Biopsy Difficulties

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truckdriver
New Member


Date Joined Jan 2009
Total Posts : 4
   Posted 1/31/2009 12:06 PM (GMT -6)   
H Folks,
Will try to keep this short as possible. I'm a 57 year old truck driver.. about 8 years ago had my first PSA test taken simply because the Dr. thought I should, not because of any difficulty. Came back as 2.4. Sent me to a urologist who's first thought was that I needed a biopsy to check for cancer. DRE showed prostate swollen but smooth. Understand that my dad had just died that year from pancreatic cancer. I had helped take care of him at home his last 2 weeks and had been at his bedside when he died, so I was well aware of cancer, scared of cancer, and didn't asked any questions or check any farther. I went along with everything the Dr. had to say and scheduled a biopsy. From what I came to find out afterward, would have never gone along with this so willingly.

My first surprise came as I was getting on the table for the procedure and it was explained to me about the EIGHT! samples he was going to be taking. (Says something about how much had actually been discussed about the procedure to begin with.) Being anxious, ignorant, and scared I thought "a" biopsy meant just that, not eight! Was assured by the Dr. from the beginning that he does "hundreds of these a year" and rarely, rarely has anyone that experiences any problems. The procedure was very uncomfortable, no local anesthetic. I couldn't wait to get out of that office! Nearly passed out about 30 minutes later on the way home. To make this saga brief, over the next 2 weeks I experienced extreme discomfort (aka pain) especially on the right side of the prostate, passed a lot of blood, passed numerous large bloodclots, and was in ER twice. Thankfully no infection. Took almost 2 weeks after that for me to begin having a normal looking color to my urine. For years after that if there was any discomfort in the prostate area it was always on the right side.

That whole episode caused me to change the way I was living. Had been living the truck driver diet. Immediately stopped the red meat and used very little dairy. Increased fresh fruits and veggies. As of a few years ago I even stopped the poultry and now eat only fish. Had dabbled with prostate supplements, but never got real serious with them. Had chest pain problems and have had some BPH symptoms for a while, so had blood tests last November. Found that in spite of my diet I have high cholesterol, and I had a PSA of 9.2. Intensified diet to lower cholesterol and began with supplements. Dr. set up an appointment with a urologist (not the same one) for a month later. Again DRE showed prostate swollen but smooth, wanted to do a biopsy. Explained to him the difficulties I had and asked that every other possibility be eliminated before I would consent to a biopsy. He agreed to a free PSA test. 2 months after the first, PSA down to 7.8, free PSA 11%. (Cholesterol also down 30 points). Urine flow and regularity has much improved. Urologist still insists on biopsy. Used the "hundreds of these a year" statement which, as you can imagine, didn't impress me a bit. His difficulty rate of .9% means nothing to me as I have a difficulty rate of 100%! He took a urine sample at my first exam and declared before I left his office that I do not have prostatitis. Since the DRE I have begun to experience what I believe to be prostatitis symptoms as far as pain and discomfort are concerned. Will not discuss any available options. When told him I was not getting a biopsy until he further examined other possibilities our conversation was over.

Needless to say I have an appointment with another urologist in a week. Also, just as needless to say, my opinion of urologists at this time can't be written in this forum. In my limited time of reading this forum I have not noticed any talk about problems with the biopsy itself. Sought out this forum this morning, joined and am sitting here in my prostatic discomfort entering my first post. My apologies for the length.

LPdriver

RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 1/31/2009 12:16 PM (GMT -6)   
truckdriver,
I am very appreciative of your experience and fears. Taking the biopsy is one of the scariest things I have ever encountered. Ironically though, my biopsy was not that bad. The experience was not as bad as the fear leading up to it, and I, unlike you, had no real after affects.

I would suggest that your experience was the exception and not the rule. I don't know why you had such problems following the biopsy, but think should you have to have it again that stats from most of the experiences you read about here would say it should not happen that way again. I hope another biopsy will not be necessary, but if it is (and of course the biggest issue is to ID cancer if it exists) then be encouraged that very few have the kind of trouble you describe. I wish you God speed!

