Biopsy Time/ Questions

Hi Everyone,

I was on this forum around 6 months ago when my husband was going to have a saturation biopsy as his first biopsy. Realizing that he went to a cancer center for his first ever PSA and DRE with an RO, I had him step back a little and go to urologist for another opinion. His PSA at the RO was 5. I was never against the biopsy, just the saturation one out of the gate. Little did I know that the urologist didn't even go that route, he said he didn't feel the same thing (Spent way more time), but it was enlarged and slightly assymetrical.  I fully expected an appointment for biopsy not a month wait, but my husband was ok with it so he went a month on antiobiotic along with Rapaflo for symptoms(frequent urination and some burning which this did help with). His PSA at the urologist was 4.1 and free PSA at 24 before antibiotic, after it did go down slightly to 2.9? I of course still freaking out that men can have low PSA and advanced cancer would want to know. Thinking infection, Urologist said come back 4-6 months. Of course my husband ran with that at first, but since I was so worried he said that he would not wait that long. Of course he did and that brings us to the present. We went back and the DRE was about the same, but the phone call regarding the PSA was horrifying. It went to 6.3!! With all the reasearch on PSA doubling in such a short time and it signifying the worst, I am now a mess. I am so upset that this wasn't done 6 months ago and I blame myself for not pushing it. maybe I should have just let the saturation biopsy happen. If he had it all along and was aggressive, and that wait caused it to spread outside the gland, I will hate myself.  Of course his doctor is playing it down, just saying its time to find out. This doctor has great credentials, but the whole time I asked any questions, like retesting after the jump or lab error (of course still keep the biopsy appt), he got deffensive and said lab error would be 5(doesn't make sence?). He has been like this from the biginning with me. Not mean or rude, just not sure how to discribe it. I think I brought up PCA3 at some point and he shrugged it off, didn't believe in it.  I told him my concerns about more men getting diagnosed with advanced cancer, even with low PSA and normal DRE (albeit low) and told him of a freind of ours that had this happen. I think I got well, he is not related to my friend. Really! That wasn't the point. I really didn't dissagree all that much with the antiobiotic, but I feel the Doctor should have had him come back in after no more than 2 months.   My husband likes him, but also listens to any doctor at the time.  Cant go back in time, but these things stick with me. I want my husband to out live me, because I do not want to be on this earth without him, and I will do anything to make that happen. I am trying to stay optimistic, even with all the reasearch on fast rising PSA. 

He is having the biopsy in office tomorrow morning. He is a workaholic and thinks he is going to go back to work. I convinced him to come home for a while and see how he feels first. I am sure symptoms after the biopsy are different for everyone. No twilight or vallium. Of course I asked the doctor where they send the slides too and he said they have their own pathologist, and that he usually gets the results in two days. Isn't that fast? Of course I am curious to see how the slides are marked, but afraid to ask. have any of you asked to look at your slides before hand? Do they have your name, area taken ETC? I am paranoid that they get mixed up. I do know  if/when we need to have it rechecked with a second opinion, I would shoot for Boswick or Johns Hopkins hopefully? Why don't they just send it there to start with?

OK, strange question. Is it necessary to ejaculate at some point after the biopsy in order to clean things out. Will it hurt anything not too? He is on Rapaflo and not sure with the side effects of this drug anyway. Just curoius.

Here is a weird question for all of you. Why in the world do doctors/ nurses call patients on the phone with biopsy results? I realize if they where to call and say we need you to come in to talk about the results, it would be obvious. besides the emotional part, you then have a million questions. Maybe tell a couple to come in no matter if it is good or bad? Your driving in your car or at work, your phone rings and you get the news (especially if it is really bad). I know guys might react different but at that moment you have just changed someones life. I guess there is no better way? Might be bad idea, but we told him if he gets results on Friday, good or bad, to wait to call until Monday. We have holiday family parties this weekend and would like to be able to enjoy them. I doubt we can do anythiing over the weekend anyway. Is this a bad idea? We are in the Chicago land area. I am new, so I will work on a signature in the near future. I will still be praying for good news. Thanks for hearing me out.

PS: Casey59, If you are out there, please check your e-mail, I would love to hear back from you.

Nosywife

your questions are fine and normal.

