URO Tomorrow - What Questions?

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newtopc
Regular Member


Date Joined Dec 2009
Total Posts : 90
   Posted 2/17/2010 5:18 PM (GMT -6)   
I see the urologist for the first time at 3 pm tomorrow. My wife is coming to the appointment with me. I think it will be good to have her hear things first hand. I am sure to expect a thorough DRE and expect to be scheduled for a biopsy. Any suggestions on what questions we should ask? I have researched as much on the internet as possible and have followed many, many posts here. This place has helped me, thank you.  Greg
47 Year old male, smoker, healthy
Routine physical May 12, 2009, PSA 4.12
Follow up PSA October 27, 2009, PSA 4.61 / Free PSA 4% (Not good)
Referral to Urologist Feb 18, 2010
Follow up PSA January 7, 2010, PSA 3.95, Free PSA 4% (still not good)


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 2/17/2010 5:33 PM (GMT -6)   
I carried along a small pocket recorder for all the sessions, and asked each time if I could record our discussion. But at that point (biopsy day) there wasn't much to discuss for me. The serious session will be over the results, and you will want a recorder that day, even if your wife is there. Too much information will go by, and you may miss some or a lot.

There are some long lists of questions that you should print and take along for the followup to the biopsy. I'll see if I can find the links to post on this thread later.

Should have also mentioned - you will want to ask what to expect as to rectal pain and blood in semen after the biopsy. There may be some of both, and you will want to know what to expect.

And Welcome - sorry to see you have to be here, but I got here the same way.

Post Edited (142) : 2/17/2010 4:43:07 PM (GMT-7)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/17/2010 6:14 PM (GMT -6)   
Tape recorder might be worth having. You might want to not let on that you are studying this and don't mention you are like on this forum and just see if he is going to do a DRE (rectal exam)before doing the PSA test, you can interrupt if this is about to occur. It would be a clue as to how wise is this uro-doc. It still happens out there and there is no reason for such ignorance from experts. I wonder how many biopsies are later done on patients whom got the DRE prior, which would inflate your psa score to make it look like you have issues?????? It is not as wonderful out there as alot of people dream it to be. Let us know how it goes.

There is a list of questions on this site and at www.yananow.net to consider using.


Youth is wasted on the Young-(W.C. Fields)


keysailfisher
Regular Member


Date Joined Dec 2009
Total Posts : 346
   Posted 2/17/2010 6:27 PM (GMT -6)   
Welcome sorry your here. Yes there is a list somewhere on here maybe one of the mods will be along to find it for you. Try to relax, i know that's easier said then done. I'm not sure what a thorough DRE is but mine was about 10 seconds and i was done. Good luck tomorrow and let us know how it went.
 
Neal
age 45
psa 3.09
Biopsy results 12/9
Left side base 3+3=6 21% 2/2 cores positive
Left side mid  3+3=6 100% 2/2 cores positive
Left side apex 3+4=7 88% 2/2 cores positive
Right side - 0/6
CT & Bone scan negative
Davinci Feb. 5th 2010/ cath removal 2/16
 
Gleason-3+4=7
Extent of tumor-Bilateral
Extraprostatic Extension-Absent
Seminal Vesicles-Negative for tumor
Surgical Margins-Rt apical margin focally positive
lymphovascular invasion-Suspicious in areas of capsular involvement
Regional lymph nodes-One node negative
Stage-T2c NO MX


mlbsm
Regular Member


Date Joined Mar 2008
Total Posts : 85
   Posted 2/17/2010 10:41 PM (GMT -6)   
Personally, since the DRE is not definitive, one way or the other concerning Pc, I would rely on the PSA numbers, and go straight to biopsy.

Either way, he's going to go to biopsy anyway if the PSA is elevated.

I went through the DRE, and the scans, and was told every time, that the results were negative, but that doesn't mean you don't have Pc. So why take them?

Many folks here had tough biopsy's, and just as many did not. The way my doctor acted, I thought I was going to hit the roof when he took the sample's. I had Lido cane and a sedative, and never felt more than a small thump on my prostate.

There was certainly some blood in the urine, but it went away in 2 or 3 days. Blood in the semen took a while longer to go away, so you might want to flush the system out before you make the wife happy.