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008


truckdriver
New Member


Date Joined Jan 2009
Total Posts : 4
   Posted 1/31/2009 12:49 PM (GMT -6)   
RB,
Thanks for your reply. I don't doubt the Dr. when he states rate of success. I just don't understand why he can't be more understanding of my experience and checkout other options that seem to be available to narrow down the probabilities of cancer before he sticks an already uncomfortable prostate with a dozen needles. I also don't understand his unwillingness to even discuss them. In what I've been able to find, there appear to be a few other options available. What would be the harm in pursuing these other than taking the risks of another bad experience with a biopsy? At this point, I have a lesser probability of having cancer and a greater probability of difficulty with biopsy.

I am glad you or the many others on here have not had the troubles I had. The fear I have of another biopsy is not fear of the unknown, it is fear of the known.

Lpdriver

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/31/2009 1:49 PM (GMT -6)   
Sorry for you as a brother warrior on PCa, did I ever mention on this forum how righteous alot of these docs are???? Maybe once or so....wouldn't you think!!!!! Hack n slash docs out there???
Gee this must be another expert uro-doc, wouldn't you like to have him also as your surgeon????
This is the world of PCa.....not everyone gets an informed reasonable doc, although in this country especially they should. No mention of anethestic for biopsies, not telling the patient totally what was going to happen and the possible issues and side effects? Whom even knows if this "expert" did fubar on the biopsies on this good guy patient herein, sounds like a real possiblitiy, but he has done hundreds....so he says. If this doc keeps this up perhaps he will get the darwin award for this year.

Now am I being rough on some docs???
 


DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 714
   Posted 1/31/2009 3:12 PM (GMT -6)   
LP,

I had a lot of pain from the biopsy as well. There used to be a number of discussions on biopsy pain, and maybe they're still here somewhere. But I can't find them even with a search. As I recall, there was something of a debate. One side wanted to make sure doctors offered local and general anesthesia as options. The other side said most guys have hardly and discomfort, and you don't want to scare people off from getting the biopsy in the first place.

I compare it to having dental work. My dentist gives me some local before starting, and during the procedure, if we jointly decide the first amount wasn't enough, he gives me more. This makes me more inclined to visit my dentist. The dentists seem to have the pain issue much more in hand than a lot of medical docs.

Moot point for me now, since that prostate is gone. Hopefully, that is, I hope I'll never need a lung or liver biopsy.

DJ
Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
Pathology: pT2c; lymph nodes negative; margins involved; 41 grams, 8% involved by tumor; same Gleason 4+3=7
PSA 1/22/08 non-detectable! 8-)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/31/2009 3:32 PM (GMT -6)   
Truckdriver, hello and welcome here. Sorry your biospy was an unpleasant one, I have had 3, each was a little different. A good doctor can make it as painless as possible for you. The fear of it is usally worse then the reality. On the other hand, if there is a sound reason to do the biopsies, i.e. your rising PSA, it is still one of the best tools available to detect Prostate Cancer (PCa). And you are correct, the fear what might be there can be overwhelming before you know if you do or not. Some men here have strong negative feelings about the biopsies, and others, it's no big deal. A lot depends on the fear factor and your tolerance of pain, again, that is where a good doctor can help put you at ease.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/31/2009 3:36 PM (GMT -6)   
LP,

I understand it all. The biopsy was shocking, mine was also eight cores.
You have a serious situation, your PSA is too high and your free PSA is too low. You do not have to be subjected to the same treatment as before with the biopsy, it can be done under what is called IV sedation and I think you should ask. More Dr.s should ask the patient before subjecting them to an office procedure.

Please get the biopsy but make sure that they do not make you hurt in doing so.

Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/31/2009 3:59 PM (GMT -6)   
Truckdriver,
Welcome to the best patient to patient site on the web. I had the biopsy (10 core) 18 months ago followed later by RPP. So far as the biopsy is concerned I was totally unaware of it. It was done in a similar fashion to having a colonoscopy. Light anesthesia, deep in the twilight zone and never felt a thing. I came to in the recovery room, great cup of tea, a sandwich (which was so nice I asked for another) and away I went after a couple of hours. Had to be driven home though as their policy was no release without somebody accompanying you home. I don't remember any real post biopsy discomfort, a little blood was passed for a week or so and that was it. If you are apprehensive then insist on anesthesia and I would think that a bowel preparation pre-biopsy, along the lines of that used for a colonoscopy would be a great help in minimising the possibility of infection. There are a couple of tests and scans you could undergo but unfortunately the biopsy is far more accurate re. diagnosis.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/31/2009 4:16 PM (GMT -6)   
Zufas, got me curious now. Can you give a list of doctors that you have used and liked and thought were competent?
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


truckdriver
New Member


Date Joined Jan 2009
Total Posts : 4
   Posted 1/31/2009 5:02 PM (GMT -6)   
I really appreciate all of your responses. However, there seems to be too much focus on the discomfort of the procedure itself. The number of you folks that have taken a biopsy and experienced little if no problems is great to hear but means little to me in regard to my own personal success. The biopsy was uncomfortable and I have no question that can be controlled by medication. It was the damage done by the biopsy that most concerns me. It's the complications caused as a result of the biopsy that I would like to avoid. I have no reason to believe the first biopsy was performed by an unqualified doc. My complaint with him was that he did not fully inform me about the procedure not that he did a shoddy job. I would have still gone through with it, anyway. He is a recognized doc in the area. The results of the test were negative in more ways than one.

If I can be convinced that I have a greater chance of having cancer than I do of having difficulty with the biopsy it would help. With what is known now I have a greater chance of not having cancer than I do of having it. All I am asking is that a few more tests be conducted that demonstrate my likelyhood of cancer before I take the rixk of having the same problems or worse taking a biopsy of that can still miss the cancer. There are other non invasive tests that can be performed before taking a non definitive biopsy.

LPdriver

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/31/2009 5:13 PM (GMT -6)   
LPdriver,
You stated that you are about to see a new urologist. This is good, you can start with a clean slate with this one, and hopefully he will be better about disclosing and explaining things. One of my longterm habits with any doctor, is to go in with a written list of questions I want to ask or hear answered. Its too hard when I am in a long waiting room, or nervous with the doctor. Most doctors love it, because they are stretched for time to start with, and it makes it easier to stay focused instead of going off on rabbit trails.

With what you stated originally, with your psa numbers, and the fact that prostitis was ruled out (if I understood correctly), then a good biopsy is still needed. Some men here have PCa detected on the first one, me- took 3 spread over about 15 months, someone else here, I believe has had 13 biopsies.

Hopefully, your new dr and you can communicate freely and openly from the first visit. And if he/she does suggest another test, procedure, or even biopsy, then fire up your list of questions. If pain is an issue, most dr. will work with you, if it is anxiety, most will work with you.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


jetguy
Veteran Member


Date Joined Sep 2006
Total Posts : 741
   Posted 1/31/2009 5:36 PM (GMT -6)   

Don't want to sound negative here, truckdriver, but if I had an 11% free, I'd be getting a biopsy in a heartbeat.  Just my $0.02 worth.

Best to you,

Bill


August of 2006, PSA up to 4.2 from 2.7 one year ago. 
October free and total PSA 12% free and 5.0 total.
A month, or so later, 4.7.
Late in the year decide on Image Guided IMRT.
Begin 43 treatments on January 23, 2007 and finish on March 23.
 
Wow, almost two years behind.  I had a typical radiation bounce that
scared me, but it seems to be ok.  PSA is about 1.0 which is ok for
a rad guy at this stage of the game.
 
