Three newbie questions about biopsy & reversing psa

Walt:

I'm going to answer your questions:

1. No. It's not a big deal and does not take long. You're fine when it's over....you walk out of the office the same way you walk into the office.

2. No. You will have an ultrasound and needle biopsy. The tissue will be sent to the pathologist who will put them on slides and render a report.

3. There's nothing you can do. You have an elevated PSA times two during the past six months; therefore, prudence requires you undergo the biopsy. Your urologist is following good urologic medicine by ordering the biopsy.

By the way, I had four biopsies over an eight year period and know what I am talking about. Hope comments from a veteran of biopsies eases your anxiety.

Post Edited (SJC) : 3/11/2007 4:16:24 AM (GMT-6)

SJC,

Thanks very much for your direct answers to my questions and concerns.  Your response was exactly the type that I needed.

I have been taking some over-the-counter stuff for more than three months that promised to keep my psa in the healthy range.  Now that that failed, I am doubling up on it between now the Biopsy only because that is the only path that offers any other recourse.  For the small cost and large possible payoff, I am going with it.  When the time for the biopsy arrives, I will let you know my results.

So my future for the next two weeks is to get the biopsy at the urologist's office, and come back to this forum for some more guidance. 

The strangest thing during all of this was that I could not get a recommendation from my primary care physician (pcp) for an excellent urologist.  He was willing to give me several to choose from, but would not rate any with high marks.  I live in Pittsburgh PA, which has a large number of urologists.  My pcp has been affiliated with Shadyside Hospital for more than ten years so he has experience with many.  Are there any urologist in Pittsburgh that some of you may like to recommend?  The one I am seeing was a recommendation from a neighbor.

Dear Walt,

Not too long ago B and I were in the same boat. B had been taking herbs ever since his PSA started rising. It rose over 4 years, but the spike from 3.2 to 4.3 in one year caused the primary care physician to recommend a biopsy. Boy, that was not something we wanted to do! But, as he told us, PCa in a man of 51 years old can be fatal. So, we did a few things prior to biopsy. First, we went on a trip to Europe! Then we started some alternative therapy in the form of Reiki. Several sessions a week created a sense of calm, re-vitalization and helped both of us prepare for the procedure. Besides that, it can cure you, and we wanted to give it a chance. Once the biopsy was taken, with positive for cancer in 5-10% of 4 out of 12 samples in one lobe, we got serious about lowering PSA while we researched our options. We turned to a vegan diet. Check out the study done at SF State University and (I think) Sloan Kettering (or Johns Hopkins). They took 95 men who would not do regular treatment for PCa and put half of them on a vegan diet (no dairy, meat or fish), whole grains, fruits and vegetables, had them do moderate exercise, meet in support groups and do meditation. After one year, the protocol stopped or reversed evidence of cancer in the half to the extent that they followed the regimen. Of the other half, the control group, some had to go to conventional therapies due to the spread of the disease, and none had a reversal. Studies are now definitive in showing a link between PCa and high dairy fat and/or red meat intake. Nevertheless, if the mind/body connection, coupled with genetics and environmental factors caused this present situation, did B have the muster to try and radically change the progress of the disease without the aid of modern medical science with complete faith in the desired outcome? Even though his PSA lowered to 3.9 before surgery, as one kind person said in one of these rooms, "It doesnt matter what your PSA is if you have cancer!" In the end, we decided to make healthy changes and use the "insurance" of modern medicine. He had a robot assisted, laparascopic prostatectomy on Feb 27 at a "teaching hospital" and has had an optimal outcome. The biopsy did not show all the cancer; after all, biopsies are somewhat like finding needles in a haystack. But his Gleason stayed at 3+3 and we are happy we got it out. All in all, we took about six months from PSA to surgery, with lots of research and careful consideration. Best of luck to you,

Becky

Post Edited (B&B's World) : 3/10/2007 9:25:02 PM (GMT-7)

