my advice to brother about biopsy

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lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 9/22/2009 6:51 PM (GMT -6)   
My older brother emailed me today asking for my thoughts on prostate biopsies.  He is going in tomorrow morning for a biopsy after his psa had doubled and the DRE showed some firmness.
 
He got more advice from me then he might have wanted.  He said that his urologist, who he does not know, would be doing the procedure with just local anesthetic (or maybe none).  This is a HOT BUTTON issue with me.  I believe that anything less than full IV Valium reeks of farmyard medicine.  I told him to be sure to have the doctor move the pigs and chickens out before he started the biopsy.
 
My brother has already had colon cancer surgery, so he knows about IV valium.  I am shocked that any responsible urologist would still practice medicine in this fashion.  I told my brother to call and cancel the procedure unless it was being done properly.  When you get a colonoscopy you get IV valium, I can't believe that there are still doctors out there who are so ignorant that they would perform a prostate biopsy without proper anesthesia.
 
Im sorry that I might have upset my brother, but I have read enough stories here about bad biopsies and insensitive urologists.  What are your thoughts on this?
 
PS  I went online and checked out some of the BIG guys (Mayo, etc)  I can't believe that they still list a local as their main method.  My advice, go to a young but experienced doctor, the old guys are stuck in their out of date ways.
PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 9/22/2009 7:26 PM (GMT -6)   
You probably suceeded in scaring the H out of your brother. Really, the biopsy is no big deal to many people. If you have white coat phobia, or are afraid of needles, anesthetic may be in order, but for most men, havinf to be driven home, losing control, and having more people involved in what is kind of a private moment for many, is worth the no anesthetic.

I personally get ill from most anesthecs, so I only take them if doctor forces me to. This includes biopsies, colonoscopies, tooth fillings, and even a kidney stone exam with a scope into the kidney.

There is a little noise from the procedure, but really nothing I woulf call pain. Discomfort is a better description of anytime someone sticks something up your a**, or your penis.

Really, your advice to your brother is not what he needed to hear.
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)


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 9/22/2009 7:29 PM (GMT -6)   
It sounds like you have a macho attitude about pain.  I respect that you disagree with my advice, but I believe strongly that I am right and Barnyard Medicine has no place in modern America.

I suspect that my brother will go ahead tomorrow despite my concerns, he has been ignoring my advice for years.

PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941

Post Edited (lifeguyd) : 9/22/2009 6:34:39 PM (GMT-6)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 9/22/2009 7:34 PM (GMT -6)   
I really don't have a macho attitude, it's probably the loss of control that my type A personality doesn't like. I can tolerate some discomfort if I don't have to be put out, for something that is not a big deal.

Every time they stick a needle in your vein, or take you to a level of unconsciousness, you are risking your health. I just want the risk to be worth it.
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)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4275
   Posted 9/22/2009 7:54 PM (GMT -6)   

We have had several threads on this subject over the past year.  Some guys say it is no big deal with little pain and some guys find it very painful and extremely uncomfortable.  Unfortunately, the patient doesn't know beforehand which experience he will have.

Personally, I'm with lifeguyd on this one.  My uro-doc is not a youngster, in fact he is very experienced and highly recommends IV anesthesia with his biopsies.  His reasons are two-fold:  (a) he believes that there is no reason for his patients to experience unneeded pain and (b) he wants to take his time without a wincing patient begging for the procecure to end.  I think this is a rather civilized approach and recommend it highly.

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"!

OKboy
Regular Member


Date Joined Apr 2009
Total Posts : 55
   Posted 9/22/2009 8:16 PM (GMT -6)   
I was really dreading the biopsy - the family doc prescribed a hydrocodone tablet to be taken an hour before the procedure and a 5 mg valium as I walked through the door. The uro injected lidocaine (no pain at all) and proceeded to take 12 cores (also, absolutely no pain). The entire procedure from lidocaine injection through the last core taken was no more than 7 minutes. I can honestly say the most uncomfortable parts of the procedure were the DRE and being in that spread eagled position. Looking back, I really don't consider the biopsy to be nearly the ordeal that a colonoscopy was - and I was pretty well out for that one! Good luck to your brother.
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.