Got my FAA medical certificate back four months after starting my
treatment.  It's still a First Class, just jumping through a few hoops.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4089
   Posted 1/31/2009 6:06 PM (GMT -6)   

Dear truckdriver, here are a couple of thoughts:

1.  Re your question about other tests, there was a lengthy discussion in another thread on this forum about the "PCA3" test.  I looked back and could not find which topic that was under but perhaps a moderator or other member will find it and let you know via this thread.  In the meantime, here is a link about the test:

http://www.prostate-cancer.org/education/preclin/Torres_PCA3.html

You can also google "PCA3" and find tons of info.  The test is non-invasive and being recommended by some docs (and some members here) as a test that should take place between PSA and biopsy.

2.  My biopsy experience was very similar to that posted by BillyMac in this thread.  IV sedation and no big deal...I had 16 samples taken.  My urologist did it that way for 2 reasons, (a) patient comfort and (b) so he could take his time and not worry about patients jerking and moving while the needle goes in.  It's not about being a wuss, it's just why suffer any unnecessary pain or discomfort when you do not need to do so.

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 1/31/09.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4089
   Posted 1/31/2009 6:10 PM (GMT -6)   

oops...I just saw the thread...it's called "If the PCA3 test is so good how come I haven't..." and it was started by cvc.  As I'm typing it's on page 1 of this forum.

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 1/31/09.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 1/31/2009 8:52 PM (GMT -6)   

Truck Driver, With your PSA and free PSA numbers you have to get a biopsy, the other alternative will be much less pleasent in the long run.

I've had a total of 13 biopsies, so I know a little about them.There are several possible ways you can go.

You can go to a doctor that will sedate you. In this case get as many samples as you can, at least 24.

You can find a doctor that gives a lidocane shot, this decreases the pain a lot. Also take a vicodine, this helps with immediate and post pain and won't cause bleeding. (Docs won't tell you this).

You can get a color doppler targeted biopsy. This is by far the best method as it is the most accurate; if there is no suspicious area no biopsies are taken. If a suspicious area is seen only that is biopsied. Rarely are more than 6 cores are taken. If nothing is found then a base line picture is established to compare changes. If cancer is found it can be accurately staged as to exact location and tumor size. A normal biopsy can't do this.

The only problem is there are only a few doctors that are skilled in it's use. Dr Fred Lee in Mich, and Dr Duke Bahn in Ventura Ca are two that I know of; there may be a couple more around. If anone knows of other good doctors that use this please let this forum know. 

After 13 biopsies I would only get another color doppler biopsy, even if it meant flying across the country. It's that much surperior to a normal biopsy.

JohnT

 


I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/31/2009 9:17 PM (GMT -6)   
John T, the talk of the color doppler is interesting to me. After my 2nd biopsy, taken 12 months after the first, it came up negative officially, but from the regular scan on it, my doctor noted 2 suspicious areas. On the 3rd and final biopsy, taken 6 weeks later, he did 6 cores only in the suspicous areas and hit pay dirt, cancer on 6 out of 6. Would love to have had access to the color doppler even before the 1st biopsy, might have already showed the prescence of pc even earlier yet.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


Dandapani
Regular Member


Date Joined Jan 2009
Total Posts : 62
   Posted 2/1/2009 11:04 AM (GMT -6)   
I had a 12 plug biopsy. No pain. It was a two person procedure. The Urologist and the ultrasound technician. The technician numbed me with a local injectable. I had little blood in my urine, but a lot of blood in my ejaculate, for 8+ weeks following. Cancer was found in only 1 of the 12 plugs.

