Anxiety - waiting

Hello, there’s a lot of information on here and I am struggling with high levels of anxiety. I live in Minnesota and in early August I requested a PSA from my Doctor Who two years ago had suggested it was probably not the right thing to do. I thought I should establish a baseline since my last PSA test was in 2007. I received two results the first was an 8.88 and the second was a 8.66. I was referred to a urologist who seems great. He has scheduled an MRI. He did a DRE and said that he felt that the prostate was enlarged and that there was a hardness on the left side. His plan is to do a biopsy depending upon the results of the MRI. How do you manage the anxiety associated with this? I am 65 years old and in great health but this is my first major health challenge. And it weighs on me every minute of the day. My wife has been great but is counseling in order or how do people manage this?

Hello, Geordi ---

As Tom Petty's song reminds us ... "the WAITING ... is the hardest part."

You are getting the right steps in place --- you had the PSA test --- you met with your doctor --- you had a physical examination --- and now you have an MRI scheduled.

Is your MRI coming up soon?

Meanwhile --- it's important to stay busy --- mentally and physically.

Immerse yourself in projects --- hobbies --- usual interests.

I found that taking a daily walk or two helped keep the "wolves of worry" at bay.

Watch a football game --- do some yardwork ---- clean out the garage ---- paint the backyard fence --- walk the dog ---- whatever it takes to stay busy and productive.

It's natural to be anxious --- we have all been there. But focusing on staying ACTIVE is the best antidote.

Visit a county park or state park this weekend with your wife. Pack a picnic lunch, and take some walks together.

We're here for you. It helps to know there are others who UNDERSTAND. That's why we're here!

Keep us posted, Geordi! We're here to support you!

With my best to you, from the American MIDWEST ---
CYCLONE - # Iowa State University

Geordi, welcome to the forum, i hope you end up with a negative biopsy and are just passing through.
First its great that your Urologist is doing an MRI prior to the biopsy. This will guide him on any areas that might need to be targeted and reduce the possibility (not eliminate it) of a false negative.

As far as the anxiety, theres no easy answer. I can tell you to try to stay in the present moment and not worry until its proven that there is nothing to worry about. But that would be pretty useless advice.

So think first of all, there is a possibility that your biopsy is negative. Thats the best case scenario. Obviously the worst case scenario is a positive biopsy. And most of the time, prostate cancers are very slow growing. In some cases you might even be able to not treat, but just monitor it (thats called active surviellance). Even if its the more aggressive kind, it will not be like other cancers, such as pancreatic, breast, colon, in that it grows more slowly.

So for now, just focus on that, take a deep breath, and do one foot in front of another.

I was diagnosed at your age, 65, and i had surgery, 6 years ago this coming January. I did need additional treatment 3 years afterwards, but thats behind me now, and life is good FWIW.

Please stick around and keep us posted. Everyone here has gone through what you are going through, or is a spouse of someone who has, so we get it. And if it is a positive biopsy which we all hope its not, we can help you walk through next steps.

Yes--the MRI is scheduled for next Friday. My Urologist indicate that depending upon the results of the MRI he will confer with me on the type of biopsy (fusion? or grid pattern) (not sure of the language).

duke48 said...

I didn't have anything else done in Dallas. I went to MD Anderson in Houston. I can't say enough good things about that hospital.

Not to hijack thread, but could you explain a bit about that? Couldn't find the docs you wanted in Dallas?

I am probably going to need SRT down the road and was hoping to try in Dallas (maybe UT Southwestern) or maybe MDA in Houston, though it's farther from me. Any info would be appreciated.

Thanks!
Robert

Thanks. The Twin Cities has had its challenges over the past 18 months. We are hanging in there. Thank you so much for your thoughtful words and insights. I appreciate it.

Geordi - I agree that anxiety has been higher in general for all people around here since Covid and the riots in the Twin Cities. Having any sort of health issue during this time makes it more difficult although it is much better now.

