Introduction & biopsy bleeding question

Newby here -- first post! I've read for a couple of weeks before posting and I really do appreciate the support this site provides!! Thanks!!!

CT scan for another minor health issue revealed "mildly enlarged prostate" in August. I'm 51 years old, no prostate cancer history in family. For probably 8 months I had noticed thicker and lower volume semen. In late July, "the feeling associated with needing to urinate changed". Can't really describe it, other than that way.

General doc put me on 14 days of antibiotic cipro after me telling them that I had some urological symptoms because of the CT scan results. PSA was 0.86 18 months ago and 0.80 three weeks after ending the 14 day cipro regiment. Symptoms did not change with cipro. I took PSA and CT information to urologist (my first visit with him) and he felt a ridge during the DRE. He didn't see anything on the CT scan (calcification or stones) to justify that ridge, so he wants to do a biopsy. He did say that CT scans were not the best way to diagnose prostate issues.

Even though he said 70% of the biopsies at his practice are 'in office', he recommended doing mine at the hospital under a 'colonoscopy type' general (I had met insurance deductibles for the year). Honestly, I was expecting either "it's normal aging process" or "you need a different antibiotic" instead of "biopsy land", so I wasn't probably thinking real clearly during the visit, so I didn't question why he was strongly suggesting the hospital.

I did schedule both the biopsy in mid-november and a results meeting 9 days later.

Anyway, I decided to get a second urologist's opinion because the biopsy seems a bit aggressive to me given my history and PSA and I can always cancel the biopsy. Your ideas?

Secondly, about the bleeding to expect if I have the biopsy: I know to expect blood in "all outputs" for a while, with semen being the last to clear up -- could be 6-8 weeks afterwards. Should I expect some spotting type bleeding when not doing 'restroom functions' (e.g. should I plan to bring pads to wear after the biopsy?) For about how long afterwards should I expect that spotting type bleeding to last?

Undiagnosed, perplexed and somewhat scared...

Welcome Alan! The biopsy is not painful at all just "uncomfortable".
I have had 3 of them. I was a little surprised to see a pool of blood on the paper mat I was laying on after the last one but it was a 12 core biopsy and the others were 6 & 8 core.

The only blood I saw after leaving the office was in my semen for about 6 weeks. It was a very strange color red. After that I protected the sheets until it cleared up.

Bill from Florida

Get a 2nd opinion, not sure why a biopsy is even recommended? Especially one in a hospital setting?

I think you have it correct about the bleeding. Biopsies can be easy to hard, in terms of pain. I chose to get it done under sedation, and have no regrets.

Feeling a lump or ridge is sufficient to warrant a biopsy. Period. But get a second opinion (ie: another DRE from a second doctor). Your PSA is fine

Mel

Alan B, I would agree that your first uro's approach appears to be rather aggressive given the PSA number and your family history. Your decision to get a second opinion from another uro is a good one. In the end, the go-ahead on the biopsy will be your call especially if the second uro disagrees with the first.

After the biopsy, you will be sent home with a pad stuck to your rectum. In all likelihood, the pad will reveal very little or zero blood when you get home. A week to 10 days prior to the procedure, you will be asked to stop all blood thinners (aspirin, advil, even vitamins, etc.) to minimize the bleeding. Since you asked, don't bring pads, they will provide it. Best wishes on your next check up!

Hello Alan and I'll also welcome you here, although hoping yours is a temporary visit.

In my opinion based on the combination of symptoms that didn't clear up with a 2-week course of antibiotics as well as the finding of the DRE - I would search out a urologist that has a significant amount of experience with examining men w/DRE.  I would also look into having a transrectal ultrasound done that may also aid in understanding where you're at.

With respect to the biopsy itself it seems to vary from man to man.  For me I decided the trip to la-la land was in order.  Then, post biopsy I had blood in urine and semen, both have a reddish tint and yes in my case the urine was clear in a few weeks and the semen took a few more after that to clear up.

Best to you, and keep us posted.

An "abnormal" DRE trumps a low PSA reading...With your low PSA, your Urologist probably feels that any cancer will be small and hard to find so he is recommending the saturation biopsy so you don't have to return for a second or even third biopsy later on....The "lets find out now for sure approach"...Great, as long as your insurance does not squawk..

Welcome Alan B, hope your visit here turns out to be a short one... You have the right idea with getting that second opinion. As others have said, PSA is not the concern, but the DRE ridge is.

My 12 core biopsy was done in the urologist office, pretty much as lapilot described, but I wasn't given any Valium. My experience wasn't very pleasant on the pain side, not sure the doc waited long enough for the numbing to take effect, but that's seems to be the exception. My brother had one done, by a different urologist, a few months after me, and had a much easier time.

As you mentioned, I did have blood in "all outputs", during the act, for few days, but for me nothing that required pads. I could have used a pad post-biopsy, but all the office offered me was some tissues to wipe up with, and sent me on my soar bottom way (I'm sure they would have given me some pads if I asked). My bottom was pretty uncomfortable on the ride home, and I was glad my wife drove me, it allowed me to periodically lift my butt up off the seat.

Be sure to come back and share with us the results of your second opinion.

Thanks! Just an update: I have a second urologist's opinion and DRE scheduled for November 1st. I'll post his findings, and I'll also post what I decide on the biopsy.

The original urologist did not say anything about a saturation biopsy, but I figured he might have been thinking that he would take more samples along the ridge in addition to the normal 12, so it might be better if I'm in "la la land" as someone else expressed. Maybe not saturation but more in the 18-20 range? But that was not said nor was it in his report to my general doc.

I'm trying to stay positive and all, and trying not to let it do a mental number on me.

