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Biopsy Next Week

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Posted 7/26/2017 1:52 PM (GMT 0)
Thankful to have found this forum! My dad is scheduled for a biopsy next week (8/1/17), wondering what to expect and getting more nervous by the day.

66 years old
No symptoms
DRE in June found prostate enlarged but smooth
PSA was 6.5 in March, then 5.48 in June
Free PSA was 8.32% in June

I understand the low Free PSA puts him at a 56% chance of having cancer. Hoping that no symptoms and smooth prostate is a good sign that it is either not cancer or Stage 1.
Posted 7/26/2017 2:33 PM (GMT 0)
Try not to stress, you just won't know until you know. Stats seem to be good mostly at raising anxiety levels.

The biopsy is usually pretty easy. I've had 4! They do the biopsy through the nearby conveniently located rear access port we all have (sigh). It feels like a rubber band being snapped against your skin, but "inside", so it's odd. Often they will also numb the area with a couple small injections first.

Most biopsies turn out negative. PSA is elevated for a variety of reasons other than cancer. With similar numbers in my mid-40s, I had several biopsies, all negative. Infections can cause numbers like this, for example, and they're notoriously hard to clear up.

If, heaven forbid, it does turn out positive, you'll get a pathology report. It will describe the Gleason score in the various cores (usually 12), and % involvement in each. If that happens, get back with us. Everything will hinge on those numbers.

But seriously, try not to get too fussed about it. Most biopsies are negative.
Posted 7/26/2017 2:48 PM (GMT 0)
Thanks so much. I know, the waiting and wondering stinks. That low Free PSA worries me, but hoping for the best!
Posted 7/26/2017 3:05 PM (GMT 0)
Smooth DRE is much better than nodule or firm. I have a good feeling he will will be just fine.
My DRE was firm and nodular and doc was almost certain even before biopsy that I had PC.
Posted 7/26/2017 3:26 PM (GMT 0)
The biopsy is a little uncomfortable but mine was not painful. No worse than a trip to the dentist. Takes about ten minutes. If it turns out to be positive the important thing is to not panic but learn as much as possible about your options. For most men wading through the options is the most difficult part. My diagnosis was a common one and I had a number of options that would all be successful at treating the cancer. I selected the option that I felt was best for us including having the least quality of life issues. I'm a month post treatment without any issues or side effects. Good luck and keep us posted. There is plenty of help on this forum if you end up needing it.
Posted 7/26/2017 3:47 PM (GMT 0)
I would add about planning for the biopsy to ask and make sure the Urologist uses Ultrasound to guide the biopsy direction and that a deadening injection is used prior to the Biospy and that antibiotics are prescribed.
Especially, some Urologists do not inject a deadening to the prostate prior to the biopsy and I would not want to do a biopsy that way. On the morning prior to the biopsy you will also need to do a self enema.
Posted 7/26/2017 4:10 PM (GMT 0)
Hello Hill and welcome to the forum!...just wanted to add that when I had my transrectal biopsy done ,I did NOT have to take and enema the day before. The experience was like Redwing said , not a big deal, but somewhat uncomfortable especially when the first of the 12 "snaps" started .......after that it was over in a few minutes. Scared me more than anything else when it first started . Tell your Dad to try and relax and it will all be over so quickly. Then the waiting to find out whats up will be the step on his journey.....good luck .....David
Posted 7/26/2017 7:24 PM (GMT 0)
Good info, thank you! Will report back with results.
Posted 7/26/2017 8:29 PM (GMT 0)
I was concerned about pain with the biopsy so my urologist gave me a Valium to take about hour or two prior to the procedure. I was uncomfortable with the first couple of punches but it got more and more unbearable, it hurt so much I was sweating.

So I'm one of the guys that had a problem with the biopsy (the Valium had zero effect for dealing with the procedure.) If I was a guy on active surveillance and getting periodic biopsies I would insist on Demerol or something like that.
Posted 7/26/2017 10:43 PM (GMT 0)
As previous members have said it isn't bad, yet it isn't fun either. I too had a valium prior to my biopsy and it didn't do anything. I had 13 cores taken about half felt like a rubber band snap and the other half was worse. Luckily each time the pain is very short and I think the anticipation of each shot was bad.

You dad should be aware of the after effects of the biopsy, including blood in the urine, semen and possibly in the toilet. All should clear up quickly except the semen usually takes several weeks.
Posted 7/26/2017 11:51 PM (GMT 0)
For me the biopsy wasn't bad. I had a consultation with the urologist after my PSA went up and he said he could do the biopsy right then and there. I suggested that I needed time to build up anxiety, but we went ahead with it anyway. The procedure wasn't bad. It's uncomfortable, but I wouldn't call it painful. It's not the most dignified thing I ever did, but you do what you've gotta do.

Be sure to tell your dad about the side effects that lapilot mentioned. You can pretty much count on some blood, and for me it lasted a couple weeks. It's nothing to worry about. I would only add that you should have some extra strength Tylenol handy after the procedure (they won't let him take NSAIDS such as ibuprofen). I was very sore for about a day; that soreness kicked in when the local anesthetic wore off. It was a pretty uncomfortable ride home for me.

All that said, the tough part is waiting for the results. I'm wishing your dad the best. If you need any insight into what the pathology report means, this is a great place to get some informed perspectives. Make sure you get a copy of the pathology report. It's entirely possible that he doesn't have prostate cancer, and if he does it's likely to be very treatable, if it needs treatment at all. Good luck to you and your dad.

