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PSA going up having biopsy

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Posted 11/16/2012 1:10 PM (GMT 0)
My PSA has risen as follows (dates approx)
2009 - .7
2011 - 1.1
march 2012 - 1.6
Oct 27 2012 - 2.2
Nov 15 - 2.7 (this was taken at a different lab and right after DRE)

I am age 62.
Went to Columbia Prysbeterian NY met with a Urological Oncologist, rather than continue with my local urologist. He confirmed normal DRE . suggested biopsy. I am having in Wednesday
Crapping in my pants.
I don't even know if there is a question here, i have done a lot of reading and know too much. Still the jump FROM 2.2 to 2.7 in 2 weeks is bothering me even though i think it could be that its a different lab and was done after the DRE.
Doc told me he doubts he will find cancer. But still i;m real nervous. about both what they will find, and how bad the biopsy will be.
Posted 11/16/2012 1:45 PM (GMT 0)
Biopsies are more annoying than painful. If your doctor offers a mild sedative for the procedure (Valium, or the like) that would be a good idea. I have had several biopsies and I found a bit of pharmaceutical detachment to be helpful.

Good luck with your biopsy. Don't forget to come back and tell us the results.
Posted 11/16/2012 1:53 PM (GMT 0)
Pratoman,

Did the Uro (or your regular doc) offer a round of antibiotics first?  From my understanding, the usual first step after a rise in PSA is discovered is to go through a round of antibiotics (such as Levaquin) in an attempt to rule out a prostate infection.

If the antibiotic results in a significant decrease in PSA, then the chances of having PCa are reduced.  If, however, the PSA remains elevated, then further investigation is needed and a biopsy may be warranted.

However, if your Uro performed a DRE and found an abnormality (nodules or firmness) then I can see why he would go straight to a biopsy.

Posted 11/16/2012 2:12 PM (GMT 0)
Welcome to the Forum Pratoman.

Yes a DRE can make your PSA jump, so bloods should always be taken before a DRE, and also before a biopsy. (my biopsy pushed my PSA up from 8 to 13 in a couple of weeks!) Sex, riding a bike and infections can also cause PSA to go up.
2.7 is still very low. I agree with uro that he is unlikely to find anything.
Some guys at HW have had painless biopsies others (including me) have had painful ones. On the basis of my experience I'd ask for some pain relief, I had none, the uro said it was not possible to give a local, yet the next uro I saw said that they always give a local for a biospy!
(Antibiotics should also be given with a biospy so that the needles don't spread any infection from the bowel to your insides, and that course of antibiotics should thus start the day before the biopsy is scheduled.)
As for worrying about it. It's difficult I know, but just try not to worry at all. You'll hear the same result regardless of whether you worry or not!

Alf
Posted 11/16/2012 2:16 PM (GMT 0)
Thanks for the responses

@Peter - do you mean like Intravenous valium or something like that? I don't think they do that out of a hospital setting, i could be wrong. At my request, he did give me 2 xanax pills .5 MG each. I intend to pop one at 8 AM the morning of the biopsy, which is scheduled for 10:30am, and another one at around 9:45, just before i get to the doctors office.

@HD_Rider - My original urologist did prescribe cipro. He didnt bring it up, i asked him, after i read about it. He responded by saying that usually, when its an infection, it is a sudden large rise, as opposed to a multi year slow trend upwards that i am showing. He followed with 'but it can't hurt you, so if you want i'll prescribe Cipro for you, and take it, then lets retake the PSA in 6 weeks.

I then decided, before taking the Cipro, to see this new Doc at Columbia Prysbeterian who said the same thing, that it would normally be a more sudden and pronounced rise if it was an infection.

Combine that with the fact that my prostate is small (Columbia Doc told me that) which means its probably not BPH, and thats why i am so nervous that they might find PC. Even though there were no nodules or hard spots in my DRE which showed normal prostate.

Posted 11/16/2012 2:19 PM (GMT 0)

English Alf said...
Welcome to the Forum Pratoman.

