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Posted 12/29/2016 8:44 PM (GMT 0)
Hello Folks my name is Jim and I'd like to ask a few prostate biopsy questions. First of all my PSA was 6.9 on September 2nd 2015. As of December 20th 2016 it is now 14.8. I had a DRE and was told it was smooth. I also did a new test called a 4K score blood test that came back saying I had a 95% chance of aggressive prostate cancer. SO I have a biopsy scheduled for next week and it doesn't sound like a pleasant test.... Is it painful and if so how are the next few days after the procedure? I was also told that my FREE PSA is 7.8 does this mean that I absolutely have prostate cancer? I'm hoping it doesn't but the gloomy look I saw on my urologist face told me what you all are probably going to say. Anyway I'd love to hear from some that have had similar numbers to mine. Thanks in advance and I truly appreciate it, oh by the way I am a 54 year old guy probably 30 lb's heavier than I should be.

Jim
Posted 12/29/2016 8:56 PM (GMT 0)
Bummer for you. Yes I'd be very much thinking that a cancer diagnosis is likely.
Brother and I both had biopsy with the same doctor using the same technique. We had it done in the exact same room!...
He went out and ate and I believe he may have even taken in a movie after his procedure. I on the other hand had my wife drive me home and I was somewhat uncomfortable for the rest of the evening.
Best of luck!
Hero
Posted 12/29/2016 9:05 PM (GMT 0)
Uncomfortable but necessary. I asked them to knock me out right away and they complied. smile

You have found the right place, read the stickeys at the top of the page.
Posted 12/29/2016 9:50 PM (GMT 0)
Hey Jaydubs-

you are in the best place to start learning this stuff-

regarding the biopsy- I have had three of them over a period of about two years- looking for a reason for my high PSA

first one occurred on new high PSA of 6.24, 12 cores, no cancer

~year later, PSA = 14.8, 19 cores, no cancer

at this point, my URO placed me in finasteride to reduce prostate size and see of PSA goes down- at 6 mos out, PSA = 10.6, at 12 mos out PSA = 6.8- seems to be working..

8 mos later, PSA = 19.4, MRI fusion biopsy (where they use MRI images to place the pins in suspicious tissues), 31 cores, cancer all over the place and Gleason 10; now everything is different

two points I would make: first, the local anesthetic works fine- the procedure is of course not comfortable, but really quite tolerable overall;

second, and very important from my experience, what to do if you get a negative result? I do not have an answer for that; since prostate cancer is not an overnight development, it is highly likely I had it even on my first biopsy, my bad luck the pins missed the tumors; the transition zone of the prostate is harder to hit in biopsy, and it is a less likely to be a cancer source, but my third biopsy and the MRI showed plenty of tumor in the transition zone-

this study showed a false negative rate of ~30% for the standard 12 core sextant biopsy
/www.ncbi.nlm.nih.gov/pmc/articles/PMC3668408/

it also mentions another study on 20-core procedures that showed ~10% false negative rate

so, given a PSA of 14, a free PSA < 25%, and a high 4K score, I would get in line for an MRI right away if you get a negative on the biopsy-

best of luck to you guy, nothing is writ in stone yet

here's to fightin'
rf




my URO voiced the opinion that I had Gleason 6 cancer in the early years that was missed by the biopsies, then some mutations happened to turn type 3 cells into type 5 and it grew big time in the last year (one zone of the prostate was actually a 5+3 Gleason 8, the other three were 5+5 Gleason 10s)-

so stuff happens- but the MRI fusion biopsies can minimize the shot in the dark aspect of placing biopsy pins; I believe they are recommended only as second biopsies after a negative and after PSA continues to go up; insurance may not cover an initial fusion procedure- but maybe that is changing--

good luck to you
Posted 12/29/2016 10:00 PM (GMT 0)
I'm sorry that you have to do this. Necessary but not fun. For me the biopsy was not a big deal. The anesthetic worked very well. Each time my doc took a core sample there was an unpleasant feeling but it did not hurt. After he removed the apparatus, I felt no pain or even significant unpleasantness. I remember thinking, as I walked to the car, how amazing it was that this highly invasive procedure had left so little residue. Nonetheless, I was glad to have my wife driving. Good luck, and try not to worry too much about this.

Post Edited (fiddlecanoe) : 12/30/2016 6:23:46 AM (GMT-7)

Posted 12/29/2016 10:06 PM (GMT 0)
I had my biopsy 10/2016.

It really wasn't bad, the device they use makes a click each time the needle takes a core. The click was a little odd feeling, but it didn't hurt at all.

For me it was unsettling having blood in my semen afterwords, it is normal, and passed in a couple of weeks.
Posted 12/29/2016 10:22 PM (GMT 0)
None of those things tell you you have prostate cancer, but they certainly increase the probability that the biopsy will find some.

