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Posted 8/28/2014 10:46 PM (GMT 0)
There may be another thread for this but I have looked so please move me if need be. I am posting in regards to my husband and will try to be brief but need opinions and answers from those that have been through this. Two weeks ago first PSA 4.1 He has some ED and constant urge to urinate day and night. My husband is 53 and was sent to the urologist yesterday. Urologist took urine specimen and did DRE. On DRE said prostate was only slightly enlarged and certainly not large enough to be throwing the 4.1 PSA number. Immediately said he needs a biopsy of prostate which is scheduled for next week. All according to urologist "only has 20% chance of it being cancer", "biopsy will cause no problems", "because of his age this needs done NOW". I've read any and everything I can on this subject and immediately felt this is being overly aggressive. Why not take another PSA? Why is it being rushed this fast? Should we have the biopsy? From what I've read the PSA test is not very reliable and varies from lab to lab and even catches cancer that will never even turn into anything or is not aggressive. I guess what I am asking is 1. Should we do the biopsy? (I know you guys aren't doctors and it's your opinion from personal experience) 2. Should we be freaking out over this? Any and all comments are welcome and appreciated.
Posted 8/28/2014 11:04 PM (GMT 0)
Typically they would prescribe a course of antibiotics to rule out a chance of infection. Certain activities prior to a PSA test can also bump up your numbers. I'm not a medical professional, but it does seem like the biopsy is being rushed to me.
Posted 8/28/2014 11:26 PM (GMT 0)
You may be interested in reading the posts on another thread that addressed the question of over-biopsying:

Over-biopsying

I assume he refrained from sex and bike-riding for a couple of days before the PSA.

The AUA does not recommend routine PSA screening before the age of 55. If the Uro felt lumps on the DRE, that might be different. PC doesn't usually start with urinary symptoms, but prostatitis does. I agree with Michael_T that antibiotics may help rule out infections by susceptible bacteria at least. I don't understand the cause for the rush either.

- Allen
Posted 8/28/2014 11:44 PM (GMT 0)
When will you get the results on the urine sample?

Whether it is positive or not, you don't need to rush into a biopsy based on a single mildly high psa.
There are dozens of reasons he could have a 4.1 psa.
A inflammation or "itis" , that may not even be bacterial in origin.

At a minimum wait 3 months and retest. Pay attention to his day to day urgency or need to urinate.
See if it calms down for days or weeks at a time. His current frequency is not normal.
Has it been that way for weeks... or months?

Stay hydrated but don't flood yourself.

Personally I wouldn't give it a second thought to wait a few months before retesting. That advice EVEN if he is given a antibiotic in the interim. Even after a possible infection is addressed, it can still take time for a prostate to calm down.

Yes, it sounds like the urologist is rushing things. Who knows the motive?
Also know that many men have PSA results that vary wildly from test to test.
Others are more steady.

Look at this video, especially around minute 4:45 discussion of psa and jumping to a fast biopsy.
http://www.medscape.com/viewarticle/804988
Posted 8/29/2014 12:14 AM (GMT 0)
4.2 is high but not high enough to push the panic button..First, I would try a course of antibiotics over two weeks and then do another PSA test. See if there is any response to the drugs..If his PSA does not respond, then you might consider a biopsy or just do wait and see..Have another PSA test in 4 months and see what the trend is...

As for the biopsy itself, properly done, it's a quick, painless procedure done in about 10 minutes...It does involve inserting a well -lubricated wand into the rectum which is uncomfortable and embarrassing but not painful..There will be some bood in the urine and ejaculate afterwards...But at least you know (with 90% certainty) whether or not he has prostate cancer...

If you wish to learn EVERYTHING about PC, read Dr. Walsh's book "Guide to surviving prostate cancer"...

There is a lot of noise on the internet about "over-treating" PC..Here are some facts to ponder.

1) One in 6 men will be diagnosed with PC in their lifetimes..
2) The sooner PC is detected and treated, the better your survival chances..
3) about half the PC detected is Gleason 6, a low-grade, slow growing type that is seldom if ever fatal...It needs little if any treatment. But many men choose aggressive treatment anyway. This is not the fault of the PSA test..
4) The other group, about 100,000 men a year, have more aggressive cancer that needs treatment to cure it or to extend survival hopefully until they die from something else....
Posted 8/29/2014 12:17 AM (GMT 0)
They didn't even say anything else about the urine sample after he did that. They did another blood test but only to check his T-level because I mentioned he has low T and has for years. His urine and ED symptoms have been going on for I know 7 years (that's how long we've been married). He did not have sex or ride a bike before the PSA test, in fact we didn't even know the family doctor did one, he had went in for a staph infection on his lower back and he prescribed him bactrim for that and did the blood work. I'm going now to read the article listed and the video listed. I appreciate each of you responding. It makes me feel like I'm not being paranoid that this urologist is rushing this. It felt to me like he had his mind made up before he ever set eyes on him that he was going to do the biopsy.
Posted 8/29/2014 12:28 AM (GMT 0)
Low-T... Has he been taking anything for that the past year(s)?
Posted 8/29/2014 12:30 AM (GMT 0)
This is just a personal observation and probably has no medical value but it seems to me many men diagnosed with PC have "low T" also.....The two seem to go together...