Yes a DRE can make your PSA jump, so bloods should always be taken before a DRE, and also before a biopsy. (my biopsy pushed my PSA up from 8 to 13 in a couple of weeks!) Sex, riding a bike and infections can also cause PSA to go up.
2.7 is still very low. I agree with uro that he is unlikely to find anything.
Some guys at HW have had painless biopsies others (including me) have had painful ones. On the basis of my experience I'd ask for some pain relief, I had none, the uro said it was not possible to give a local, yet the next uro I saw said that they always give a local for a biospy!
(Antibiotics should also be given with a biospy so that the needles don't spread any infection from the bowel to your insides, and that course of antibiotics should thus start the day before the biopsy is scheduled.)
As for worrying about it. It's difficult I know, but just try not to worry at all. You'll hear the same result regardless of whether you worry or not!

Alf

 

Thanks for your thoughtful post Alf.

Yes, he gave me an antibiotic to start taking the day before the biopsy. Regarding the pain, he told me that he first puts an ultrasound device in my butt (excuse me) to guide him in giving me lydocaine around the prostate. Once thats done, he said it shouldn't be too bad, he said most people find the hardest part is when the ultrasound first goes in.

 

ugh!!!!!!!! Still scared

Posted 11/16/2012 2:21 PM (GMT 0)
Boy, that's a tough one. I would think that a PSA test right after a DRE would push it up. You have low numbers and I hope you are okay. I was put under for my saturation biopsy, so I did not feel a thing.

Good luck and I hope you report back that they found zippo.
Posted 11/16/2012 3:24 PM (GMT 0)
Pratoman,

My doctor prescribed Valium capsules for me but the Xanex will do fine. It works quickly. I'd take the first one at 9:00 am and pop the second one in the waiting room when they call your name to go in. That way if the doctor gets behind your meds don't wear off before you need them.

I am not sure you are aware of it but there is a special dispensation in the "Manly Men's Rulebook" for procedures involving men in white coats prodding around up your butt with spring-loaded instruments. You are allowed to be nervous. But you mustn't use the word "scared". Instead, use the word "anxious", as in "Doc, my urologist is doing a prostate biopsy on Wednesday and I am a bit anxious about it. Could you hook me up with something to calm me down while I wait?"

That's how I got my insight into the merits of Xanex.

Good luck.
Posted 11/16/2012 3:39 PM (GMT 0)
Thanks Peter. Ok, I'm anxious
Posted 11/16/2012 3:54 PM (GMT 0)
Here's my take on the biopsy procedure -annoying, embarrassing and undignified. The after effects are just as strange but it's the only way to discover for sure if it's PC.

A good doctor and the team working on you will do their best to put you at ease - if needed ask for the drugs.

All the best,
Andrew
Posted 11/16/2012 4:02 PM (GMT 0)
Andrew - question - when you (and others) refer to 'if needed ask for the drugs", do you mean intravenous, or just a pill, like what i have (xanax)

Doc told me they dont do general anesthesia, except under special circumstances, and in the hospital only (or outpatient surgical facility)

Posted 11/16/2012 4:08 PM (GMT 0)
Two pills ought to do the trick. No gas or IV line needed. One pill like a vicodin to prevent pain, the other like a zanex or ativan for anxiety. You'll be fine. It will go very quickly.
Posted 11/16/2012 4:15 PM (GMT 0)

Pratoman said...
Andrew - question - when you (and others) refer to 'if needed ask for the drugs", do you mean intravenous, or just a pill, like what i have (xanax)Doc told me they dont do general anesthesia, except under special circumstances, and in the hospital only (or outpatient surgical facility)


Just pills, IV aren't needed. A pain killer and maybe a mild sedative - zanex.

I did the procedure without any pain or other meds. Just the cipro to ward off infections.

I found the procedure merely annoying.

You'll do find.
All the best,
Andrew
Posted 11/16/2012 5:02 PM (GMT 0)
Assuming you are getting an ordinary needle biopsy (usually 12 cores) there is no need for general anesthesia. The first thing the doc will do is to inject some Lidocaine through the wall of your rectum into the prosate. That will probably be all you need for the pain. The tissues involved are not particularly sensitive to sharp sensations so the Lydocaine shot won't hurt much (it will ache a bit for a second or two.) With the lidocaine the biopsy gun will feel like the doc has poked a rubber band gun up your behind and shot you with it. The worst part may actually be the noise the gun makes (like a mouse trap going off.) The Xanex will help keep this from bugging the heck out of you.

I have had four biopsies and I never learned to like them but they are not that bad. In addition to the Valium that my urologist prescribed for the procedure (one before I left home and one before the procedure) I asked my primary care doctor for some Xanex to keep me from getting too nervous in the days leading up to the procedure and while I was waiting for the results (another excused anxiety in the Manly Men's Rulebook.)

