Seeking advice - likely a new member (prostate nodule and PSA velocity)

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Fat Sailor
New Member


Date Joined Sep 2009
Total Posts : 7
   Posted 9/22/2009 3:47 PM (GMT -6)   
I'm 47, and I thought healthy. I had a routine PSA done this past Feb with my annual check-up. It was 0.9. I saw the urologist last week to arrange a consult. During the DRE, he was digging around a bit. I figured either he liked me, or there was something wrong. Unfortunately, it was the latter. He found a nodule on the right half of my prostate. He ordered a PSA, and I had blood drawn a few hours later. The results came in today, and the PSA is 2.1. Biopsy is scheduled a week from today. Everything I've managed to find so far indicates the biopsy is moot except for confirmation and calculating the gleason score. If anyone here knows of case with PSA velocity and a nodule being benign, I'd love to hear it now! ;)

One question I have is that the doctor has given me the choice of either a local or general anesthesia. I've heard even with the local it is rather painful. However, I never like being put under unless it is necessary. I'd appreciate any advice here. I'd also appreciate any general advice people have. I'll admit that I'm not too worried about survival at this point as I hope we caught it early. I am, however, scared to death of the post-op collateral damage. Impotence and incontinence were things that I never thought I'd have to worry about in my 40's.

Finally, I want to say that I've found this forum to be incredibly useful so far. Admittedly, I've also found it a bit scary. I'm a firm believer, however, in having knowledge to help make informed decisions.

Thanks in advance!

Bill

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 9/22/2009 4:15 PM (GMT -6)   
Hi Fat Sailor,
 
The biopsy is not as bad as you think, its all over within minutes.  I elected to stay awake during the process, and the pain level, was very low in my opinion.  Obvioulsy uncomfortable but certainly bearable.  Good luck with your results, lets hope you dont have to join our club here.  ................Cheers Kev
Age 51yrs
DX 11/11/08
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4
Gleason Score 3+4=7
Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleanson Score 4+3=7 Gleason Differential 60%/40%
Stage T2c
Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week.
ED- taking Meds- Its been 9 mnths now getting some action ! yah
PSA 1/09  .03
PSA 2/09  .03
PSA 5/09  .03
PSA 9/09  .03
"Everyday in Everyway I get better"


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/22/2009 4:28 PM (GMT -6)   
Bill, welcome to HW, are you an ex-squid like me and some of the other guys?

The PSA velocity is one of the most important factors to consider these days. I am the victim of PSA velocity. And to answer your question, I had several years of strong PSA velocity, and about 6 or 7 negative DRE (Digital Rectal Exams). I had 3 biopsies, in the span of 18 months, I was not put out for any of them. Didn't like them, mostly didn't like the probe up my a**. With one, I had pain meds injected in the area, and the needles from that hurt me worse than the cores being taken, so on the third one, I went back to no pain meds and did fine with it. You can expect some minor bleeding from your rear (not always), and sometimes bloody ejaculate, which can freak you out the first time, but its harmless. Only you know your threshold of pain, so do or ask your doctor what you think you need.

The biopsy is critical at this point. There still may be non-cancerous explanations for what you have going on. You probably know, we have more than our share of men in their 40s with PC. At 56 when I was diagnosed, my dr. said I was one of his youngest PC patients.

Until you have your biopsy, I would assume you don't have cancer. But still a good time to keep researching and asking questions. If you do have cancer, yes, catching it early would work in your favor, and depending on the pathology of that biopsy, its way too soon to have a firm opinion on your treatment options, or even if you need to have one.

I will be hoping you come back clean. Not a club you would go out of your way to choose, but if you end up one of us, this is the greatest place on the web to be part of the family with, we are indeed a brotherhood here.

Please keep us posted.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl., agreed to start radiation, does not rec. HT at this time, mapping on 9/21/9


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4149
   Posted 9/22/2009 5:04 PM (GMT -6)   

Hi Bill:

There have been a couple (at least) of topics on biopsy pain the past 6 months, so you might want to see if you can find them.  My recollection is that most guys suffer through the biopsy without too much pain, even if sedative free.  However, there were several guys who found the pain very real and very uncomfortable.  For me, I had my biopsy under IV anesthesia and it was definitely a piece of cake...one vicodin afterwards and that was it.  My uro-doc recommends the anesthesia for two reasons:  (a) he sees no reason for his patients to suffer needlessly and (b) he likes to take his time doing the biopsy without a wincing patients begging for it to be over.  Your call....