I had 3 biopsies spread over 18 months, and in each case, I was able to go back to work fine at the time.

yes, there will be likely to be blood in the first 2-3 ejaculations after the biopsy, its gross to look at but perfectly normal. first time kind of spooked me even though I was prepared. I wanted it out of me, so it was clear by about the 4th time.

not all doctors call with biopsy results. my uro doesn't do it that way, all results were gone over in person several days after the biopsies were completed.

the only way to know what is really going on now, is to do the biopsy and hope for the best

good luck, I know this isn't easy for either of you

david in sc

If it is possible, my first advice would be to take 3 deep breaths, and relax a little. Generally speaking, prostate cancer is a slow growing cancer. A few weeks, even months does not make significant differences in the ultimate outcomes, so don't be so hard on yourself, or blame yourself.

The other thing I would observe is that the PSA tests may have been done at different labs. That alone can account for differences.

I would recommend you have a second opinion on your biopsy slides. There are several prominent labs around the country that you can have the slides sent to.

Lastly, I would recommend you try to listen to the doctor a little more. If you put the doctor on the defense, he/ she may interface differently with you. Ask your questions without implying that the doctor is wrong or misguided.

That being said, don't be afraid to get second or third opinions, or just change doctors if you don't feel you are getting the best advice.

Good luck on the biopsy. I had two of them, and I got up, wiped the KY off my butt, and went back to work. They really aren't all that bad.

Nosywife (GOODWIFE),

I like you did all the research before finding HW. We also made a fast decision to have RP, but one can never look back, and will never know if we made the right decision, look at stats below.

Keep researching and asking all the questions you want. We are all here for your support. I went and still do to all my husbands appts. and I ask all the questions as my husband is not assertive. Some Dr's can't handle that but it's too bad as it's you and your husbands lives, and Dr's need to realize it!

Keep positive and being the goodwife you are,and please let us know if you have any concerns, cuz we have all been there.

We are thinking of you both,

BOOGEE

Hi Nosywife...hey, better to be nosy that disinterested!!!

In response to some of your questions:

1.  Please don't beat yourself up.  What's done is done and all you can really do is be supportive and help guide hubby in the future.

2.  His PSA level is still not all that high and the chances are that if he has cancer it is slow growing.

3.  You should most defintely send his slides to a knowledgeable PCa pathology specialist like Epstein or Boswick.

4.  Don't ever forget that you and hubby are the customers...your doctor owes you answers and you should not be less than satisfied.  If you are not happy, then seek another doc.

5.  Maybe he will be able to go back to work, maybe not.  The reactions to biopsies vary.  His body will tell him.

6.  There is an advantaget to getting the info over the phone first before getting it in the office.  When you first get the bad news there is definitely a shock effect and you probably have not settled into reality mode.  My wife got the news, told me and then we spent the next couple of days researching the subject so that by the time we got in the doctor's office we were reasonably well educated and the doc could spend his time discussing the options, the realities, the future and answering our well thought out questions rather than being dealing with the shock of bad news.

Hope this helps and good luck.

Jim

Nosywife,

I have a question for you. Did the Uro give your husband antibiotics before this latest PSA? If the earlier higher readings of 5.0 and 4.1 were caused from BPH or prostatitis, 6 months could cause it to rise again from either of those. If he was not on the antibiotics before this latest test; I might suggest that he does try that, and another PSA test, just to see if it goes down again with treatment. If so, then it is probably one of those two ailments causing the higher readings.

If he was on antibiotics for this latest test, then I would be more inclined to think that the lower reading of 2.9 was an aberration. If, instead, the PSA went from 4.1 to 6.3 that is a much lower velocity. Not to make light of a 2.2 jump. That is still a fast rise; but much better than doubling. But you do need to realize that it is still a pretty low PSA, and that is good news. My own PSA went from 1.5 to 5.1 in 3 years, and I ended up with a pathology Gleason of 8; but nearly a year after my surgery, my PSA is still effectively at 0. Your husband having a PSA under 10 still gets you fairly good statistics with the Partin and Han tables even if; as in my case; you have a high Gleason score and Stage of pT3a. Catching the beast early is always a good thing.

So, I would check on that antibiotic question first; then take a deep breath, as suggested. You are doing the right thing asking questions. Just don't let the situation overwhelm you. You've got some good things going for you. Your husband is relatively young; that plays in his favor for recovery, should the outcome be PCa. You've caught the PSA when it is still under 10. That is a very good thing. You are educating yourself about this beast. That is more than a lot of people do. My Uro was pleased that my wife and I had educated ourselves; but he said that in his experience that was not the norm. And lastly, your husband has a good support in you. That is vital. I don't know how I would have coped without my wife in there encouraging me, and having my back during doctor visits when I was first diagnosed.