Hello Becky,   Thank you very much for writing.   What you described helps me enormously.     Here is the message that I am getting from your experience.   I would have opted for that vegan life style in a heart beat; however, this is a little late to expect short term results.   With my psa at 6.9 my options are strictly within conventional medicine.   If by some small miracle my biopsy is negative, that would be a wonderful second chance to go with the vegan life style.   My 32 yo son has been a vegan since he was 15, and he would help put me on that track.   If the biopsy turns out that the big C is present, then I am back to review my results with you kind people here for some guidance.     The urologist that I have seems very black and white about what he intends to do and seems to delight in dismissing all of my questions.   You touched on one of my questions to him about the effectiveness of a biopsy.   It seemed to me that since he described the biopsy as a 0.1 area sample from an area of 40, there was little chance the biopsy would detect any cancerous material unless it was far along.   My math says that 1 in 400 is a very small sample.   He claimed that the results were 40 samples yielding a 40% certainty of showing any cancer present.   Ok, 40 in 400 is still only a 10% sample.   I don’t really need a “Bedside manner” from him, and he is the only one who I could come by from recommendations.   At this point there seems to be only one option for me, and that that is to go ahead with my biopsy scheduled for March 23.   It is so very considerate of you to write with your surgery being as recent as Feb 27.   I hope you and B are enjoying complete recovery with little to no after affects.   Thanks again for being so helpful.

Dear Walt,

I am so happy that our experience is of help to you. I too wanted B to avoid the discomfort of an "inadequate" biopsy, and read studies on PET scans, ready to spend the money to get a complete "picture" of the prostate. The problem is, there is no reliable isotope for the prostate cancer marker, and even though there is one kind, it cannot distinguish the kind of cancer, when evident. And grading is so important to diagnosis and treatment.

My opinion, after our experience, is that the advances in prostate cancer treatment have left some local and small town urologists in the dust. Despite a generally forgiving attitude, we had to leave our local urologist after experiencing poor, and probably inadvertantly uncaring, handling. With PCa, nothing is black and white, and any urologist that is not ready to get into a lengthy discussion is not, in my opinion, worthy of walking down this path with you. If you end up with the diagnosis, and I HOPE NOT!, in my opinion, full caring support is essential to your recovery, from the appointment scheduler on down the line. One of the reasons this website was so helpful was for the support. I learned a lot here while gathering my facts.

Kindest Regards,

Becky

Greetings Walt,

Yeah, you need to do the biopsy and the uro's office is the place to do it.  It's unpleasant, but tolerable.  I described it in a thread I posted.  I'll bump it to the top so you will know what to expect.  Be advised that each doc does things his own way.  In my case, the biopsy caught cancer when it was very treatable. 

Regards,

Bill

Besides the internet, one of my main sources has been Dr. Patrick Walsh's book "Guide to Surviving Prostate Cancer."  While it was printed in 2001, and doesn't discuss a lot about the Da Vinci Robotic procedure, it gives a lot of the basics about prostate cancer.  I wish I had read this once I turned 50, and I may have looked into a biopsy earlier, when my PSA was rising but before it hit 4.  (He recommends a biopsy for:  40's - >2.5;  50's - >3.5; 60's - >4.)  Even so, there are those out there who feel we treat this too aggressively - I'm definitely not one of those!  He mentions that high PSA may not indicate PC, and other factors can effect it as well.  Even sexual activity should be curtailed two days prior to the test - I never know that!

Overall, my advice is to get informed, and find a urologist you feel comfortable with and can trust.  I have been very happy with the "team" that I have been dealing with at Virginia Mason in Seattle.  From some of these postings I've read here, it appears that there are some out there that aren't so good.  Good luck and keep your spirits up.

    Hey Walt,  Sorry to welcom you to our club.  I have a detailed description of my biopsy on my journal page called "KW's Journey".

    As long as you follow your pre-biopsy cleansing instructions, and followup care you should be fine.  It was easy to do it in the office.  It was a bit uncomfortabe and humbling it isn't all that bad.

    You have to do what is right for you.  I just wanted to let you know we are all on your team here.

    You should think about clicking the chat button at the top of the page and join us in the chat room sometime. 

