The Accidental Patient

Hi All,
I have been lurking this forum since I was given a PSA test during a physical without my knowledge a few months ago.

I am a 45 year old man and was told by my PCP my PSA was elevated to the tune of 6.7. He suggested that I take the test again in a week to eliminate any errors. It came back at 6.6, so not much difference. I am asymptomatic and besides having being pre-diabetic, I am relatively healthy.

Two weeks later I was sent to the urologist and he gave me a 10 day prescription of cipro to eliminate any bacterial infection. I retested my PSA thereafter at a different lab. That result was 7.0. This can be interpreted as higher or simply rounded off my last result.

My urologist suggested a biopsy. I was desperately trying to avoid that due to the fears of pain and infection so I asked for a MP-MRI. Unfortunately, it discovered a small Pi-RAD 4 lesion. Now I have been scheduled for a biopsy next week.

I had a second opinion with another urologist. He gave me a DRE which he felt was normal and pegged my chances of actually having prostate cancer at 50%.

I am scared as hell. I have a young family and I want to be around for them but I am concerned about over-treatment. I've done my research regarding this from the federal task force recommendations and Richard Albin's Prostate Hoax book while also reading up on this forum. As much as I would like to avoid the biopsy and hope this tumor never effects me, I know I would not be able to sleep knowing I might only have 10-15 years left on my life.

My urologist instructed me to take Cipro days prior to the biopsy. He indicated he would give me a sedative ("like two martinis") on the day of the biopsy and I had to ask him if he would provide a prostate block shot. He said he could which would indicate he wouldn't normally? Is that normal?
The urologist whom I got a second opinion said he would have put me under anesthetic as I am young and it might be too painful. From my understanding, doing this would require a hospital room and that would complicate insurance matters?
I'm just trying to mitigate the pain and anxiety. Thanks.

First off, I like the title...accidental patient indeed.

Second, even if (and it's a big if) you do get diagnosed, there is NO reason to believe that you won't live long enough to die of something else. Absolutely none.

Let's look at some more of the data: If you get diagnosed with a G6 or G7 cancer (by far the most likely), you may not need treatment for years. Even if you do need treatment, now or later, you're still probably in the 95% who never need anything beyond primary treatment.

So, get the biopsy. Be prepared to pee blood for a few days. And for blood in your ejaculate for up to a month. It will be progressively darker red over time. It might freak both you and your wife out.

And then, a few days or a week after the biopsy, they'll tell you the results. And then come back and tell us what they are. You'll do fine.

One more voice agreeing: pain/discomfort-wise, biopsy is no big deal. Mine was done under local, it was perfectly adequate. For me, the ultrasound wand up my butt was more uncomfortable than the biopsy gun. You can’t make rational decisions about further treatment without a biopsy at this point. Just do it.

I never trust people who say 13 needles stuck up my but is no biggie. They offered my brother in law general anesthesia. I told him they never offered it to me. He said...."You've gotta ask for it. If you do....they'll give it to you".

So, that's what I did. And that's what they did. They never questioned my request.

Island time—
Your wisdom knows no bounds! What can I say. I had a dental deep cleaning recently under local that was much more painful than the biopsy. Maybe the indignity of the procedure adds to the fear factor.
Your reference to my 13 cores makes me sorely regret I didn’t choose “5 of 13” as my handle, kinda like “7 of 9” in Star Trek Voyager.
SP.

Dnny,
I know it may be difficult for you to see right now, but that PSA test may be the best thing that ever happened to you. You may not have prostate cancer. You may have PCa that will require no treatment. If you do have PCa and it requires treatment you probably have caught it at a manageable stage.

Best of luck to you.

Dnny - I asked my uro and later my RO about procedures under anesthesia and they said that while it could be done that way it almost never is. This is because most clinics can do procedures under local on-site, while they often need to refer the patient to a fully-equipped OR to be able to use general anesthesia. I had my biopsy done in my uro's office.

The key, with TRUS biopsy is to ensure that the uro will use a prostatic nerve block, and that he/she is well-experienced in the use of such meds. If they have the experience to hit the right nerves, then the whole procedure is a lot like a root canal -- the first couple of shots are a minor pain, but after that, you feel nothing. Maybe a bit of pressure when each sample is taken, but that's it.

I, too, was very afraid before my biopsy. I asked my uro to use the nerve block - he said that he always uses it. The first two shots were just an annoyance - not more than discomfort. After that. . . no big deal. I still shy away from pain, but the biopsy was a big nothing. Right after the procedure, I took the wife out to lunch, then went back to work.

As for infection, it also pays to ask the uro if they ordinarily take a rectal swab in advance of the biopsy. They often do this to identify if your system harbors any bacteria that are resistant to the Cipro they usually give before the procedure. My uro took the swab a week or so before the biopsy and then was able to customize an injection of antibiotics to administer just before the biopsy procedure, along with the oral Cipro given the day before, day of, and day after the procedure.

NONE of this should in any way seem like any more than an undignified annoyance. Your chances of infection are probably less than your chances of hitting the lotto, and you know how likely that is. Just do it. You need to know what's in there, and biopsy is the only real way to know.

Since DX I have had DRE's that are more........painful, upsetting, embarrassing ?????????? than that Bx ever was.