I found the biopsy to be very painful (I've had 3). But many guys find it merely uncomfortable. My last biopsy was a breeze - here's why: they used a nerve block. This means they locate a specific nerve using the ultrasound probe and inject lidocaine into it. That's different from the more common "local" injection where they just inject some at a random place. There are two kinds of nerve block: periprostatic nerve block or a pelvic plexus nerve block (I had the former). Sometimes they start with a lidocaine suppository or brush the inside with a lidocaine gel, so you won't even feel the pin prick. The nice thing is that I was fully awake and alert, but felt no pain whatever. If you want this, you have to ask for it. It may require a different urologist.

The antibiotic before, during and after is very important. And if you've had a lot of that antibiotic in the past, let your doctor know - you don't want a resistant infection. Sometimes they swab the inside with povidone iodine. Be alert to any fever in the week following.

Afterwards, you may have a little bleeding from the rectum, and maybe a little soreness when you sit. You might have some bleeding into your urine for up to a few days. You certainly will have lots of blood in your semen. For me, that lasted up to 4 weeks before it worked itself out. It starts looking like you are ejaculating pure blood, and over time develops a brownish tint, and finally beigish. It's not something you or a partner will want to see.
Posted 12/30/2016 12:26 AM (GMT 0)
I had a biopsy a couple weeks ago, I also have hemorrhoids, that was the bad part As others have said the test isn't bad, they give you a numbing agent and about the only thing you feel is the pressure. Although I did have one sample that kinda hurt but was tolerable. Also what Tall Allen says, you come blood. But that's normal
its the waiting afterwards that really sux. Good luck to you
Posted 12/30/2016 12:38 AM (GMT 0)
Hey Jim, sorry you have to join us, but welcome.

My first biopsy was a piece of cake because they put me out and when I woke up I was wondering when they were going to start and they were already done. I just love how that stuff works.

My second biopsy was a targeted biopsy with the MRI/ultrasound and they wanted me awake for that one, which I didn't realize until they were wheeling me in. Rough surprise. I had a hard time with all the digital exams that I was getting in the prior 6 months because I found them to be extremely uncomfortable (I would whimper so much some times the Doctors would feel so bad) so being awake with all that stuff going on in my a** was very unpleasant to say the least. They gave the shot of lidocaine to the prostate which I could feel the needle going in, ouch. Then I could feel it way too much with each core they took,. They could tell I was struggling and asked if I wanted more lidocaine and I told them just give me the maximum, so after another shot and a few minutes the rest of the time I was fine. They could of had a party in there and it wouldn't have bothered me (actually I had so many people involved behind me because they were working on some newer techniques with the MRI/ultra sound overlay and it also is a teaching hospital, so with that many people watching my a** I thought they were having a party).

So my thought is if they don't knock you out make sure they give enough of the lidocaine, and TA's thought on targeting the lidocaine sounds great. But don't let my experience worry you, I have heard from so many that were awake for all of their biopsys and had zero issues.

No issues after for me but as someone mentioned before I had blood in my semen which they told me might happen. But I was not prepared for the amount of it and the way it looked. It really freaked me out at first, it was just like ejaculating all blood.

Anyway best of luck Jim, keep us posted...Jim
Posted 12/30/2016 12:58 AM (GMT 0)
Hi, Jim, and welcome to the club. I had my first (and only) biopsy last July. I was fortunate in having read many posts here, so when I set up the appointment for the biopsy, I specifically asked if my uro used a nerve block. He told me he always uses it. Still, I was a total basket case for the weeks between my high PSA reading and the biopsy. In the end (pun accepted), my biopsy was a non-issue, totally. The anticipation was far worse.

Unfortunately for me, the first time was the charm. We found enough cancer to warrant my decision to move immediately to treatment. I won't overload you with all that I went through to decide, but when you get to that point in your journey, come on back and a few of us can help you through some of the process. Your test results and scores do point to a different pathology than mine, but the general process of learning and discerning treatment choices is broadly the same.

Sorry you have to join us, but welcome to The Waiting Room - the virtual room where many guys await their own turns to take the journey.
Posted 12/30/2016 1:16 AM (GMT 0)
Welcome !...for me the biopsy was no big deal.....yes, I was worried ...and when he did the first core sample I about jumped off the table....not from pain , but just startled . I had 12 samples taken and it was over in less than 10 minutes ....please don`t worry about it too much . It is over so fast and you will be walking out of the facility saying...Ok...whatever ....another new experience .....Happy New Year !!! ~ David
Posted 12/30/2016 2:04 AM (GMT 0)
Fear creates pain...its pretty much as simple as that...I can already tell you will need something to allieviate the "pain"...do it...You got cancer...no bout a doubt it in my opinion...doesn't mean its agressive...odds are in you favor...it is not... ps get to the gym...lose some weight...what else you got to do...it will ease your worry and make whatever ts you choose go smoother...Oh stick to cardio...I know...I know it s boring...what I tell folks that say that to me as a reason/excuse not to...the boredom is a reflection of...
Good luck in the season ahead...
Posted 12/30/2016 2:55 AM (GMT 0)
Welcome to our club, let's hope your stay is brief. The typical TURP biopsy is unpleasant, but not freaky. I think the worst part for me was the ultrasound probe. Do they lube the thing? Here's how mine went, as I recall...Go in, do paperwork, get in the room (having had a couple doses of cipro to take the night before and that morning, plus a fleet)...PA comes in and says, "I see you're allergic to penicillin" yea, I said. So she leaves and come back with a syringe. I roll my sleeve up and she says, "nope", come over here and drop trou!. THAT hurt. And it hurt for a week. The biopsy itself took about 5 minutes. Then home. I passed a big blood clot a few hours later, and peed blood off and on for about 3 days. Then the wait. I had my biopsy on a Monday, and I got "the call" on Friday the same week.

