New to the Forum. Looking for some positive..

Apologies in advance if this seems rambling..I’m having my first prostate biopsy next Monday. I’m nervous about the process and more nervous about the potential results. I’m turning 49 this month. My first PSA screen that I can remember was a 3.1 back in May of 2022..my second one was a 4.1 this past June of 2023. At that time the Dr believed it was due to an enlarged prostate. I had been having some minor issues with, urinating often and sometimes with urgency. I also didn’t feel like I was emptying fully. Was prescribed Flomax. It seemed to combat the “not fully emptying” feeling.

Forward to last month (December 2023), I had my annual physical and he said my PSA jumped to 5.1 from 4.1 in May and referred me to a urologist. I met with the urologist last week and he performed a DRE. After the DRE he noted that there was “something”, assuming a nodule..I should have asked more questions but I was in shock..He also wasn’t certain if it was on the rectal wall or the prostate itself. I had a colonoscopy in September 2022 (no cancer, just some non cancerous polyps) and informed him of this. He then seemed to think that it was more than likely on the prostate and recommended biopsy. When I asked what the chances were of cancer he said “I don’t like to say. We won’t know definitively until the biopsy results come back”. ..that was that.

I’ve been in a state of extreme anxiety ever since. There is no prostate cancer or cancer that I’m aware of in the family (not that this seems to matter). I’ve also read so many different things online about the possibilities that my head is spinning (I know..Dr Google never a good idea). Could it be some type of module from BPH? Something else? What can I do to calm my nerves?

Thank you all in advance. I’m happy to see there are these types of forums out there.

Thx for the info. No MRI discussed. Straight to biopsy.

JPS1 - First, MRI is really a good idea and now standard practice when anything is suspected. Second, it is important that the urologist have the fusion biopsy equipment that permits the ultrasound data from the biopsy probe to be overlaid on the MRI image for more precise targeting if possible targets are noted on MRI. PAdude explained it pretty well above.

I was not sure on your exact timing but Flomax and other prostate meds will depress PSA so your tested 5.1 PSA could be significantly higher if you were not on the meds, many say 2X as high. You should determine which values were influenced by Flomax and compare.

Welcome to the show that never ends. Even if you are clear, PCa is permanently on your radar screen now and you will be reminded often enough about it as you get older. We all share that common bond and know what you are going through. Please try to relax a bit and wait for someone to tell you something is wrong before assuming the worst. Easier said than done, I know but you can try.

JPS1, welcome to the forum, sorry you need to be here, but glad you found us. This is a very knowledgeable, as well as supportive, group.
I 100% agree with Mumbo, the MRI is an absolute must. Do not let your urologist talk you out of it,.
I had my first biopsy in 2013, and it was negative. No MRI. In 2015 I had another biopsy. At the time, MRI was not yet accepted standard of care. However, my Urologist at the time, was pretty up to date, and he scheduled me for an MRI, actually a few months before we decided to do another Biopsy. Sadly, with it not being SOC, insurance turned it down
For that reason, he moved me from 6 month PSAs to 3 month testing. The next test PSA took a jump, and he did another biopsy (without the benefit of MRI. I got "lucky" they found cancer. And he told me, likely, it was there and missed in the first biopsy. The MRI would have seen it.
So settle for nothing less than MRI Guided biopsy

As far as anxiety....no easy answer. When I got here in 2013, before being diagnosed, I was out of my mind. I was 64 years old, an age at which PCa was more common than at your age. And my dad had PCa. When I came back, in 2014 (might be off by a year I don't even remember exactly anymore, except I know my surgery was Jan 2015), with a positive biopsy, you can imagine how crazed I was. GUESS WHAT! i'M STILL HERE, AND LIVING LIFE TO THE FULLEST.
The vast majority of PCa is highly treatable, and even in advanced cases, very manageable for years, even decades. As evidenced by the many guys who are and have been here. One other thought - a nodule, is a nodule, until proven otherwise. We all have nodules all over our bodies. I have 3 nodules on my kidneys (aka cysts). So yeah, could it be cancer? Sure. But it's not necessarily cancer or anything else of a sinister nature.

We know it's tough, we've all been where you are now. Waiting and the uncertainty and anxiety that comes with it, is the hardest part. Hang in there, you may not have cancer, but even if you do, it will be treatable and you will be fine.

Stick around, ask any questions you may want to ask, everyone is here to help.

You guys are great. Thank you.. I should have come here sooner. All of the stress induced googling nearly brought me to my knees. I’ve been on here less than a day and I’ve already learned more than in a weeks worth of culling through both oversimplified and over complicated internet articles on the topic.

To answer some questions, I believe it’s going to be transperineal. I will be awake. Don’t know how many samples are planned. In terms of my location, I’m in Fairfield County Connecticut, about an hour drive or train ride into mid town Manhattan. I’ve considered trying to find class act urology facility in NYC of which I’m sure there are many. If anyone has suggestions, please feel free to share. I would definitely not mind going into the city vs local if the quality of physicians and care is in a different league.