It is difficult to give you much additional advice until we see your biopsy results.  There are multiple treatment options...including active surveillance...depending on your stats.   Come back and let us know and you will gets lots of advice.  In the meantime, of course, there are a multitude of threads that you can read thru here if you want to get some background.

Good luck...hope all is clear and we never hear from you again!!!

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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 9/22/2009 5:23 PM (GMT -6)   
Every one is different, but to me the biopsy with a local was no big deal -- not fun but easily bearable. In fact my biggest problem was that it was done by a female uro and a female nurse. I am just not used to having a team of "girls" poking large objects up my a*s. It was done about 2pm and I cut work and took the commuter train home with no problem, :Later on blood in the urine and semen is frightening but normal

As others have said, we hope you are negative and go away, but you can be sure that you do not have a single worry or fear that we have not shared.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


reachout
Veteran Member


Date Joined May 2009
Total Posts : 725
   Posted 9/22/2009 5:41 PM (GMT -6)   
I had a biopsy under local and hardly felt anything at all. I went to play golf right after the biopsy and never had an issue with it. So don't be afraid of the biopsy, it's the best thing that you could do right now.
Age 64 yrs
DX 5/2009
8 out of 12 cores positive
PSA 5.6
Gleason Score 3+4=7
Stage T2a
Da Vinci Surgery 08/07/2009
Upgrade Gleanson Score 4+3=7
Stage pT2c
Neg Margins and Nodes
Neg Extraprostatic Extention
Dry immediately
Waiting for first PSA


Fat Sailor
New Member


Date Joined Sep 2009
Total Posts : 7
   Posted 9/22/2009 5:43 PM (GMT -6)   
Thanks for the help so far guys! I'm definitely holding out hope! I do appreciate the advice.

Thanks for the pointers to biopsy pain. I'll do some searches, but right now I'm leaning towards staying awake. I guess I am a control freak. I don't like the idea of not knowing what's happening.

Dave in SC - I was a Coastie (shallow water sailor / mud duck) for a year on a 44' when I was 17, and then I went to WooPooo and jumped out of perfectly good airplanes for a while. I never gave up my love for the water though, and I have a sailboat berthed in Annapolis now. My oldest son (14) and I were planning on sailing to Bermuda and back in '10. Worst case, I'm still hoping we can beat hurricane season.

I'll post an update once I get my biopsy results in a few weeks. In the mean time, I'll stay tuned.

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 9/22/2009 6:03 PM (GMT -6)   
I don't think you can rely on the last PSA reading of 2.1, taken just a few hours after the DRE. Prostates protest! So I would expect the true PSA to be somewhat, maybe a lot, lower.

Still the nodule needs to be investigated, so a biopsy is a good next step. But in view of the low previous PSA, I think you have reason to be hopeful. Let's all hope that it turns out to be benign.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
ED:
After a learning curve, Bimix injections (0.2ml) are working well. VED also works but we find it inferior to Bimix.
14 months: Occasional nocturnal erections.


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 9/22/2009 6:29 PM (GMT -6)   
I followed a nodule for several years before it biopsied as cancerous. They found HPINS, which are the precursor to cancer cells, but I enjoyed several years with a nodule.

I wouldn't assume it is a done deal yet.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)


OKboy
Regular Member


Date Joined Apr 2009
Total Posts : 55
   Posted 9/22/2009 7:23 PM (GMT -6)   
Just responded to the brother of the guy going in for biopsy - I stayed awake and had taken a pain pill and a 5 mg valium an hour before the biopsy. Uro injected pain meds (no pain) and then took 12 cores (also painless). All folks are different and I don't profess to having great pain tolerance, but as i got off the table I remember thinking that this was a pretty pain free procedure - not even approaching the horror stories I'd read. Good luck.
DOB=March 1959
PSAs (*s done @ uro's lab; others @ family doc): 10/05=1.2; *10/06=1.22; *12/07=1.68; 08/08=1.5; *12/08=1.93; 04/09=2.9; 04/09retest=3.4; %fPSA=15%; *05/13=3.17; *08/09=3.45; 5 DRES=neg.;
06/09 Biopsy=12 benign cores, 3 cores show prostatitis.