Best,

Jonathan
Posted 7/27/2017 12:08 PM (GMT 0)
There is a way to make the biopsy much more bearable. Tell your dad to ask his uro to use a peri-prostetic nerve block. This consists of a couple of very, very small injections of a numbing agent (lidocaine?) directly into the prostate where the nerves that carry pain sensations to the brain are located. The patient only feels a couple of tiny pinpricks (like getting novocaine at the dentist), and then the prostate goes numb. All he will then feel is a slight tap when each core is taken. My uro uses nerve block every time - his patients don't have to ask for it. My biopsy was such a "non-event" that I took my wife out to lunch right after, then went back to work for the afternoon.

In my case, I said that if the uro wasn't going to use a nerve block, then I would have to find another doc to do the procedure.
Posted 7/27/2017 12:47 PM (GMT 0)
Thank you, I will message his uro today and ask about the nerve block!!! He is worried about the procedure, I know. Have any of you heard of anyone getting infection after the biopsy? I know they'll give antibiotics, but he's got that in the back of his mind too.
Posted 7/27/2017 2:13 PM (GMT 0)
When I had my biopsy, lidocaine was administered without me even requesting it. The 14 core procedure was a very simple event.

My Uro sent me to another Uro at the hospital who "specialized" in doing biopsies. Perhaps we need to be as inquisitive about biopsy experience as we are about surgery and radiation numbers. Too many, IMHO, are reporting issues with this procedure.
Posted 7/27/2017 2:54 PM (GMT 0)
Hill-- There is a small risk of infection typically less than 5%. My Dr gave me an antibiotic injection prior to the procedure. Especially important if Dad has other medical conditions.
Posted 7/27/2017 3:03 PM (GMT 0)
I found it to be very painful. He should ask for a pelvic plexus block so he won't feel any pain.
Posted 7/27/2017 3:14 PM (GMT 0)
Welcome Hill, As everyone's mostly covered this 'good times' event already. Only things I'll add is that I've had two biopsies. The first, with a local uro group, was with a lidocaine injection prior to the 'main event.' The lidocaine needle was the worst part. But not a really bad experience. More weird than anything. For my second, a MRI fusion guided biopsy at Johns Hopkins, the nurse administered some numbing gel prior to the lidocaine needle, and that was much more comfortable. I barely felt anything! That may be at least be worth asking for. For both procedures I received a prescription for a single dose of Valium to take prior each time. I also had to use a fleet enema the morning of both procedures. This is to help prevent infections which, unfortunately, occasionally occur. Not too often though. He should also be given antibiotics. I think I actually started my antibiotics just prior to the procedure.

Also, if you both weren't already aware, he'll likely have some blood tinged urine for a couple of days, and maybe even pass a small clot or two. His semen will also be discolored. It'll eventually clear up too.

Good luck. He'll be fine.

MD
Posted 7/27/2017 4:27 PM (GMT 0)
Regarding infection, the doc gave me one Cipro tablet. He said that studies showed it would be sufficient. It was.
Posted 7/27/2017 5:51 PM (GMT 0)
Undermedication with antibiotics is unsafe. It can cause resistant infections. Fluoroquinolones (like Cipro) are becoming increasingly useless. Biopsy-related infections are up to about 7% and increasing. Make sure he takes the full dose, and if he's taken a fluoroquinolone before, he should tell his doctor.
Posted 7/27/2017 6:19 PM (GMT 0)
if he's that worried about it they can do it outpatient and under anesthesia. My brother in law was given that option and so was I. You may have to ask for it. No honor lost. That's what I did.
Posted 8/1/2017 5:20 PM (GMT 0)
My dad has his biopsy this morning, lidocaine was given and he said it wasn't that bad!

We have an appt scheduled for next week to discuss results, but I can see the urologist's notes and was wondering if anyone can help interpret a couple of things I'm seeing:

Median lobe hypertrophy: no

Hypoechoic region in the medial right base (assuming this means a nodule was seen)
Posted 8/1/2017 5:30 PM (GMT 0)
Good he got through that.

The notes don't mean much without the pathology report.
Those are likely just things seen on the ultra sound or where samples were taken.

It's difficult, but the job now is to wait. and wait. and wait...
Andrew
Posted 8/1/2017 5:35 PM (GMT 0)
I know, this waiting sucks! And I can't help myself, I want to Google, Google, Google until I find something that makes me feel better.

Is there a "worst" region of the prostate to have a nodule? Or does it really just matter whether or not is contained to the prostate? When I see "base" it makes me feel like it could be close to another organ.
Posted 8/1/2017 8:04 PM (GMT 0)
Waiting sucks big time.

Do something to distract your mind. Watch a movie, read a book, yard work, house work, hobbies, ask all your family and friends, "Are we there yet?" Have a drink, go for a walk, take a trip, ride a horse, count all the grains of sand in a bucket, then estimate the number of grains on the beach.

sigh, sorry, all I've got for you is waiting, waiting, waiting,
Andrew
Posted 8/2/2017 12:27 PM (GMT 0)
I, too, know the perils of the waiting game. I have "played" that game in numerous medical situations - all potentially life-altering.

My method of dealing with the prostate biopsy wait was to begin the decision process. If I have a negative result, what will I do? If positive, based upon diagnostic group, what treatment do I want to learn about? In doing this, I had a lot of my preliminary path mapped out, and was much more ready to discuss treatment with my urologist than any patient he had encountered so far.

For example, I was tending away from surgery due to my age, and due to my co-existing heart issues and past surgeries. I then started researching various radiation therapies and selected a couple that seemed to fit into my lifestyle. I then read about the efficacy of those treatment modalities and began investigating practitioners in my locale who specialized in these treatments. Then, when I met with my uro, I was ready to discuss treatment with him as an informed patient. I directed the conversation, and left his office with his firm support and referrals.
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