    Good Luck.  KW 

Hi KW,

     Thanks for your welcome.  I would like to read your journal page called "KW's Journey".  This newbie does not know how to find it.  Would you mind stepping me through whatever I need to do to see it?

Thanks,

Walt

Hello SJC,

     Many thanks.  Here is the main thing that you may have cleared up.  I was under the impression that the ultrasound detected in some way the suspect areas for pc, and that helped determine where to take the biopsy sample.  If I am wrong about that, then there appears to be no advantage to the ultrasound.

     Can anybody help me out by letting me know what the benefits and drawbacks  are with the three types of biopsies?

Walt

Hi gang;

I'm a newbie too..

I was surfing this forum and had to join and ask some questions about this topic...

I live in a very small town. In recent years my local doc routinely finds abnormal PSA numbers when I get blood work done. He keeps sending me to the urologist. Our nearest urology practice is about a 2.5 hour drive. They do my biopsy in the office. Not fun! I had to come back for a biopsy five times in the past two years because they could not find a positive result. Yet, my numbers keep gradually creeping up. This urology practice is very small (one urologist and one internist). They never mentioned anything about "ultrasound". Your discussion here is the first time I ever heard that term in relation to having a prostate biopsy. I just thought they went in and took a bunch of samples and hoped for an accurate result. From the sounds of your discussion, it's more like a "crap-shoot". Why else would I need this procedure done so repeatedly? Even SJC had four done himself! I'm beginning to worry that my current urologist may not be using (maybe can't afford) the most modern equipment.

Two questions:

1) What specifically should I ask my current urologist concerning the instrument that he uses for the biopsy procedure to be sure it's the most current?
2) If given the opportunity, should I travel to a large city where this procedure is done much more often and where they use the most modern equipment, and have the biopsy done there?

Any suggestions?

Post Edited (TonyB) : 3/12/2007 9:11:22 AM (GMT-6)

Walt and TonyB,

I think one good thing you guys can do is get either the Patrick Walsh or Peter Scardino books on Prostate Cancer.  Or better yet, check them both out.  They're doctors, we're not.  We'll talk to you all the time - they won't.  Combined you can come up with some good info, but most importantly, get a doctor (uro or other) that you are comfortable with.  Having issued the medical disclaimer, I'll add my two cents to the questions you've asked.

Most of us have what is known as a Trans Rectal Ultrasound (TRUS) and Prostate Biopsy. The ultrasound probe is like a guidance system so that it's not truly a stab in the dark.  The ultrasound will guide the needle for the biopsy.  Most uros use a "sextant" pattern.  They divide the prostate in half lengthwise and then into thirds going across.  Some take just one sample in each zone, some take two or more.  If they found a suspicious area during the DRE (Digital Rectal Exam) they may take a few extra snips there.  I had 18 cores the first time and 24 the second.  As to other types of biopsies, I've read of going through the urethra when reaming out an enlarged prostate (ouch) or through the perineum (ouch, ouch) to access a different area of the prostate.  I'll stick with the back door.  My next one is in May.  I go the outpatient route but you can see that a lot of guys here have no problem with going in the doctors office.

PSA is Prostate Specific Antigen.  It's a protein.  It's produced in the prostate whether you have cancer or not.  It's part of the goo in ejaculate that helps your swimmers survive their journey through the hazardous environment of the vagina and cervix (hazardous to them ladies, not me.  I love you).   PSA can be measured in your blood stream (serum level).  "Normal" ranges are what spills out of the prostate due to normal production.  Elevated levels can have many causes.  Cancer is one, but so are BPH (Benign Prostate Hyperplasia), infection, irritation (physical not mental), and recent ejaculation (no roll in the hay before the blood test).  Some docs like to eliminate possibilities like infection before going further.  Do what the doctor you trust wants.  You can have a low PSA level and still have cancer.  Many of those are found through the DRE.  Personally, I wouldn't be as concerned about lowering the PSA levels as finding out what has elevated them.  When that is addressed, the levels should go down.

If you are displaying 25 topics per page, KW's Journey is on page 3 (this morning anyway).  There's also a search function on the menu bar. Good luck to both of you.

Boo