My brother-in-law has BPH so they give him annual biopsies, but his doctor doesn't numb and he had me so afraid of the procedure that I was reluctant to go through with it. Find a Urologist that will use medication to stop any pain. Good luck.
Dan

PC diagnosis @ 53 YO
PSA: 3.4 - 3.7 for preceeding 10 years, new GP advised Urologist visit

09/18/09 12 plug biopsy
09/29/09 PC diagnosis, 1 of 12 plugs, 5% cancer, Gleason 3+3 (6), left side plug w/cancer
12/17/09 da Vinci robotic radical prostatectomy, lab confirmed biopsy, 5%, PIN rest of prostrate, negative margins
12/29/09 catheter removed

current status: 3-4 pads/diapers a day, dry overnight, however; total ED


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/1/2009 11:16 AM (GMT -6)   
Dan, glad you had a no pain biopsy experience, much better that way, and most dr. will work with their patients on that if your feelings are known. Glad you didn't listen to your brother in law, as you are on your way with your recovery. My best to you.

David
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 714
   Posted 2/1/2009 11:22 AM (GMT -6)   
LPdriver,

It does sound like your biopsy recover was more difficult than average. I wonder if that could be a factor if you ever decide to have surgery. The rule of thumb (stated by my surgeon) is that you wait 8 weeks after a biopsy, to let the tissues heal, before surgery is performed. In your case, maybe a longer wait is called for.

DJ
Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
Pathology: pT2c; lymph nodes negative; margins involved; 41 grams, 8% involved by tumor; same Gleason 4+3=7
PSA 1/22/08 non-detectable! 8-)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/1/2009 2:41 PM (GMT -6)   
DJ, right you are, the 8 weeks gap is considered standard by many surgeons, as they want everything to settle down before surgery. My doc originally was going for 6 weeks, but later revised it to 8, which I am glad he did
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 2/1/2009 3:00 PM (GMT -6)   
truckdriver says:
It was the damage done by the biopsy that most concerns me. It's the complications caused as a result of the biopsy that I would like to avoid. I have no reason to believe the first biopsy was performed by an unqualified doc. My complaint with him was that he did not fully inform me about the procedure not that he did a shoddy job. I would have still gone through with it, anyway. He is a recognized doc in the area. The results of the test were negative in more ways than one.

If I can be convinced that I have a greater chance of having cancer than I do of having difficulty with the biopsy it would help. With what is known now I have a greater chance of not having cancer than I do of having it. All I am asking is that a few more tests be conducted that demonstrate my likelyhood of cancer before I take the rixk of having the same problems or worse taking a biopsy of that can still miss the cancer. There are other non invasive tests that can be performed before taking a non definitive biopsy.

Truckdriver, I understand your hesitancy to go thru another biopsy. Mine wasn't any picnic and I did have 'issues' with pain and discomfort for several weeks afterwards. However, I think that you are dreading the wrong thing here. Yes, it may be painful, yes it may take a longer time to heal, but your stats that you presented really does override your worries about the results of a biopsy. You want assurance that the chances of cancer is greater that the difficulty of another biopsy. That seems easy to answer, using your stats. IF you do have prostate cancer, (and your stats lean in that direction) discomfort from the biopsy to find it out and to treat it is gonna be much less than if you don't find it out and treat it, or you delay discovery and treatment. Prostate Cancer, if of the aggressive type and left unchecked, will ruin your whole world, in a manner of speaking. As to how to determine if you have it and avoid another painful biopsy, there's been a couple suggestions that may or may not be feasible with you. The color doppler imaging sounds promising, but is not readily available locally to most of us, I suspect. The PCA3 test is another, new weapon in our bag, we have found out this week. Whatever course you choose, I would suggest to you that with your stats, you need to do something to determine your cancer status, if any, and soon. I hope and pray that it is something other than cancer and that you can continue your life uniinterrupted.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


truckdriver
New Member


Date Joined Jan 2009
Total Posts : 4
   Posted 2/1/2009 3:10 PM (GMT -6)   
Again, I really appreciate your continued responses and suggestions, but most of the focus still seems to be on the procedure itself and getting through that. Yes, the biopsy was definitely uncomfortable, especially without anesthetic, but I could go through that again without the anesthetic if I had to. The pain was not that intense and that is not the real problem I'm concerned with. I'm concerned with the damage as a result of the biopsy.

