2010 3:45 PM (GMT 0)
With that PSA, you probably need a biopsy.

But you might want to do a PCA-3 test first (urine test). That is more specific for PC.

I had sedation and that worked perfectly.

Mel

Posted 6/7/2010 3:48 PM (GMT 0)
I had a most 10 minutes between meeting my uro for the first time and getting a biopsy. He read my PSA, grabbed a feel, and we headed down the hall. Not a whole lot of time to wait, worry, or wonder beforehand. I then took my Cipro and went to work for the day. I imagine I got a local at the time but I was in sensory overload and don't remember what now seems like a minor detail.
Posted 6/7/2010 3:56 PM (GMT 0)
Waitman,

You could also ask for a free psa-my husband had no symtoms, normal DRe and a psa of 4.7. His free psa was the clue to the urologist that he needed a biopsy. Good thing he had one because he has cancer. It's definately better to know than wonder.

Renee
Posted 6/7/2010 3:58 PM (GMT 0)
My doc said he would be using a needle and taking 12 samples. Did I understand that they have an instrement that takes multiple samples with one pop? Troy
Posted 6/7/2010 4:05 PM (GMT 0)
You folks are great. I have dicussed the PSA and biospy with my wife but no one else. It helps to have someone to talk to. Troy
Posted 6/7/2010 4:07 PM (GMT 0)
They take the samples one at a time in different parts of the prostate. Twelve separate 'snaps'. It takes about 10 minutes.

I think from the time I arrived at the Uro to the time I left was 45 minutes.

I think I was on the exam table for 15-20 minutes.

The whole procedure had me pretty nervous beforehand, but in my experience, the procedure had much less discomfort and pain than I had anticipated.

Dan
Posted 6/7/2010 4:12 PM (GMT 0)
You could ask your urologist for some sort of sedation. For example, versed or a versed/fentanyl combination. (This is the sort of "conscious sedation" often given by GI docs during colonoscopies). There are some studies showing greater patient satisfaction with this method than with lidocaine. I have linked to an abstract of one such study below. Some paitents and doctors will say "it is not necessary." But really I think that is an individual decision, and in my view one that should be made by the patient rather than the doctor. It will probably add to the cost, and may not be covered by your insurance. GI docs are often comfortable giving versed/fenanyl on their own -- without an anesthesiologist -- but your uroglogist may not be comfortable doing this, and may require an anesthesiologist or at least a nurse anesthetist. Anyway, if you think you want sedation, I would talk with the urologist about it. It is CERTAINLY not an inappropriate think to raise.

On whether to get the biopsy, I would do it. Only way I might not is if your free psa percentage is very high AND your PCA3 test results show cancer very unlikely.

http://www3.interscience.wiley.com/journal/120748100/abstract?CRETRY=1&SRETRY=0
Posted 6/7/2010 4:22 PM (GMT 0)
Waitman,

My doc had me take a Valium one hour before the procedure. My wife drove me in and they had their way with me. I watched the whole thing on the monitor along with the doc. The Valium and the local they gave me seemed to do the trick. No pain, no discomfort and no worries. The miracles of modern medicine and recreational pharmaceuticals.

Sonny
Posted 6/7/2010 4:42 PM (GMT 0)
First, welcome to the Forum. The biopsy 'gun' will take what can be called a core sample of different areas of the gland. It will remove a core of tissue, say from front to back of the gland, which gives the path lab a cross section of the particular sample. This explains why guys have thier samples listed as say- 6 out of 12 cores, 3 at 5% and 3 at 80%. This means that the single one of the 6 samples core had, say, a total length of 1 inch. The composition of cancer cells found would be - in the inch sample - 5% of the first sample, 5%. of the next sample, 80% of the third sample, and 80% of the fourth. etc, etc. Or another way 5%, 5%, 80%, 80%. The biopsy needle is really a hollow needle that takes the core sample. The snap guys mention is the sound of the spring releasing the needle to take the sample. Here's a link to more detailed info on the procedure:

a recording in detail, maybe more info than you want to know.... smilewinkgrin

www.muschealth.com/gs/TandPcontent.aspx?Pageid=P07710

more info:

www.upmccancercenters.com/cancer/prostate/biopsyneedle.html

another of general interest concerning the biopsy and later Gleason scale staging of any found cancer.

www.cancer.org/docroot/cri/content/cri_2_4_3x_how_is_prostate_cancer_diagnosed_36.asp
Posted 6/7/2010 4:59 PM (GMT 0)
Most doctor's won't do sedation because it costs more and takes a lot more time. They are usually reimbursed the same amount with or with out sedation. I think this is a valid point. A 12 core biopsy is well tolerated if a vicodine is taken about 1 hour before and the doctor uses lidocane.
JohnT
Posted 6/7/2010 5:11 PM (GMT 0)

Dear Waitman:

Welcome to our forum....hopefully your stay will be brief and you will not have PCa.  But, if that turns out to be the case you will find this is a caring place with lots of folks willing to give educated advice (but none of us are doctors...at least not ones that specialize is prostates).