And the rest, is history. When you get your results, come back and share them, and we'll be here to help you understand them and take whatever the next steps are.
Posted 12/30/2016 3:35 AM (GMT 0)
Assuming you are having the rectal biopsy -

For me, it was a non-event. Local anesthetic only, a weird sensation, and then the clicks and it was over. I drove myself to and from the appointment and then worked from home the rest of the day. I could have easily gone in to work (office job).

As others said, be sure to take the meds in advance.
Posted 12/30/2016 4:32 AM (GMT 0)
Wow, I guess i was REALLY lucky with my Prostate biopsy. My Uro Doc had me taken to the operating room were I was put under general anesthesia. Quickly went to sleep and woke up and it was all over.
That was, of course, performed in a private hospital.
A nurse at my VA hospital told me that I was very fortunate to have the procedure like that because at the VA, the entire procedure would have been accomplished in a Doc's office. After effects were very minimal other than passing a bit of blood when taking a leak or pooping.
Posted 12/30/2016 5:07 AM (GMT 0)
Jim, the biopsy was not bad, I felt pressure as he took his samples. I was given some lydocain which actually made me so woozy that I felt that I might pass out. Ask what to expect afterwards, bleeding in your stools is normal.
Posted 12/30/2016 2:12 PM (GMT 0)
All I got was a Valium for my biopsy which proved to be completely insufficient to control my pain reaction. After the first three punches I was hurting so badly I started to sweat. Knowing what I know now, I would have insisted the biopsy be done in a facility where I can be lightly put under like you would have for a colonoscopy.
Posted 12/30/2016 4:12 PM (GMT 0)
you're gonna do what??

no way.

put me under.
Posted 12/30/2016 5:40 PM (GMT 0)
Halbert Our numbers are similar. Gleason score 6, 3 of 12 cores cancerous, 14 % max, all on left side, PSA 5.6, CT and bone scans clean, tumor T2. How are you doing now?
I've elected to go with Active Surveillance, cannabis oil, nutrition and homeopathy for 90 days the do a repeat PSA.
If things don't improve I'm thinking radiation. My uro says Cyber knife is over rated. Will know more when i meet with nutritionist and radiation folks on Jan 10
Posted 12/31/2016 12:49 AM (GMT 0)

Akbear49 said...
My uro says Cyber knife is over rated. Will know more when i meet with nutritionist and radiation folks on Jan 10

That's because he is a surgeon. He should read the research and then discuss it. (Based upon the research, CyberKnife appears to be as good as any radiation therapy, and better than most.) You should discuss any thoughts of radiation therapy with a board-certified radiation oncologist.

Personally, if he persists in pushing his opinion, I'd find another uro (but that's just me, and my uro was very open about CK, even referring me to the CK RO that I eventually chose).
Posted 12/31/2016 1:09 AM (GMT 0)
I agree with Paxton my URO said sugary or radiation either would be cureative for me and even called the RO and we met him in the Uro office within about 30 min after my dx but I was treated at a teaching hospital. UAB in Alabama.. I think if he is pushing sugary and discounts SBRT he is doing you an injustice.
Posted 12/31/2016 1:14 AM (GMT 0)
Dang cell phone autocorrect makes me look like a can't spell at all.
Posted 12/31/2016 1:26 AM (GMT 0)
Totally agree with above posts by Paxton and Chipmaker. SBRT is beyond what mosts urologists learned in Med School.
Posted 12/31/2016 6:30 AM (GMT 0)
I just had a prostate biopsy on 12/14. very very Unfortunately, I got an E Coli infection in my blood and urine afterwards. I was hospitalized for 3 days due to the infection in my blood. I am still on IV antibiotics (home care) for another 10 days and followed by oral antibiotics for another 3 weeks. The biopsy procedure was not painful, I drove an hour back home by myself after procedure. The most important thing is the antibiotics you took 24 hours before the procedure can prevent the infection. In my case, the antibiotics (CIPRO) The doctor gave to me can not kill E Coli (bad luck). So I was getting sick (chills and shaking, then fever 103 F) one day after the procedure. My advice to you is to watch out your temperature frequently after procedure, if you start to feel chills and shaking. Go to ER immediately.
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