Evidently I appear to be the only one here who has experienced this much difficulty. I appear to be one of those tiny% of men who don't do well with this. The Dr who performed it was experienced and has a long running established practice. It seems that I'm having a difficult time making that point clear to the Drs and to you folks here on the forum. Believe me, I understand the need for early diagnosis. If I need a biopsy I'll agree to one, but I just need a little more substantiation using other options available rather than subject myself to the same or possible worse consequences from a test that may miss cancer, if I have it, anyway. A simple "pee in a cup" and 15 minutes later proclaiming "no prostatitis" is not a thorough enough test for that as I understand it. What if my problem is from something that can be found with less invasive testing? Why would I agree to having more needles stuck in my prostate before I know for sure? According to my results so far, I have a 72% chance of not having any cancer and 100% chance of having problems as a result of the procedure. Is it wrong for me to insist on another test or two to eliminate other causes and confirm the possibility of cancer before I submit to another biopsy?
Thanks for the info on the PCA3. It and the PSAD were two of some of the other options I had read about.
LPdriver

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/1/2009 3:39 PM (GMT -6)   
LPdriver, it is not wrong of you in any of your choices in dx. and treatment, it's your choice(s) clearly. With my 3 biopsies prior to the PCa dx, I reacted to each one differently. The 3rd and final one was actually my best, hardly bled in the the urine, just barely pink, nothing really in the ejaculate, and the pain was the least afterward. The news I got about having PC from the 3rd biopsy made me instantly forget about any of that part, trust me. The only way you are going to know with certainty is to continue the biopsy path, I believe that is what James in the post above was making the point. Your stats are already way too iffy to delay much, if at all. Someone on this site once quoted or said, the best time to have PC surgery is one day before it spread outside the prostate capsule. It can make all the difference in the world once it begins to spread and is no longer contained. That's something to think about. My own dr/surgeon was not hard up to do another open RP, he knew with my stats, there was more of a chance of agressivness, and when we did decide on surgery, I was actually bumped way up on his schedule, and he re scheduled some lower psa/gleason operations so that he could do mine sooner than later. It is all about your choice, brother, wishing you only the best, and hope you get the answers soon to make the choicesy you need to make

david in sc
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2457
   Posted 2/1/2009 4:10 PM (GMT -6)   
Truckdriver,
I had a free PSA of 11% and a PSA of just 3.3. My Urologist told me that with a free PSA of 11% I have a 30% chance of having PC. He immediately suggested that I should get a biopsy. I had heard of some bad experiences with biopsies but the fear of cancer was more than the fear of a biopsy. My biopsy was uneventful. I had no pain, no blood in the stool or urine. I do however have very aggressive type of PC so I'm grateful tpo have done the biopsy. I can understand your fear since you had a bad experience but you do need to know if you have PC.
Age: 67
5ft 10 inches 182 lbs
Schedules for Robotic surgery on Feb 9th
Surgeon: Dr. Randy Fagin, Austin TX.
12 sections tested 2 with cancer
Gleason score (4+4) in one nodule
(4+5) in another nodule
Negative CT scan and bone scan
PSA 3.5


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 2/1/2009 4:26 PM (GMT -6)   
I had 2 biopsies 7 months apart. I was sedated for each one and I experienced a little blood in the urine and blood in the ejaculate. The first biopsy said "atypical cells" meaning that they couldn't be sure if it was PCa. The 2nd biopsy confirmed PCa. I had PCa less than 5% of 2 cores out of the 16 samples. My surgeon said that I should wait another six months. I opted for surgery immediately. Sure glad I did. The pathology report came back Gleason 7 (3+4) with a positive margin. My only regret was that it wasn't caught on the first biopsy and I could have had surgery that much sooner. PCa is nothing to mess around with, believe me.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable

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