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 9/22/2009 7:41 PM (GMT -6)   
Hi Bil
I had my biopsy without any medication and I felt little to no pain. It was over if just few minutes. It certainly was the easiest part of the whole battle that I've been through. Hopefully your battle ends with a clear bill of health.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 9/22/2009 8:04 PM (GMT -6)   
I had high velocity and high values. A twofer!
The biopsy was a mixed bag for me. 11 of the shots were fine but there was one that was much more "exciting" than the others. Yikes!
The blood in my ejaculate was a little disconcerting but normal. By the third week it had changed to black so I was shooting crude oil - like something from Aliens.
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
----------------------------------------------
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
----------------------------------------------
Post Surgery Status:
Potency - 9/17 2 months, Still no activity
Incontinence - 8/20 4 full pads per day
. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
9/17 2 months: Still 3 pads per day. At this rate I'll be fine in 2011.
Post Surgery PSA - 9/3 6 weeks - 0.05


Bluenose
Regular Member


Date Joined May 2008
Total Posts : 260
   Posted 9/22/2009 8:19 PM (GMT -6)   

 

...myself, put me out, I was,  it's the twenty-first century and who needs the pain and/or anxiousness of anticipation of the biospy.....don't remember a thing. On the other hand, my brother-in-law was DX'd the day before my surgery, I always loved his descripition on his bi-op......"it was like being raped by a fire hydrant".......you're call...I can deal with pain and discomfort, and have.....but why do it if we don't have to? Good luck brother.

 
 
  age: 53 @ Dx, Pre-op PSA Feb 08' 5.0, April 08' 4.1
  Biopsy 5.1.08, 5 of 15 cores postive, T2a, Gleason 3+4=7
  DaVinci performed 7.29.08
  Bladder sling installed, umbilical hernia repaired during surgery.
  Path report, "cancer fully contained, margins clear".
  Cath removed 8.8.08, ED therapy begins 8.9.08
  100mg Viagra three times a week, pump for ten minutes daily
  and hold for ten minutes.
  8.16.08 switched to Levitra 20mg, immediate results
  9.15.08 Pad free at night, one thin (light) pad during the day
  9.18.08 1st Post-op PSA Undetectable Zero's....Yes!
  12.22.08 2nd Post-op PSA  Zero's still...
  6.23.09 1yr Post-op PSA Still a zero..
  Pads gone 1.3.09, finally found the courage...Thanks ya'll
          ".....tryin' to reason with hurricane season...."
       


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/22/2009 8:49 PM (GMT -6)   
Sailor, got you now. Sailing has always been a passion of mine. The past two years only I have been without a sailboat. Love Maryland and Annapolis is a great place, I envy you. Want to be well enough one day to have another sailboat. In western SC, there are nice freshwater lakes, two in particlar great for sailing, and the the Atlantic is about a good 3 hour drive towing a boat. So there are options.

Please stay in touch, we care. If you are fortunate enough not to have PC at this time, then it was nice meeting you. If it comes back positive, you will be glad you are here, and so will we.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl., agreed to start radiation, does not rec. HT at this time, mapping on 9/21/9


Modelshipwright
Regular Member


Date Joined May 2009
Total Posts : 215
   Posted 9/23/2009 6:30 AM (GMT -6)   
My biopsy was with a local and the level of pain was minimal. I drove home 30 minutes later and the obly discomfort was a little tenderness in the scrotum a few days later which turned out to be an infection that was treated with an antibiotic. It was no big deal in my opinion, although I suspect it is different in every case.

Regards,
Bill
Age 64. Diagnosed with Pca January 2009, PSA 5.6, Gleason 3+3=6, T1c, TRUS biopsies of prostate left adenocarcinoma of prostate involving part of 1/4 biopsy fragments, less than 10% of the surface area involved, CT scan clear. Robotic Assisted Laparoscopic Prostatectomy surgery for treatment - September 29/09.  Pre-op PSA down to 5.28 which I atribute to visualization techniques and a new vegetarian diet.

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