My wife and I have been through the cancer situation over the last three years and know the medical environment here pretty well if you have any questions about local cancer care. I am just watching 6 month PSA’s at this point but my wife is getting treated at the U of MN (M-Health) which started right at the beginning of the pandemic (Jan 2020j so that was a lot of fun to deal with. The Mayo Clinic is a great resource but you can get almost all testing and treatments in the Twin Cities also. The oncologist we met with at Mayo is good friends with the oncologist my wife works with at the U and they both had the same care recommendations so local treatment was much easier for her. There is a lot of interaction between the University and Mayo as you might imagine.

However, don’t let me get you too far ahead in your planning. The key is getting the first pieces of concrete information regarding your situation which your urologist has outlined. Once you have a diagnosis and a copy of the MRI and biopsy pathology results, you can decide on next steps as needed. The idle mind is the devil’s workshop as they say so the last thing you want to do is make up scenarios in your mind and try to solve each of them. The decision tree with PCA is long and complicated with many forks in the road so don’t overthink the situation when not necessary, one day at a time.

Are you thinking about what you are going to do next if you get hit by a car on the way to the doctor? Probably not which is why you should temper anxiety with reality and realize that there is little you can do about most things at this point other than complete the investigation. Easier said then done I know but that is the goal.

Thanks Glen. I appreciate your kind words and good thoughts. I think my greatest fear is that my dad also had prostate cancer at age 67 which is just a year or so older than me. I didn’t remember a lot about it. A friend told me that my dad had a PSA of over 14. He chose the radioactive seeding and then radiation and ultimately he had bladder cancer and had his bladder removed and a colostomy and it ended poorly for him at age 81. I have so many fears about what happened to him. I think if I end up having my prostate removed assuming there is a necessity for it, I would like to avoid radiation at all costs. I didn’t realize what a higher risk group I was in because my father had prostate cancer. It’s not something any doctor had ever asked me about. I have seven brothers and I will be letting each of them know about these risk factors. Having done quite a bit of reading, I see that African-American men are in a very high risk group as well. I mentioned this to a few of my African-American male friends and they were not aware of it.

Hi L.G. If your uro decides to do a "targeted biopsy" (based on any suspicious targets identified in the MRI), I would request that it not be a "target-only" biopsy, but rather a "targeted + systematic" biopsy, where "random" cores are taken in all prostate zones that don't have an MRI-identified target in them. For several reasons, adding these random cores finds clinically significant lesions missed by a target-only biopsies about 7-8% of the time. These reasons include (1) targets missed by the reading radiologist; (2) misalignment of the MRI image and needle sampling; (3) lesions too small to be detected by MRI but randomly hit in other prostate zones.

These "random cores" aren't truly random, because the uro uses the ultrasound screen to visualize and aim for shadowy areas that appear suspicious. "Atypical" tissue becomes less dense (and malignant tissue can become friable) and reflects less of the energy used in ultrasound and other imaging than healthy tissue. However, not all atypical tissue is malignant -- some may be precancerous and only the pathologist can distinguish the two. Usually 2-3 cores are taken per MRI target and one "random" core is taken in each of the other prostate zones.

I would inquire ahead of your biopsy day about the type of biopsy planned, since the appropriate number of sterile specimen cups need to be set up ahead of time, and your uro, even if amenable to the random cores in principle, may be reluctant to change the setup right before a target-only procedure.

Djin

A few more things you may wish to ask about prior to your biopsy.
1) Transperineal vs Transrectal approach. Transperineal is less common in the US, but has much lower risk of infection and can provide access to parts of the prostate that are inaccessible to the Transrectal approach. It is often done under anesthesia.
2) If you cannot get transperineal and must go transrectal, see if they can culture a swab from your butt to check your local flora and find the most effective antibiotic to avoid infection.

Thank you Jim!

Geordi - All sounds good and proceeding on schedule. Try to just let it happen as best as you can. Someday you will have some answers that you can plan around.

Geordi
Keep us up to date. I start SBRT October 6th but want to add that I was first diagnosed in 2018
Pca can be very slow growing so usually time is on your side.
Lot's to consider but keep coming here to see what others have done
Glen