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 9/22/2009 8:21 PM (GMT -6)   
goodlife said...
I really don't have a macho attitude, it's probably the loss of control that my type A personality doesn't like. I can tolerate some discomfort if I don't have to be put out, for something that is not a big deal.

Every time they stick a needle in your vein, or take you to a level of unconsciousness, you are risking your health. I just want the risk to be worth it.

  I'm afraid that I disagree with your comment about risking your health by sticking a needle in your arm.  There are many things that can risk your health, but we have injections, blood tests and IV's all the time without adverse affect.  I agree that some people resist because "not being in control" is  an uncomfortable thought.  The nice thing about a valium IV is that it is short in duration and does not overwhelm a healthy body.  It can be administered by a technician and does not require the monitoring of a general anesthetic.  It is general procedure for colonoscopies, I just wonder why that is not true for prostate biopsies.  A prostate biopsy is Much more invasive than a colonscopy.
 
This has become sort of a crusade for me.  I have talked to enough men who were not happy with the non IV procedure and have taken it upon myself to comment whenever asked.  Now I have commented to my brother. 
PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 9/22/2009 8:35 PM (GMT -6)   
lifeguyd,
I'm the same age as you and had my biopsy without any medication. I didn't ask for any simply because I didn't know if it will hurt. I had absolutely no problem and felt no pain at all. I have to say, it was easier than getting my teeth cleaned.
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


RacingOyster
Regular Member


Date Joined Aug 2009
Total Posts : 31
   Posted 9/22/2009 8:36 PM (GMT -6)   
My biopsy involved 12 cores and I was given a local anesthetic. It was only slightly uncomfortable at the time, and there was no lingering pain at all. Two hours after the procedure I drove myself to the airport and flew to a business meeting.

A general anesthesia would have made the event much more disruptive, and far more expensive, too.

The most unpleasant part of the whole procedure for me was the gallon of Golytely solution that I had to drink the day before.

Living in the northern Atlanta suburbs.

Good health and no symptoms when my annual physical uncovered an elevated PSA.

Diagnosis at age 55: PSA 4.6 - positive biopsy 3 of 12 cores - Gleason 3+3=6.

Open Radical Retropubic Prostatectomy with bilateral lymphadenectomy on 6/18/2009.

Pathology report after surgery showed negative margins, cancer contained in capsule

(60 gram sample, Gleason 3+3=6, T2c N0 MX).

PSA at 4 weeks after surgery <0.1 (all other problems are minor considering being cancer-free).

Catheters required on-and-off for 34 days after surgery due to recurring urinary retention.

Anal fissure due to trauma to rectum from biopsy, surgery, and antibiotic-induced diarrhea.

Using 1 pad during the day for occasional stress incontinence, dry at night (12 weeks after surgery).

Taking 2.5 mg daily Cialis for ED with no joy so far.

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/22/2009 9:34 PM (GMT -6)   
Gentlemen,

The first thing, is that pain is a very personal and subjective thing. I would never discount someone else's level of pain. Well trained and experienced doctors and nurses know this all too well, which is why they use the old 1-10 pain scale with patients to get to some level of understanding of the patients true pain level.

With my first biopsy, didn't know what to expect, never had one before. It didn't hurt me as much as it was uncomfortable, and being a straight guy, didn't like feeling violated up my anus. To me, the snapping noise is what spooked me, as I am ultra sensitive to noise in general. No pain medication ,drove myself home, fine by next day. A year later, same doctor, offered local pain med, so I said sure. When he shot the stuff with the needles, the pain from those needles were light white bolts of pain from my spine through the tip of my penis, it hurt like hell. Once deadened, and calm again, the cores didn't hurt a bit, but the same snapping noise unglued me. Eight weeks later, 3rd biopsy, I told the same doctor, no pain med this time, just get the job done. Having had it done both ways, I knew what to expect, the short pain of the cores being taken were far less painful than the needles to deaden it. That's my experience.

