Going for a biopsy

Hi,

I'll be 45 years old in a month and for the past year or so I felt some changes in me, mainly weak urine stream and ejaculation, sex drive and less energy. I thought of as aging but I made an appointment with my GP to make sure and she order a PSA test and the result came in very high 39.4. I was refereed to a urologist and he did the DRE a week later and he said my prostate is hard as a rock and I need to do a biopsy. I did another PSA test right after the DRE and the result was also high at 37.1. He was confident over 95 percent that I have cancer based on the PSA level and it has metastasized based on my lower back pain. I have to add I have had back pain and lower back pain for the past 14 years and I mentioned it to him. He was still for spread of cancer.

So I thought I get a second opinion outside Kaiser which is my insurance. The 2nd Dr also confirmed it's abnormality.

As you all know it was a shock. I haven't been able to sleep or function at all for the past week. I have two very young kids and they give me hope and somehow an escape from this nightmare.

I have my biopsy scheduled for this coming Thursday.
Anyone on this forum knows any great Kaiser urologist in LA/OC area? Should I sent my biopsy to another lab? Is Kaiser a good place in general to receive treatments?
I asked because I have never had any major health concern and I have always been very active in sports. I still work out 4 time a week.

Appreciate it guys.

Welcome Steve, sorry you had to seek us out.
Sure sounds like a high PSA, and combined with an abnormal DRE (which should only be done AFTER PSA blood draw, not before, as that can raise PSA results), it's worrisome.

Nevertheless, only a biopsy can confirm cancer. For now though, just know, that even if advanced, prostate cancer can usually be treated as a chronic Disease. So you aren't going anywhere soon, plan on being round for your kids. We have one member here, Todd1963, who was diagnosed with PSA in the thousands. 10 years ago, and he's still doing well.

Re the biopsy, note that after it's done, you will likely have some blood in your urine, and your semen will be scary to look at, very deep blood red, which will over a couple of weeks turn lighter, browner, tanner and then back to normal. This is totally normal. If I didn't know to expect this I would have freaked out, and my doc didn't warn me. I knew only because of the guys here.

Good luck, keep us posted.

I can see how you'd be alarmed, but I wouldn't jump to any conclusions just yet. Typically, uros will give you a course of antibiotics prior to a biopsy, but not sure if that ship has sailed for you. The other thing I'd point out is that there are many, many things that can cause back pain and they are much more likely than PCa mets. (For example, I've had back pain for more than 10 years and it's caused by stenosis, not my PCa.)

I'm not a doctor, but my non-medical opinion (anecdotally, based on lots of folks on this forum) is that your odds of having PCa are definitely less than 95%. And the chances of mets are even less.

Good luck to you and hope we can help!

Prostatitis is usually negative for infection.

No problem waiting a month.

You are right Elsa68 but I assume he thought DRE wouldn't change the result much since it was initially very high.
Tall Allen, I was looking for the sign and symptoms of prostatitis and couldn't find the hard or rock hard prostate. Is that how the prostate feels in DRE in case of prostatitis?

SteveJ,
Welcome to HW. I'm so glad you have sought out a more experienced uro. That first one did you NO favors and obviously has you in a state of near panic, with good reason.
My DH had a psa of nearly 2000 @ dx, and he had plenty of back issues way before he had mets from PCa. Those back issues masked his met pain. Your back pain is probably back pain. Your urinary issues are probably from prostatitis. One thing that may indicate weirdness unlike PCa is that your second psa dropped some after the DRE, when it should have gone up just from having the DRE.
Try to stay calm and wait for the better doc. It's easier said than done, but those here, especially TA know more about PCa than most GPs. IMHO.
Keep us posted, and if it all turns out to be a big scare, you can go and call that first mean ole uro a big ninny for making you fret. Even if you do have cancer, he should not have scared you with prognosis not based on evidence beyond pain that could be attributed to a whole host of other things!
Beth

Your weak urine stream is another prostatitis symptom, fingers crossed it's that and not PCa.

