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Second Biopsy Jitters

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Prostate Cancer
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Posted 6/26/2014 7:54 PM (GMT 0)
I know that this is a forum for guys who have already be diagnosed with PC but I have recently been lurking reading as much as I can in preparation for a second biopsy in about three weeks. I am 47 years old and had a biopsy two and a half years ago after a PSA of 2.6 with some urinary symptoms. That biopsy was negative. I have continued to have urinary symptoms (frequency, some discomfort) and have been on antibiotics on and off during that time. My PSA has continued to slowly rise (with the exception of a spike to 17 last fall). I had a PSA of 3.65 one year ago and a free PSA of 13 which my doc said was "Favorable". After some frustration with my urologist in Canton, Ohio I got a referral to a urologist at The Cleveland Clinic. Monday he did a PSA and Free PSA test (and yes, it's The Clinic so the results were available in about an hour!) My PSA was 4.26 and Free PSA 10. He scheduled me for a biopsy. I wanted to thank you for your postings here as they have been very helpful in the education I am giving myself about the prostate and prostate cancer. Most of the information available is the same wherever you look and here there is so much and so much support!! I also have an issue called atonic bladder (my bladder holds up to 900cc's of urine but generally only releases half of that when I urinate. My doc wonders if there might be a blockage. Did anyone else suffer from atonic bladder before or with PCA diagnosis? I honestly don't feel like I have to urinate even with as much urine in my bladder as many people have for their capacity. I'm curious if I'm the only one. I have to go in a week before my biopsy to learn how to catheterize myself and I'll have to do that twice a day for as long as it takes to discover the cause.


Thanks again for all of your great information!

Brad
Posted 6/26/2014 8:13 PM (GMT 0)
Brad,

Welcome to the forum. Sorry you have worries but glad you found us.

We have lots of members here who have never been diagnosed with prostate cancer. Guys with worries about their PSA or about their family history post all the time, and we get lots of guys passing through who are nervous about an upcoming biopsy.

Has your urologist mentioned the size of your prostate? Some of the symptoms you describe sound more like an enlarged prostate than a cancerous one. Prostate cancer seldom has much by way of urinary symptoms. Your symptoms also sound like prostatitis. That can be a chronic, hard-to-diagnose, hard-to-treat disease that can give you an elevated PSA. Your PSA spike that came back down certainly doesn't sound at all like prostate cancer. It's a pretty good bet that you have some sort of prostatitis. That doesn't mean you shouldn't get the biopsy -- one can have chronic prostatitis and prostate cancer both at the same time (I did, for instance) but if your biopsy comes back negative some sort of inflammatory disease could also account for everything you have described.
Posted 6/26/2014 8:22 PM (GMT 0)
Thank you for the warm welcome!! I appreciate that! I just know you all have some very important information to share with each other and I don't want to clog up the works (so to speak!). I'm very confident in my new urologist. He said if this biopsy comes back negative they will continue to watch my PSA and if there continues to be a rise they will do an MRI. The Clinic really is a great place to be.....and even though I have terrible insurance they are comparable to my former urologist in price.....so it's worth the hour drive when I have to go there.
Posted 6/26/2014 9:33 PM (GMT 0)
Hi Brad,
You are doing the right thing!
Let me know if you want to connect offline as I am more than happy to give you the run down on my experience at the Cleveland Clinic. It is a great place!
Posted 6/26/2014 11:29 PM (GMT 0)
Thank you samster!! I'd love to hear your experience at the clinic!! Please feel free to email me privately!!
Posted 6/27/2014 1:08 AM (GMT 0)
Hi Brad,

I had symptoms from an indent or growth into the urethra, which caused bladder wall thickening, frequency, nocturia and the inability to void completely. The prostate shrinkage from 63cc to 23cc from HT and radiation did not change that. As they say, it's not the size of the donut, but the donut-hole that matters.(not sure who "they" actually are, if if "they " really ever said that)

That little"nub" almost caused a trip to the ER after the biopsy from the resultant swelling and closure. It did later require a laser "trim" in the middle of my treatment plan adding to the fun and excitement of treatment. So the blockage I had, is what initially prompted me to seek treatment. as PC in and of itself is symptomless until it's probably too late to do anything about it.

Anyway, the spike you points to infection, but the slow continuous rise in PSA, along with a low free PSA, point to a higher likelihood of having PC. Sometimes it's a combination platter

You might want to look into a color doppler or the newer MRI guided biopsies to provide more accurate results and limiting the number of biopsies
Posted 6/27/2014 1:34 AM (GMT 0)
In addition to prostatitis, acute urinary retention can cause your PSA to rise. Why not fix your urinary retention first and see if your PSA goes down?

As for tests, PSA and % free PSA aren't very good. Since you've had a negative biopsy, your insurance may cover a PCA3 urine test (and your uro may be able to use the urine catch to zero in on any pathogen that may be causing prostatitis - if you ask him to). There is also a new test called PHI that is better able to distinguish PC from other causes.

I would exhaust the other possibilities before getting another biopsy, but it sounds like you are committed to getting one.

- Allen
Posted 6/27/2014 9:52 AM (GMT 0)
Thank you everyone for your replies....they are all very helpful.

I probably should have given more details. I apologize. My catheter training is on July 16. In addition to the biopsy on July 21st my urologist will also be doing a cysoscopy and a urodynamics test. (yes...I'm planning on a quiet evening that evening). I think because of my age and no history of neuropathy he is curious as to why I would have an inability to void completely and is suggesting that it might more likely be caused by some kind of blockage. I have only been seeing him for three months and he was not the one who did my first biopsy and I think he wants to know he is working with his own information. In addition to the retention my urine flow is also suggestive of some kind of blockage. He offered me self cath training three months ago when I retained 200cc's of urine and I declined. I was in shock that this was even a problem since I had been tested for retention at least three times before at former urologists. Either they didn't know what they were doing or this is a new issue that is progressively getting worse. I have complete faith in my urologist at The Clinic but the information you all give me helps me to be able to ask the right questions and find the right treatments. Thank you so much for taking the time to write!!

Post Edited (BradOhio) : 6/27/2014 4:57:46 AM (GMT-6)

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