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2nd Thoughts - Biopsy

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Posted 1/7/2018 12:46 PM (GMT 0)
Hey

I tried to list my history in signature for context, hope it works.

I have had urinary symptoms for approximately 1 year. Restricted flow, getting up 2x per night, not sure if completely emptying bladder so get some dribbles. At times worse than other times, so fluctuates.

In any case, after reading of biopsy side effects and potential issues, having 2nd thoughts on biopsy scheduled in a few weeks.

Asked Urologist about PHI his response was that only comes into play with enlarged prostate or BPH.

I guess i am looking for advice or suggestions at this point.

Thanks.
Posted 1/7/2018 1:57 PM (GMT 0)
Most of us who've had biopsies had initial concerns like you're having. Will it hurt, or I might get an infection. I think after it's over that you'll realize it wasn't a big deal at all. I worried too before my first 12 core. It was a non event.
Posted 1/7/2018 2:06 PM (GMT 0)
TXguy

As with any procedure there is some risk, but the biopsy is a required step. I can personally tell you I had no issues from the biopsy. It was over fairly quickly.

I tried rapaflo for the emptying of the bladder. In my case it did not help. I ended up getting a camera inserted up my urethra which showed a very narrow passage in the urethra. I had a procedure called a Turp and now pee like an 18 yr old. I wish you the best of luck.
Posted 1/7/2018 2:12 PM (GMT 0)
TX: Biopsy is no big deal just do as the URO says for enema and antibiotics and all will be fine. I had no blood in urine, no pain, the only way I knew I had Had a 16 core BX was a slight discoloration of the semen for about 6 weeks.

Be well and really consider doing the biopsy as something is going on with your prostate.

Roger
Posted 1/7/2018 2:16 PM (GMT 0)
Like Everton said there's always some risk with any invasive procedure but I think the benefit far outweighs the slight risk of complications. Your PSA velocity is a cause for concern.
Posted 1/7/2018 2:25 PM (GMT 0)
Hi Tx,
I can relate to your having second thoughts about having a prostate biopsy. I searched
for reasons and tests I could have to avoid a biopsy. Ultimately though I did have one and discovered I
had Pca.

As you are doing I took the potential of having negative SE from a biopsy serious. There
is somewhere around a 3-5% chance (people use different numbers) of getting a bad nasty infection if doing the biopsy thru the rectum which most Urologist practice. If you get the Biopsy done thru the perineum the risk of infection is much much lower I think < 1%.
Some doctors do not use any pain deadening - you want to make sure if you do have a biopsy that
your Urologist does them "routinely" and uses preferably nerve deadening injection to kill the
pain.

Prior to having a biopsy - some (and this is what I did) have a 3Tmp-MRI which can identify
serious legions or tumors that maybe Pca - but still have to have a biopsy to confirm if it is Pca.
But, the 3TmpMRI can be used (fused) in doing the biopsy so that there is more certainty the identified tumors
will be sampled. In my case had the 3TmpMRI been negative for serious legions/tumors I was going to delay having a biopsy and monitor my PSA and get some additional evaluations.

You list your PSA as being 1.5 - 5 years back and now being around 5. Do you have PSA readings during those 5 years? PSA from Pca usually rises slowly in it's early stages.
The PHI test is a more accurate test than just PSA so not sure why your Urologist just relates it to BPH.
What does your DRE indicate?

Good luck and hope your evaluations do not show Pca.
Posted 1/7/2018 5:44 PM (GMT 0)
For your urologist to state that the PHI test only comes into play with an enlarged prostate or BPH shows that he is uninformed about the purpose of the test. You then have to wonder what else should he know, but doesn't?

As for biopsies, I had three with no issues, and two that caused pain for six months, tripling of my PSA, and hemorrhages within the prostate. Also, 3 in 100 result in hospitalization for sepsis, and 1 in 1400 results in death.

That's the scary part...the reality is that the great majority of men do not have such issues, just blood in urine and semen for a while.

If your tests lean towards needing a biopsy, and I would think that a 12% FPSA would warrant it, then you have to do it. Just follow all the instructions for prep and medication, and hope for a good outcome, both with the biopsy procedure and the analyses of the cores taken.
Posted 1/7/2018 6:35 PM (GMT 0)
Thanks to all for encouragement and reassuring comments. I have read and researched alot trying to make well informed decisions, maybe read too much and overthinking!

Busman - during those ~5 years PSA went from .4 to a 1.9. I just kind of averaged it out. My last check prior to the 8/17 test was 1.9 in 11/16. It was still below the 4 threshold so nobody raised any concern or question. DRE was unremarkable.

Busman & AsAdvocate - I too was a little puzzled by Uro comment regarding PHI, as that is contrary to what I have read while researching.

Thanks again.
Posted 1/7/2018 6:40 PM (GMT 0)
Txguy - Your stats are very similar to mine - and you can see in my signature where that took me. This does not mean that you will follow my path, but it is possible. The biopsy is the most straightforward way to know.