First of all, don't let the fact that you do not have symptoms fool you.  Most of us were diagnosed with no symptoms.  If fact if you had symptoms that could be a bad sign that a cancer might be advanced.  Secondly, you said "doctor".  I assume you are seeing a urologist as that would be appropriate. If you are hesitant to have the biopsy I suggest you discuss two other tests with your urologist, just as medved advised.  I assume your second PSA test also tested for % free PSA...if not, shame on your doctor.  You can easily google "percent free PSA" and understand that can be an indicator of cancer.  You can also google then discuss the PCA3 test with your urologist.  This is often given after a first biopsy shows no signs of cancer but a high PSA remains and the question of another biopsy is at hand but some docs do it pre-first biopsy. Finally you should discuss non-cancer causes of a high PSA, e.g. prostatitis. 

Once you are satisfied with the answers to the above you may decide to go forward with a biopsy.  A 12 sample biopsy is the minimum these days. We have had a number of threads on this forum where the subject of biopsy pain has been discussed.  For some men it was "no big deal" and for others it was "excruciating pain".  My urologist used IV sedation (think colonoscopy).  This was peformed on an outpatient basis at a surgical center.  My urologist's philosophy on this is (1) why cause a patient unnecessary pain and (2) he wants to take his time and do it right without a squirming patient wanting to get the he** out of there.  Also his protocol was 16 samples.

Hopefully this is helpful.  Please let us know what you decide and how you progress.  Good luck.

Tudpock (Jim)

Posted 6/7/2010 6:02 PM (GMT 0)
For me, the worst part was the shot for the local. While the rest was uncomfortable, it really wasn't as bad as rubber band ligation treatment for hemorrhoids. (If you have never had that, consider yourself fortunate.)
_______________

Current age: 56
Palpable tumor found during DRE
PSA then: 5.9
One of twelve cores positive 10%
da Vinci 4//09 City of Hope
Final Gleason score: 7
Staging: pT2 organ confined
PSA now: 0.10
Posted 6/7/2010 7:57 PM (GMT 0)
I'll agree with the comments about symptoms of a problem - I had none at all.
It was just a randomly added PSA test that flagged a problem (7.4 at age 56). They retested, then did the "free %" test, which flagged worse.
Then a DRE - finger in the arse - found rough and unexpected texture.
Then the 12 core biopsy. I did the prep, drove up, had it done under the local anesthetic, and drove back to the office for the rest of the day at work.
A general anesthesia of Valium would have been a problem for me - no one to help drive -

I didn't like it, but it was not near as bad as my last crown.

After surgery, mine was upgraded to a Gleason 4+5. All things considered, I didn't have much longer to wait before it would have become a much bigger problem. And I would not have known until it was too late in the game.

My personal, non-medical opinion is to suggest that you get all the information you can now instead of later.
Posted 6/7/2010 8:15 PM (GMT 0)
Waitman,,,,,

First and foremost, welcome. The guys on this forum are truley helpful. I to am new as of about two weeks ago. And as some of them can tell you, along with reading my past posts and replies that I received, I was out of my mind about getting a biopsy. I have not had ANY invasive procedure, minimally or otherwise since I was 5 years old. These guys got me through mine. I can tell you from my experience 2 weeks ago. I went in thinking it was going to be a painful ordeal.... I received 3 lidocaine shots. On a scale of 1 to 10.... my whole experience was about a 3. Everyone is different obviously and your result will vary.... (wow, I sound like a commercial). But seriously... the only discomfort I had was the last 2 samples taken. My PSA was 2.75, DRE was negative as was my ultrasound. Also no symptoms, but one of the coars was positive for cancer. I for one am glad I didn't wait. My Doc gave me some Zanax which I took about 1 hour before and that seemed to take the edge off.

Hope this helps!
Posted 6/8/2010 12:54 AM (GMT 0)
Waitman, you are very wise asking a lot of questions here on this great web site. My Uro Doc wanted to do the biopsy and of course I agreed. I thought it'd be performed in his office under a local but found out a couple days prior to the procedure that he does his in our local hospital and in the OR. I was totally out during the entire procedure. Correct, it is more expensive having it done in the OR but since my insurance picked up most of the cost, I'm happy that it was performed in that facility. Since I was totally "out" for the biopsy, naturally my discomfort was truly a zero on a zero to ten rating. Do have your biopsy and don't worry too much about it, just git er done. Please do keep us posted.
Posted 6/8/2010 1:40 AM (GMT 0)
Waitman, I am a total wimp when it comes to pain (even getting my teeth cleaned scares me!!). But, my experience with the 12 core biopsy was exactly the same as April6th. The only time I jumped was when the first core was taken - the "gun" makes a snapping sound. Has your uro put you on antibiotics first to see if your higer PSA is possibly due to prostatitis? It seems like a lot of uros try that first, before the biopsy. Anyway, if you have any doubts, or a family history of prostate cancer, go for the biopsy. Hopefully it will be negative and you can just keep watching annual PSA results. Squid.
Posted 6/8/2010 3:36 AM (GMT 0)
Your PSA numbers bracket mine, and you are close enough in age, a year, and also no symptoms, so I have some idea what you are going through.

You need a local anesthetic, not a general (generals actually carry their own set of risks) and you need the biopsy.
Wish I had a better answer for the last part, but even being an amateur doc, I have no hesitancy here.
If the Gleason numbers come out too high, like mine did, at least you know and then you take a deep breath before you select an option.
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