I would simply ask the doctor; "If the DRE comes out negative, and you don't feel any problems, are you still going to recommend the biopsy?". Then you decide from there.

(If Tony or James thinks this is wrong advice, please feel free to delete it.)

Billy
DIAG. 2/08
DRE POSITIVE
PSA 6.8
CONTAINED, LEFT SIDE, GLEASON 9
LUPRON, (3 MO.) 2/28
RRP, 3/26, HOME 3/31
GLEASON SCORE, 3+4
TUMOR CONFINED TO THE PROSTATE, INKED EXTERNAL SURFACE FREE OF INVOLVEMENT. VD AND SV CLEAR AS WELL AS LYMPH NODES AND A BLADDER SECTION.
PSA 5/21 O.O1 UND TESTOSTERONE 0
PSA 6/30 O.OI UND TESTOSTERONE 10
PSA 9/30 O.O1 UND TESTOSTERONE 311
PSA 1/12 O.O1 UND. TESTOSTERONE 219
ED, BUT I CAN FIND WAYS AROUND IT.
PSA 4/10 O.O1 UND. TESTOSTERONE 119 Rx. FOR ANDRO GEL
PSA 6/15 O.01 UND. TESTOSTERONE 217
PSA 9/15 O.O1 UND. TESTOSTERONE 144


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/18/2010 5:43 AM (GMT -6)   
Although the DRE seems neandrathal, it is used as a clue for hard spots and non-normal feel for docs whom actually acquire the 'touch' and sensitivity for such. The DRE is not going to be rejected as a useful approach in further 'anal'-ization (LOL). Disagree with above poster to some degree(not totally)- you should not subject yourself to biopsies unless you have very good cause there are risks of infections and trauma to the gland and who can prove if possible PCa cells could be released (seems like it doesn't happen...but can we be sure 100%??). Does everyone else want to take the risk on a whim?

A patient might want to have much further testing before subjection to such: like psa histories-velocity-pasdt, PAP tests, pyrilinks test, PCA3 test, sonomgrams, DRE confirmation of suspecious feel and/or some other possible tests, prior to biopsies. The PCa oncologists (name brand experts-Strum-Scholz-etc.) do not recommend going straight to biopsies without a warrant (lol).

Then post biopsies you have these issues: are there any missed PCa areas (easily possible), could you have a missed area with a higher Gleason score (yes you could), what is the grading of what is found and is it accurate, whom did pathology?, did you get a through pathology report by reknowned experts as to even ploidity analysis, perinureal invasion, percentages found and even more data that is possible through these folks. Then later the assessments, nomograms, Partin tables, opinions, risks/rewards are next to be computed by patient and doc(s). Then the hard decisions: whom, what, when, where and hopefully after that you don't have to ask-why?


Youth is wasted on the Young-(W.C. Fields)


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 2/18/2010 9:34 AM (GMT -6)   
The links I had for the question lists are gone - that site (Malecare) is reorganizing. I have a list that I cut & pasted into a text doc, but it is several pages. I checked your profile for an email address, but you are not "public". (I'm not either, for that matter.)
I'll ping James and see it there is a way to park that file for you.

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 2/18/2010 9:44 AM (GMT -6)   
www.healingwell.com/community/default.aspx?f=35&m=1300628
www.yananow.net/questions.htm

Here's a start on some questions
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 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
32 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 2/18/2010 9:55 AM (GMT -6)   
James - thanks, the Klein list (second link) is a big part of what I was trying to send Greg. Looks like it is out there on multiple sites.

Greg - I added, for my own purposes (my surgery was in October, so flu timeframe):

Should I get a regular flu shot?
Any =/- time window around any surgery date?

Should I get the swine flu shot?
Any =/- time window around any surgery date?

Are there other vaccinations I should have before starting all this (such as Pneumonia, Hepatitis A/B)?

jacketch
Regular Member


Date Joined Apr 2009
Total Posts : 179
   Posted 2/18/2010 2:56 PM (GMT -6)   
At the end of my Q&A session with the doctor he asked if I had any other questions.

I asked if I could borrow his car.
62yo
V10.46 Dx Feb-09
RRP 5-5-09
No adverse SE
PSA 6-19-09 -0-
PSA 9-21-09 -0-
 
Thriving, not just surviving!
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/18/2010 3:21 PM (GMT -6)   
what did he drive?
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% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days

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