Ask your PCP to refer you to another Urologist for a second opinion..That's your prerogative..
Posted 8/29/2014 12:33 AM (GMT 0)
I agree with the others here. First of all, the symptoms are not at all typical of PC. They are typical of prostatitis.

A course of antibiotics for 4 weeks and then a retest makes more sense.

While a biopsy is a routine procedure, it is not without risk and should not be taken lightly.


Mel
Posted 8/29/2014 12:40 AM (GMT 0)
You've already got some great advice here AR! In my opinion you are doing the right thing by questioning an invasive procedure, and looking for alternatives.

I would love to have you come back here and tell us it was just an infection! Follow your heart, there is no right or wrong decision, just different paths we take...

All my best to you!
Posted 8/29/2014 12:41 AM (GMT 0)

compiler said...

A course of antibiotics for 4 weeks and then a retest makes more sense.
l

The problem with 4 weeks on antibiotics, followed by testing, is that over half of all prostatitis is caused by non-bacterial things.
The antibiotics will have minimal effect on those inflammations that are non-bacterial in nature.
Some inflammations just need time. A few months at the very least.
Many of these inflammations are asymptomatic and cannot be felt by the patient, yet produce significant jumps in psa.
Posted 8/29/2014 1:35 AM (GMT 0)
Let's see, he's been diagnosed w/ the low T for 5 years but has not taken anything for that because the risks outweighed the benefits on that because of a strong family history of heart disease and his high blood pressure (it boiled down to basically being afraid of taking something for it because of the side effects, whatever it was they wanted him to take was this stuff like a deodorant that you put under your arms). Would the urinalysis find the prostatitis? How do they check for that? (I can look it up though), @adjust thank you for your kind words and encouragement! In fact thank all of you. There is just so much information out there and it's all different and we really don't know what the best choice would be. I just read an article that was posted in the thread suggested above about the mortality rate 120 days after a biopsy now that has me nervous (I'm nervous anyway). You all are so good to even talk to me. I think it boils down to just needing to hear opinions and talk to people who have been/ or are going through this. I hate that any of us have to be here in the first place but such is life. I am definitely going to keep all of you posted and please be patient if I just want to whine (oh no a crying female lol) but I just feel scared and defeated. My husband is my best friend and if I could take it on myself instead of him I would. I wish I could take all his anxiety and worry and put it on me. You guys are the best for sharing all your information with me!
Posted 8/29/2014 1:57 AM (GMT 0)
Was the urine specimen taken after a thorough prostate massage? Sometimes such urine samples are taken in 4 separate batches (called a "four cup test") because they are trying to localize just where in the urinary tract the infection is coming from, but sometimes they take it all in 1 batch. A lot of Uros won't do it because it so often comes up negative. As Franklen said, prostatitis is often not caused by a specific bacteria, and antibiotics may not resolve it. Prostatitis may just clear up on its own if you wait, but it sometimes it comes back. It's a very hard disease to diagnose and cure, but a very common one.

There is a new test (a blood test) called the Prostate Health Index (PHI) that is covered by insurance that does a better job, albeit not a great job, of separating the PSA caused by PC from prostatitis and BPH. Here's a link you can show your Uro. You may have to call them to get a list of Uros approved to do the test (don't ask me why they do this!):

Prostate Health Index (PHI)

Deaths from biopsy sepsis are exceedingly rare and should not be a concern. Because of antibiotic resistance, the rate of infection is now about 7% last I looked.

- Allen
Posted 8/29/2014 2:15 AM (GMT 0)
My one thought is that the biopsy is not the same for everyone. I did not consider it benign at all. Despite pain meds and an anti-anxiolytic, it was very uncomfortable for me.

Pain persisted for almost a week. I also developed ED after the biopsy for a bit, but I can't rule out stress as a cause there.

And, FWIW, I'm one of those people who had low T and then "lost" the biopsy lottery. Cause and effect are not established. Correlation between low T and PCa does seem to be established.