JPS1…All I can add is my belief that the very best practitioner and team can make a big difference. Keep asking questions. Best wishes Terry

Hello, JPS and welcome to our forum. Sorry you have to be here but please know that we are here to help and will get you through this. Maybe your tests will be negative and your stay with us will be short. But, if not, please know that PCa is slow growing, treatable and it's likely you will have a long and healthy life even if you have it.

As the others have said, the standard of care now is to go through some other tests and/or treatment prior to proceeding to biopsy. For example, some urologists will treat for possible prostate infection first to see if the PSA drops. And certainly many will suggest an MRI prior to biopsy for the reasons by friends listed in earlier posts on this thread. So, at the very least, you should ask your doc WHY he is proceeding to biopsy w/o MRI since it will be random sampling done rather than any targeted sampling.

Having said this, still the only known way of determining for sure if you have prostate cancer is via a biopsy. Should you proceed on Monday please know that for most men this is a relatively painless and routine procedure that ends quickly. Mine was done under IV sedation since my doc believed in pain free medicine. You could also ask about this possibility.

Your biopsy results will be in terms of what are known as Gleason scores. You can consult the sticky threads at the top of our forum for more info or simply Google the term. In any case, once your results are known we are here to help you interpret them...of course your docs are the final authority. And, should your results indicate treatment is needed, we can help you assess what is right for you. Remembering that urologists are typically surgeons and they typically suggest surgery...while various radiation treatments may also be viable options.

Anyway, good luck as your proceed. As I said, we are here to help you.

Jim

Vince - This is good information for JPS1.

I was going through PCa diagnosis in 2018 also. My urologist was quite clear in our first meeting that the preferred approach was MRI first and go from there. He indicated that he had good luck getting MRI first approved but many urologists around country complained at meetings that they were getting insurance company denials all the time for MRI's before biopsy. The odd thing was it was easy to get a MRI after a positive biopsy which did not make sense with modern MRI technology.

In my case of rising PSA history, DRE noted "ridge or nodule", and family history, he said that we would schedule MRI with biopsy scheduled a couple of weeks later as he suspected the MRI would not be negative. He was right and called with the results, and said we would do biopsy on schedule. I was pretty sure that he normally would propose the MRI first and then schedule the biopsy if anything unusual showed up for those with the more marginal situations.

So my vote is for around 2018 that things started changing in practice. However, those that did not live in larger metro areas and/or near major medical universities may have not been part of the newer "state of the practice" methods nor had the more advanced MRI technologies locally available which is why it takes years for widespread usage to take hold across US. Of course, there is usually a cost attached to all of this which slows things down.

Now, I think the move is to get PSMA/PET scans into the diagnosis stage since they can detect a lot more than MRI's. Saving this technology for just after treatment recurrences is a waste of technology in my mind.

JPS1 - Hope this discussion helps a bit. It sucks when you first get into this adventure and all you want is for it to end. Take a deep breath and approach this like you might look at other things in your life. Just another problem to solve with a rational approach.

Somebody said...
When you go to your appointments, take a spiral notebook and pen. Write down questions you have before you go, and leave space to write down the answers

One thing I've done is printed out the NCCN guidelines and highlighted and marked them up with my specifics. They tend to hit the main questions I would ask the doctor, so in my visit I ask the docs to amplify the comments or help me understand what exactly my T score is, for example. It provides a good mechanism to move the conversation forward.

https://www.nccn.org/patients/guidelines/content/PDF/prostate-early-patient.pdf

Write stuff down too! I tend to brain-dump after visits.

Yale sounds like a great option to be seen by a world-class facility.

JPS1 said...
Thanks CentralPAdude. So you had a history of weak stream? I’d classify my urinary issues as mild, but I’ve had for probably a year now. I believe my GP said during a physical years back (maybe in 2020?) that my prostate was slightly enlarged based on a DRE. I’m trying to confirm that through old records.

I keep seeing online that PCa rarely has symptoms unless late stage. So I’m hoping any symptoms I have, are related to BPH.

Definite history. One thing I'll note, the BPH symptoms are like the frog in the pot that is slowly heading for a boil. You don't realize how much they had come on until they were gone after my HoLEP procedure.

You are young to join the club, and BPH can go with increased PSA. The odds are in your favor here. Fingers crossed for you!

I know it's nearly impossible not to worry in your position. But you should keep in mind that many (most?) biopsies come back negative. Among those that come back positive, many are not dangerous and do not require treatment. Among those that require treatment, most patients receive either surgical or radiation treatment, and that is the end -- cancer cured.

JPS1, welcome to HW, and you will find good information on this site as you begin your journey. Hopefully it will be a short journey and then on to other issues. Keep us posted as possible.
Michael

I truly appreciate all the helpful information. I’ll definitely follow up regarding the biopsy procedure.