Steve,
Hope your doing okay after the Transperineal biopsy. What was the pre/post procedure antibiotic recommendations. I understand the procedure just wasn't aware of the recommendations regarding infection prevention.
Read all you can over the next few days so that you can asked the appropriate questions Monday.
My best to you.... Sorry about your numbers
Good luck!
Hero

SteveJ2017 said...
After researching a bit online about my back condition which is ankylosing spondylitis I found out there is an association between noninfectious chronic prostatitis and Ankylosing Spondylitis. That gave me a little hope but when I met my urologist today he said he is not aware of it and asked me to wait in the room for about half an hour so he can research it.
He came back and said he couldn't find anything about this association except a very old research and I have to do the biopsy right away. He performed the Transperineal biopsy and took 14 cores.

Some research suggest up to 80 percent of AS patients have noninfectious chronic prostatitis. Anyone on this forum knows about this?
I guess I'm trying to be hopeful here even though 3 urologists have told me that's not my case is not a prostatitist.
I'll have the biopsy results on Monday.

I have been on AS for eight years, and I haven't read anything about a percentage of men with prostatitis. What I have seen are articles mentioning that there does not appear to be a causal relationship between BPH and PCa.

What is certain is that 100 percent of the men in any AS program have cancer, and, given the average age at dx of about 66, many of them will have BPH also.

OK - I was responding to your second paragraph.

I have no knowledge of that form of arthritis.

So I got the devastating news. Here are the results:
Left posterior 4+3 70%
Left base 4+3 60%
Left anterior 4+5 60%
Right posterior 3+4 90% perinueural invasion identified
Right base 3+4 90%
Right exterior 3+5 85%
Is there any chance to manage this? I'm not an expert but the numbers are really high. I didn't get a chance to the urologist because he was busy and I couldn't wait longer.

Steve,
I had 10 of 12 cores positive, My brother had 6 of 12 positive. Post-operative my pathology was 4 -3-(7). I had a large tumor volume. I'm doing well.

I usually feel that the recommendation for advanced imaging is overrated however I believe that in your case I would want to have it to R/O skeletal or pelvis disease.

If your pathology was not originally looked at, at a major medical center you may want to get a second opinion.

So very sorry to hear this news.


My Best

Hero

Hi Steve,
I 'm sorry to here the results that you have just received. I'm sure that many will suggest that you send your slides to Bostwick or Epstien. The directions to do that are in the sticky for newcomers.
Your numbers are very close to mine except the volume is a little higher. There are many here that are G9 's that are doing quite well. I was initially going to have surgery, but was not a good candidate. So the next option and the one I really had decided was the best for my Dx was the triple play IMRT+BRACY+HT. This is really a treatment that has shown to have the best results for High Risk guy's like us.
I was not able to have the BRACHY because of my urinary issues. What I ended up doing was 2 Yrs HT + 40 FRACTIONS 79 gys IMRT +Docetaxel chemo which Iam currently doing now.

I was told by many in this group that slow urinary and low ejaculation volume were not symptoms of PC. But they can be for a small select group. I had the same exact issues. Those issues are what made my doctors recomment that I don't do BRACHY because seeds can cause severe bladder issues with some one that already has been experiencing them.

You are quite a bit younger than I. I was DX last June at 59. Because of your age things may be different as far as your treatment. Keep studying and resaerching and get more than one second opinion and find the best Drs you can find. I live in a small town in Washington State and I traveled to Seattle for second opinions yet have ended up receiving most of my treatment right here in my home town.

There are many thing that are available toyou Steve. You have some time to get your second opinions and find a good group of Drs on your team. See not only a Uro but also get advice from a radiation oncologist and possibly a Medical oncologist. Now thwt you know what you are facing it's time to be diligent and be your best advocate. We here at HW are here for night and day. Ask question,vent, rant , whatever you need to do we will listen. So sorry you have to be here with us but you have found a brotherhood of Brothers that are all fighting this together. Keep us up to date and I,m sure the smarter guys will show up soon or already have because I type so slow.

The Artistic One - Mark