Oh, one more question -- I have a desk job. If I do the biopsy, should I plan to take a some days off afterwards? Do you think I'd be too sore to sit for long periods? It's not like I can't get up and walk around, but I'm mainly at my desk. Just didn't know how long I might expect the sore axx to last.

Thanks again for the help and support!!

Hey folks! Saw second urologist today. He didn't feel any ridges and didn't recommend a biopsy or anything.

So I have two differing urology opinions....

Joy, joy...

Congratulations, Alan. It sounds like you avoided an unnecessary biopsy. It sounds like you also found a good urologist in the process who doesn't believe in sending men down a path towards unnecessary suffering without good reason. Over-biopsying has been a big problem.

- Allen

My friend had RP 4 years ago. The doctor felt a ridge but his PSA was low. Like me, he was very glad he had a biopsy.

I was not lucky enough to be in the 75 percent of those who have negative biopsies. I sure wish I had, but that was not in the cards. Although I was one of the unlucky in the 25 percent I am very happy I had the biopsy and stopped a disease process before it got out of hand.

Each case is different. You never fully understand the implications of your situation until you live through it. My DRE was negative and PSA less than 4, but I had an aggressive cancer that was getting started and left unchecked would have rolled over the top of me. My friend had little or no PSA but the doctor felt a ridge.

Sure wish I had been in the 75 percent category, but glad I found out before it was too late. My internist told me 75 percent of those with negative biopsies are pissed off at him for referral, but the 25 percent with positive biopsies are forever grateful.

I just wanted to post an update for completion. Maybe it will help someone else. Very thankful for the support and hint from this forum.

I decided to get the biopsy done. The second urologist just did not seem as throrough as the first guy. And since early detection gives options for treatment, I decided to adopt a "better safe than sorry" approach. Also under consideration was the doctor's recommendation for sedation and that I had met my insurance deductible this year already. Waiting until next year would cause me to have to meet the deductible again which would double my 'out of pocket' cost. PSA looks really good, but doc felt a ridge during the DRE.

Prostate biopsy Wednesday under 'conscious sedation' at local hospital OR on 11/13/2013. Prostate size 40cc. 18 cores taken, which the urologist seemed to indicate was standard for a "prostate that size". Nothing looked odd on the ultrasound - no stones which might explain the ridges he felt on the DRE.

Hints from this forum: have tylenol and water in car and take immediately upon leaving. Take pillow to sit on. Someone else drove due to the sedation but it might not be a bad idea to have someone drive if you do the office procedure since your butt will be very sore, and it's nice to be able to lift your butt off of the car seat, recline the seat or have the option to sit on one side. Especially if you have a long drive.

I walked in hospital outpatient surgery area at Noon. Discharged around 3:00pm. Procedure started at 1:30pm, I was awake in recovery at 2:10pm or so and awake but "in and out" before that. Very much like a colonoscopy, if you've had one of those. Remember absolutely nothing about the procedure at all. Butt VERY sore upon awaking. Had to urinate before discharge, but it was normal (no blood). Main problem with urination was just not having any liquids that morning (sedation requirements). No pain or burning on urination.

Restrictions from Doc: No driving that day (due to sedation), no exercise and no sex/********** for one week. "Take a couple of days off from work". I had already scheduled an appointment with his office to get the results when I made the appointment for the biopsy. No aspirin, ibuprofen or Alieve for a week. Tylenol only.

Kept continuous tylenol going but started to cut back to one instead of two on Saturday morning. We'll see how that goes for discomfort. Most of the discomfort seems to be in the evenings. Haven't felt like I needed anything stronger for pain.

Blood in stools happened for first 2 or 3 times, but amounts were not large. However, I have a tendency to develop fissures back there so I suspect this was more from a fissure/hemorrhoid aggravated by the maneuvering of the ultrasound wand, than the biopsy itself. That bleeding disappeared by Thursday evening. I had Preparation H and nupercanal ointment readily available. I would strongly recommend using some type of fiber supplement or stool softener to prevent straining. Anything raising the pressure down there still hurts 3 days later!

Blood in urination - started Thursday (around 30 hours after the procedure) and was "peeing pink" for entire stream. This has been "off and on" but oddly enough seems to be worse in the evenings. Not sure if this is from activity during the day or not. Friday evening it started being pink at the very first when beginning to pee - after starting, stream becomes normal color. Drinking more fluids than normal just to keep things flushed out.

Pain - left hospital at 3:00pm with very sore butt. Would not have wanted to be at work that day (desk job). Ate dinner in stages across a few hours just to be cautious from sedation. No nausea or anything like that. Pain seemed to lessen around 6 hours after the procedure ended. Still kept continuous tylenol going. Friday, some discomfort when sitting (I wouldn't want to sit any length of time on a hard surface but probably could have worked) but most discomfort is when
the pressure is raised down there. Coughing hurts.

I decided to take Wednesday (test day), Thursday, and Friday off from work prior to the test, since I didn't know what my reaction would be. I could have probably worked (desk job) Thursday but it would have been hard sitting. Could have worked Friday with few problems, but I just did light stuff around the house. With doc's warning about no exercise for a week, I wasn't exactly sure what would constitute that level of activity, so I decided to be conservative - no yard work or anything heavy. Did errands and walked at the local mall Thursday. More errands Friday. Plan to be back at
the office Monday.

So far, no signs of infection. Monitoring that situation.

Awaiting test results....

-Alan

51 yr old, PSA 0.86 and 0.80 18 months apart.
Ridge felt on DRE. biopsy 11/13/2013, prostate size 40cc
Currently "on pins and needles" awaiting results. Results appointment 11/22/2013