One other thing to expect is that everything you expel or eject below the belt line will be a bit bloody for a while after the procedure. The blood in your stools will not last long, the blood in your urine will last a few days and the blood in your semen will last for weeks. It will start off as a vampire-movie red and fade through chocolate brown and mocha late colors.
Posted 11/16/2012 5:06 PM (GMT 0)
I wonder if its ok to mix 2 xanax with a Vicoden.

I could get Vicoden, i have a friend who will give me some.

Posted 11/16/2012 5:40 PM (GMT 0)
Regarding Vicodin and Xanax:  http://www.drugs.com/drug-interactions/vicodin-with-xanax-71-747-133-54.html

But don't just get a pill from a friend;  ask your doc to prescribe it and tell the uro you took it.  (There are docs who do not like to prescribe xanax, but you are not likely to have the same issue with vicodin).  If you are really concerned about the biopsy, there are plenty of doctors who will do a biopsy under sedation.  It is not the norm because (1) it takes more time, (2) it costs more (and the incremental cost may not be covered by health insurance), and (3) most people find the biopsy tolerable (even if not amusing) without sedation.  BUT if you want sedation, you should just tell the doctor that you want sedation, and not let him tell you that its not necessary.

[I am not a doctor and am not competent to provide medical advice]

 

Posted 11/16/2012 5:51 PM (GMT 0)
You may be worrying more than you should. I know some people have a painful experience with biopsies, but many of us don't. Mine was very easy and I just did what the uro said, with an antibiotic just before the procedure.

The worst part was laying on the table, uncovered from the waist down, with my butt out, knowing the uro and the nurse were looking at my least favorable side.

The actual biopsy felt strange, but I looked at it as a new experience and it was pretty non-eventful. The ultrasound is less problematic than the DRE, and the biopsy wasn't painful - a small jerk each time the tool worked and less pain than many injections.

I hope yours goes well and easy, too. Best of all, you should know something about the possibility for cancer and knowing is much better than wondering.

Good luck!
Posted 11/16/2012 6:16 PM (GMT 0)
Thanks for all the responses.
I don't know if i am more anxious because of the fear of the biopsy or fear of the results. But i think its more fear of the results. I guess all i can do is get it done and wait.

This is a very active board. Thanks again for all the responses. More info the better.
Posted 11/16/2012 6:39 PM (GMT 0)
Tempest in a teapot. This is not a big deal. Had 3 biopsies and it never occurred to me to ask for drugs, even after the first one (and my ignorance) was behind me.
Posted 11/16/2012 7:34 PM (GMT 0)
You know how you try to push your head back through the headrest when the dentist comes at you with a needle? Getting a biopsy is a lot like that but without the spitting. You also don't see it coming. It helps if you give up any idea you ever had about dignity, modesty, or what's right.
I never had drugs offered or even considered. I went in, got it done, and went back to work with a couple of Cipro to ward off infection. You will have some fairly interesting looking semen for a week or so after.
Posted 11/16/2012 7:37 PM (GMT 0)
Sounds exciting.... :-(((((
Posted 11/16/2012 7:43 PM (GMT 0)

Pratoman,

Here is a link to an article from NBC News.  It's actually a complete series of articles describing one man's journey from diagnosis, to treatment, to life afterwards.  The article on his experience getting the biopsy says volumes:  link

Posted 11/16/2012 7:59 PM (GMT 0)
HD_Rider,

I remember that piece. I read it while I was waiting for my first biopsy. It was, as I recall ...

not.
that.
helpful.

If he would just take my advice and get hooked up with a bit more Xanex he would be playing solitaire on his computer now, as God intended, instead of reading every response here within seconds of its being posted.
Posted 11/16/2012 8:04 PM (GMT 0)
Man, after reading that, I'm glad I was under.
Posted 11/16/2012 9:05 PM (GMT 0)
Never have a PSA blood draw after a DRE! It is also a good idea to abstain from sex a full week before said PSA. IF you have a biopsy, it may be a good idea to have needles targeted via dopplar ultra sound. Request that your biopsy slides be sent to specialists that do nothing else but PC testing like Bostwick.

NOT AN AD FOR THIS CENTER!

https://www.bostwicklaboratories.com/services/laboratory-services/urologic-pathology/pca3plus.aspx

I hope this aids you my PC brother.

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