I have had so many scopes and catheters shoved up my penis in 10 months, and its not over yet, that yes, I have developed both a fear and a phobia about the subject.

My new doctor thought it was barbaric that I underwent a bladder neck/urehtra dialation procedure with no pain med or local. I agree, I sat through it, felt every inch of pain that was a full 10 the entire time. But, it was an emergency situation, the doctor knew he had to keep going, or else we would have been in the ER operating room near his office. The problem was he was out where I live, and at the sattelite office, they didnt have all the right gear he needed. That has been remedied since.

Toughing out pain is ignorant in medical circles. It doesnt make one more manly to avoid prescription pain pills if needed. Pain control leads to proper healing and less chances of relaspes in recovery, any nurse will tell you that in a heartbeat. Now, if you honestly don't need it, and Advil or Tylenol class OTC meds are enough, then that is what you should do.

My personal threshold of pain was much more a full year ago, then it is now, but then when I think of all I have been subjected to, its no wonder.

Don't think we should be comparing pain like this. If a guy needs to be "out" for the biopsy, so be it, more important to get the biopsy right, if you need nothing, then so be that too.

Just my thoughts,

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


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4849
   Posted Yesterday 6:31 AM (GMT -6)   
Does getting an IV valium increase your chances of DEATH from a simple procedure like a biopsy?
 
I would rather get another biopsy then a root canal.

Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted Yesterday 1:18 PM (GMT -6)   
Tud and David are right about this. From one person to another, we have no idea who will have a good or bad experience with a biopsy. I did not need more than the local but I know so many who had a terrible experience with it. That said, Lifeguyd knows his brother better than any of us. therefore his call for additional sedation may be wise. I certainly respect it...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 9/23/2009 12:22:23 PM (GMT-6)


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted Yesterday 7:47 PM (GMT -6)   

As I predicted, my brother ignored my advice and had a non sedated biopsy.  He consulted with his urologist and said that it was uncomfortable but not outrageously painful.  Now we wait for the results.

I admit that I used this as a soapbox to talk about my strongly felt opinion that patients should be treated as painlessly as possible.  I think some doctors do the non sedated in their office to make more money rather than share it with a surgery center.  It is understandable that people will defend the "way it was done to them".  I still think anything less than IV sedation  is barnyard medicine.  I acknowledge that others see it differently.  End of discussion.


PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted Yesterday 7:50 PM (GMT -6)   
lifeguyd, i sincerely hope your brother's biopsy comes bag negative. pain control is so very important in dealing with any kind of medical situation. i think your view had a lot of merit
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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted Today 4:45 PM (GMT -6)   
I've had 13 biopsies, 9 without any local and 4 with. There is a world of difference with lidocaine. The 1st biopsy I had was the old way, feet up and the doc grabs the prostate with his fingers taped and jams a needle in it, not a spring loaded needle, but a very large hypodermic needle.
I had a 16 core without lidocane and by #12 I was really hurting. I personally would not want to be out. I look at the screen and ask a lot of questions about what the doctor is seeing and doing; I learn a lot.
A vicodine before hand and lidocane during makes the pain tolorable and a 15 min procedure that you can drive yourself home from.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted Today 5:12 PM (GMT -6)   
JohnT, I knew you had the record here for biopsies, so I was hoping you would weigh in on this one. Like you, I wanted to know and see and learn what was going on. On my second one, he showed me the supsicious shadows on the screen that were identified as PC on the third one.

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, mapping on 9/21/9, 9/24 - mtg & procedure? with uro/surg, IMRT starts 10/5/9

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