Nonetheless, I hope antibiotics work, or a different test rules out PCa, or a biopsy finds nothing. The odds are probably still in your favor.
Posted 8/29/2014 2:21 AM (GMT 0)
No prostate massage. Urine specimen was taken as soon as he walked in the door. The DRE lasted (I am not exaggerating) 10 seconds---max. (I was there when they did it). I am not even sure what is covered right now as we are in between on insurance right now w/ medicaid. We went from BCBS insurance that was costing us 400 dollars a month w/ a 6,000 deductible, his pay got cut and we qualified for affordable healthcare which will also be BCBS but we are waiting on insurance cards so right now have medicaid until we get insurance cards. I don't even know what testing we can get or if we can even get a second opinion. All I know is they tell us if something is covered. If we were still on our original insurance we would not be able to do anything because 6000 dollars might as well be 6 million to us. He was also concerned about an event that happened in 2008. My husband had back surgery and as soon as he got out of surgery the nurse came in and said "We liked to have never gotten the catheter in, he needs his prostate checked", as soon as he recovered family physician did a DRE said it felt fine but urologist thinks something may have happened when they were trying to get the catheter in.
Posted 8/29/2014 2:29 AM (GMT 0)
Catheter insertion is a frequent cause of infection. With any luck, the antibiotics will clear it up.
Posted 8/29/2014 5:45 AM (GMT 0)
Welcome.

No reason to freak out, absolutely not.

Very well could be a simple prostate infection at first. Under his circumstances, surprised the urologist doesn't order a round of antibiotics, then re-take the PSA test again, before ordering a biopsy.

The old standard was to do a biopsy if the PSA rose to 4.x or higher. Sounds like his doctor is going by that standard.

Good luck ahead, and hopefully you won't need to stay at this group. But if you do, you have found a great place for both information, first hand experience, and of course, support.

David
Posted 9/3/2014 1:48 AM (GMT 0)
Just thought I would fill you guys in. Hubby has decided he's going to go ahead and have biopsy done. If he doesn't he will just dwell on it and worry about it so would rather know what's going on, so looks like Thurs. (4th) he will go in and have the 12 cores done (are they cores? I know they are punching his prostate w/ the needle 12 times). He's extremely nervous and just talked to someone today that had biopsy done and developed a horrible infection. Did anyone have any complications from the actual biopsy? Still holding out hope that he's going to get good results, either way I know where to come if I have questions, need advice, or just need some encouragement.
Posted 9/3/2014 2:28 PM (GMT 0)
Don't want to make this worse for you or him, but, I had my biopsy done in a hospital under full sedation (I was totally out). Within 24 hours, I developed an infection. Called my urologist immediately (at night) and was prescribed antibiotics which quickly kicked the infection. Yes, infections can occur but they are not the norm, and mine was quickly taken care of with antibiotics.
Posted 9/3/2014 9:06 PM (GMT 0)
Hi,
Just to chime in the the other side: my husband was understandably worried about biopsy itself, but afterwards he said it was not comfortable but not very painful. He started having more pain during and the doc upped the pain med, then things were ok. Afterwards things went fine too, no issues other than manageable tenderness.

Also on the other side: his PSA went from 2 to 29 in a year, the biopsy results were G9. Maybe if he'd been biopsied earlier things would be different. So that's something to think about in your situation too (I wouldn't have posted this if you hadn't said he's decided to have the biopsy).

Good luck!
Carolyn
Posted 9/21/2014 6:51 AM (GMT 0)
Just checking in w/ everyone. Biopsy is done and we go back Thurs. (25th) for results. Nerves have taken a toll on me so I have developed an ulcer worrying over my husband. No problems w/ the biopsy at all, everything went well. I don't know why we have to wait 2 weeks for results. Why can't they just call and tell us yes or no. Did anyone else have to wait that long for results? We're grown so whatever it is we can take it, it's the waiting that is making us crazy. They pushed his biopsy back a week because doc was in emergency on the 4th so biopsy was done on the 11th. Will let you guys know what we find out.
Posted 9/21/2014 12:31 PM (GMT 0)
Here's wishing you and your husband the best.
Posted 9/21/2014 1:49 PM (GMT 0)
I think you were wise to choose to have the biopsy. Even though its not pleasant, it answers some questions and gives you more information.

Get a second opinion if you have ANY concerns about the doctor you are seeing now

Yes, the waiting for results is difficult, but you will also want to spend some time to consider your options once you get the results. PSA tests and biopsy provide information, but DONT rush into any treatment.
Posted 9/21/2014 2:02 PM (GMT 0)
Glad the biopsy went well. I'm not sure why you have to wait so long for the results either -- I'm guessing it's because your doc wants to tell you in person and that was when an appointment was available. My approach was different and I offer it for your consideration. I asked the doctor to call me with the results as soon as they were in. He did so and gave me the bad news over the phone. That allowed my wife and I to gather ourselves, do some research and then arrive at the follow-up appointment poised ad ready with a ton of questions rather than sitting there with the blank stares we would have had if we were just getting the "news" then.

Anyway, good luck.

Jim
Posted 9/21/2014 9:52 PM (GMT 0)
Just saw your post. I am glad the biopsy went well. I, too, had no problems with the biopsy. You and your guy do need to relax. The majority of biopsies are negative and even if there is a positive find, you have time to contemplate your options and there a number of options. Don't let anyone including the docs rush you into anything.
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