Keep your Uro honest. If he balks, find another one. But what you are doing is correct. Knowledge is key in this battle. And keep asking questions here. There is a lot of experience and wisdom here. You and your husband are on my prayer list.

-Bob

Mrs Nosy,

The chances are he will be fine if he does nothing. The majority of men do fine regardless of their level of 'activity' while they recover. But there are a few men who have problems and there is some reason to think that keeping the prostate busy can help. The main worry with a prostate biopsy is infection. The blood is harmless in itself and will eventually be reabsorbed. But the theory goes that keeping the prostate drained helps prevent infections from taking hold and/or persisting in the face of antibiotic therapy. Your husband will be on antibiotics for ten days after his biopsy. During that time the antibiotics need to diffuse throughout his prostate to kill any bacteria that might have been introduced by the biopsy needles. It needs to reach the bacteria that may be inside the ducts that carry the seminal fluid (that the prostate produces) to the seminal vesicles. If he ejaculates during the period that the antibiotics are in his blood then the prostate will replace the seminal fluid with newly excreted seminal fluid containing the antibiotic and his risk of infection will be lowered a bit.

Other questions -- is retrograde ejaculation safe? Yes. But it's less fun. If you think the idea will bother him there is no need to tell him but you might tell him that blood in his urine will be normal for several weeks because of the Rapaflo.

Hi Nosy,
Much has been said already so I will just add my little bit here.

I have had 3 biopsies, the last and final one was 10:30 in the morning. By 1:00, I was feeling just about normal so if your husband wants to go to work afterwards, he will probably be okay. I took the whole day off to be sure. The biopsy is uncomfortable and but it does not hurt.

I made arrangements with the doctor, at that time of the biopsy, to meet him in his office 1 week later to get the results. That was when he told me I had PCa. He explained things, showed me and gave me a copy of the biopsy results and told me some of my options. He also gave me some referrals for radiation, surgery etc. I really liked it that way rather than hearing it over the phone. Later I saw on the biopsy paperwork that he had the results for a couple of days before we met so he could have told me over the phone but waited until our next appointment. Now if the results were negative, I would have liked a call asap!! LOL!!!

Sounds like if you husband does get bad news, he will have many options to beat this thing.

Good luck tomorrow and when you get the results.

Bill

Yes, purge the blood-filled semen..A shocking sight...A second opinion on the slides is time consuming and expensive and not necessary unless a positive result is borderline...a small percentage of Gleason Grade 6 in only one or two samples...That should be double-checked by an expert. But say a sample comes back with several cores at 30% 4+3=7 Gleason, virtually all pathologists can accurately make that determination..As you have discovered, Urologists and Radiation Oncologists are seldom the best of friends..Prostate Cancer is big business and the healers will fight over your business (money)...

nosywife said...

Hi Again,

 DadOF12:  Not sure if this helps answer your question. He was not on the antibiotics at all the last 6 months. The 5.0 was at the RO lab and the 4.1 was at the urologist lab. Went to  2.9 after one month of antibiotic (was down from the 4.1 at the urologist still). The 6.3 at the same lab(urologist) 6 months off antibiotic. I think he was expecting that if it only went from a 2.9 up a slight amount it proved infection? But yes the 2.9 was after antibiotic ( with a high of 4.1 from the same lab) then the 6.3 on no antibiotic the last six months. Not sure if that changes anyhing, let me know? Thank you all again

Nosywife

Hi, nosywife.

What I was getting at, is if the high PSA readings are from BPH or prostatitis, then 6 months would be enough time for more PSA to build up from these conditions. I would think the Uro would have put him on antibiotics again the week before the latest blood draw, to be sure nothing else is responsible for a high reading again.

Regardless, hopefully the biopsy will reveal something, if it is there. If the results are negative, I would have another PSA test in 6 weeks or so (after the effects of the biopsy wear off), and take an antibiotic the week before.

I hope I'm making sense.

-DadOf12

I had the same Cipro for 2 days. Not to be concerned.
Bill

Hi, nosywife.

I was only on Cipro for 2 days after the biopsy, as well. They had me on it the day before, the day of, and then the two days after. I had no problems with infection. I think each doctor is probably different in how they handle this.

-DadOf12