That said, and given some of your uro's comments, I wonder if the uro is the best one for you, given your stats. Unless this uro does lots of biopsies and knows their stuff surrounding PCa, you may be better served by changing to a more "with-it" or up to date uro for your ongoing care management. At least ask your uro if they use a "peri-prostatic nerve block." This is a simple injection into the nerves within the prostate. Once it is given, within a minute or two there will be absolutely no pain felt when the biopsy samples are taken. It is kind of like when the dentist injects novocaine and than can drill a tooth with no feeling of what he does.

If your uro does not routinely employ this sort of block, do not accept any substitutes -- period. I have only had one biopsy (with nerve block), but I have had a trans-perineal marker implant procedure performed without nerve block, and I wouldn't do THAT again.

As for the risks. . . they may be real but they are small. The vast majority of us have made it through trans-rectal biopsies without issues. Heck, after mine, I took the wife out for lunch and then went back to work. I felt a bit "swollen" down there, but no pain. I had no blood in stool or urine, either. Semen? Technicolor like a slasher movie, but it went back to normal within a couple of weeks.

Just pick the right uro and do the biopsy. That's currently the best way to know if you do have PCa. Your stats, especially the PSA rise and low free PSA, are concerning.
Posted 1/7/2018 6:52 PM (GMT 0)
I agree with Paxton that you may wish to find a different Uro. He obviously has no idea what PHI is. f you like, you can forward him the following:

/www.accureference.com/phi/

Its entire purpose is to avoid unnecessary biopsies for prostate cancer.
Posted 1/7/2018 7:45 PM (GMT 0)
Paxton - thanks again for insight. I recall urologist saying lidocaine would be used to numb the area or prostate. This was ~mid-Dec and very brief comments and info as we were walking to front desk for scheduling, after the ultrasound.

Tall Allen - thanks so much for comprehensive link. That is consistent with my research reading also.

Appreciate the info and support.
Posted 1/7/2018 8:08 PM (GMT 0)
I had the similar symptoms prior to my biopsy, which I later found out were caused by an enlarged prostate and a "growth" partially blocking the urethra. Uro never mentioned that, even though it was clearly noticeable on the ultrasound.

Both RO consults picked it up right away during a standard ultra sound( assuming standard is an ultra sound with a probe up your ass)

Because of that physical anomaly, the normal swelling after the biopsy caused blockage, resulting in pain and discomfort and not being able to urinate, it was a miserable experience. I was angry that the URo never mentioned that was a likely possibility.

The biopsy itself was a non event and over in seconds, although I did take a pain med, valium, antibiotics, and the site was numbed prior to the act

If I were you , I'd would mention your concerns about that possibility.
Posted 1/7/2018 9:34 PM (GMT 0)

Txguy said...
I recall urologist saying lidocaine would be used to numb the area or prostate.

A nerve block is different from just using lidocaine in some random place. It involves finding the nerve where it branches and feeds into the prostate, so that the entire nerve system in the prostate gets blocked. I've had a periprostatic nerve block and can attest that it makes all the difference. There is another one called a "pelvic plexus nerve block" that I read is even better. You have to ask for these by name.
Posted 1/8/2018 1:39 AM (GMT 0)
Thanks alot Tall Allen I will ask urologist exactly what the planned procedure is in regard to pain management.

Great information, i really appreciate it.
Posted 1/8/2018 1:33 PM (GMT 0)

TXguy said...
Thanks alot Tall Allen I will ask urologist exactly what the planned procedure is in regard to pain management.

Yeah -- and if he says "the lidocaine will do fine" - RUN!
Posted 1/11/2018 1:11 AM (GMT 0)
It is worth finding a urologist who does this right. I didn't. I got a 14-core with zero pain relief. They offered me a Valium 10 minutes before getting on the table. I laughed aloud, which they didn't take well.

My wife was there, and I just about crushed the bones in the poor woman's hand.

I can man up for the burn of the 3-month Eligard injection. If, heaven forbid, I need another biopsy, I'm bringing noise-cancelling earphones to muffle the gunshot-like sound and I'm finding a doc who does nerve block.
Posted 1/12/2018 12:42 AM (GMT 0)
".....ask your uro if they use a "peri-prostatic nerve block." This is a simple injection into the nerves within the prostate. Once it is given, within a minute or two there will be absolutely no pain felt when the biopsy samples are taken...." That is a must.

Also Valium the night before, the morning of and one hour before. Be sure your are as clean as possible with the Fleet Enema.

Doing the MRI first allows for the Fusion Biopsy so the doctor can target the areas of concern instead of shooting in the dark, so to speak.

Don't let the fear and anxiety stop you. It will be over before you know it and your will be fine.
Posted 1/18/2018 1:54 PM (GMT 0)
Thanks all for encouragement and support. Decided to get one last PSA test prior to biopsy on 1/24.
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