I can only guess that I must be the "LUCKIEST" guy in the world. I have been reading quite a lot lately here at HW about the pain and risks of BX. I don't get it..........I don't understand it...................Do the prep protocols. Eat lite a few days ahead. Do an enema a few hours ahead. Take the antibiotic shot and take a pillow to sit on on the way home. I threw the pillow in the back seat as it was causing too much pressure on my ass. I drove 3 hours home after the Bx. No pain, no blood in urine just discolored semen for 2 months. But I did end up with PCa.....so all was not Rosey.

dnny-700 said...
These past few months have been horrible. I haven't been sleeping very well and it's been effecting me at home and work with mild anxiety attacks and depression. I just wish I was counseled or made aware of the PSA test during my physical. I had no idea what PSA screening was about and as soon as you Google it and hear "cancer", it feels like a death sentence. I am still very angry about my doctor and will probably replace him at some point.

Sleep is super important. And while bouts of anxiety and depression may be expected considering what you’re having to deal with, they should not go unaddressed. Please bring them to the attention of a doctor you trust. They’re treatable and don’t have to be borne stoically.
I think it’s vital to have a good relationship with a PCP who sees the whole you and not just the cancer patient. If you don’t think you can forgive your current PCP for ordering the PSA without telling you, move on and find someone else. But best if you can mend fences.

dnny-700 said...
Thanks everyone for the replies. @suttersmill, I believe my uro mentioned it would be an oral sedative.

In retrospect, I wish I just had skipped the MRI and got the biopsy earlier. The endorectoral probe insertion was unpleasant and the second opinion uro mentioned that might be actually worse than a biopsy.

These past few months have been horrible. I haven't been sleeping very well and it's been effecting me at home and work with mild anxiety attacks and depression. I just wish I was counseled or made aware of the PSA test during my physical. I had no idea what PSA screening was about and as soon as you Google it and hear "cancer", it feels like a death sentence. I am still very angry about my doctor and will probably replace him at some point.

Odds of getting prostate cancer in my age range is about 44 out of 1000. I've never been that lucky (or unlucky) in my entire life!

The fear and anxiety that comes along with an illness and cancer are real and in my own personal experience have affected my life greatly and I did not realize how much after diagnosis and treatment. All of the things that go through the mind of a middle-aged man struck down in the prime of life resonate - - loss of physical health and spiritual well-being, possible change or ability to physically love your spouse, loss of physical strength, loss of job and/or the ability to support your family financially. All of these things have happened to me over the last 5 years. Anxiety and depression affected my work performance and I was terminated from my job in 2013 when undergoing follow-up radiation therapy. I felt like everyone in town then knew that I had been treated for cancer and would not hire me as a result. I then started my own business and struggled financially for 2 years working as an independent contractor with 4 different part-time self-employment gigs. Then my father died of prostate cancer and had watched him struggle and fight through the last 10 years of his life. I witnessed the depression and anxiety that come with advanced stage cancer treatment. He often called me to tell me about his PSA and lament about how he wished he had done this and that in his retirement years.

After his death I was hired by a company which has helped stabilize my financial situation but still have kept my part-time self employment on weekends to pay down debt. Earlier this year just as I thought I was rounding the cancer-free corner my PSA started creeping up. My physical health and mental well-being was just starting to normalize and I've been able to pay off debt accrued after my career interruption. Now with my worsening prognosis, I have slipped back into the anxiety and fear of wondering what happens next and my wife and I talk about it almost daily.

Others in this thread have provided great wisdom. You willingness to post about your health and fears has helped me again put in perspective my life today. With both my Maker's and wife's help, healthcare professionals and sheer determination I have managed to make it thus far and learned to better put things in perspective. Like Andrew said above, you will very likely live a long time. Your may experience hardship and life will most certainly change to some extent - - even for the better in some ways. As Richard E. Simmons writes about in his book The True Measure of a Man, "we will learn to see hardship. . . as a true blessing in the development of our lives and our relationships with others."

@Rust, you've pretty much summarized all of my worries. Thank you. I'm sorry you had to endure more than most.

The last couple of months have been anxiety ridden and I definitely need to get some help for it at some point. Physically I feel normal but I've been in such a funk. It's just been really difficult to describe. Obviously, I'm just not enjoying life as I had prior to the physical. My kids' birthdays and the holidays.... I just can't revel in those special events and I wish that I could return to that levity. I suppose that is why I a bit resentful towards my PCP for getting me screened. Every trip to the uro seems like an endless streak of bad news: 1. Antibiotics didn't work! 2. MRI found a PIRAD 4 tumor! 3. You need a biopsy!

My father and grandfather lived to their 80's and died of causes other than PC which is why this all seems so unbelievable like a bad dream that I wish I could wake up from.

@Dogdays, yes this is wonderful outlet for my fears and frustrations. There is no one in my life currently that can relate to my situation. Nothing they can say seems to help. Just writing about it makes me feel a bit better.

Dnny, you're right, putting it down helps. What I did, shortly after diagnosis and joining this forum, I started a long thread that you can find in my signature, that I now update only rarely because, well, I'm "all but cured" (I can't call it cured for another year or so).

In there, I detailed a lot of my history, and my thought processes that led to my treatment decision. Something in there might be helpful to you.

Once you do the biopsy, and get the results, the answers will start to come.