Posted 6/7/2010 10:24 AM (GMT -6)
Waitman

From reading accounts of biopsies on this forum, I think there is a difference in how the different urologists manage the pain during a biopsy.

I had my biopsy in April with just a local anesthetic and it was very manageable. Really no worse than getting a shot of novacaine at the dentist.

The doctor put some lub with lanacaine (or lidocaine?) on the probe and inserted it--uncomfortable, but not painful, let it numb the rectum wall then injected 3 or 4 shots to the nerve. It stung just a little bit, but not bad.

Then the doctor took the ultrasound pictures while the anesthetic did its thing, then took the 12 samples.

Virtually no pain when the samples were being taken, but there was a snapping noise that sort of startled me each time (even though I knew it was coming).

There was a small amount of blood that came out of my penis during the procedure (which was normal)

Afterword, my penis had a mild sting for about two hours, then no pain at all.

I drove there and drove home myself no problem

Overall, I would rate the whole thing as a low 2 on a pain scale of 1-10.

I would inquire with your Uro on how he manages the pain during the biopsy and go from there.

I am not a tough guy when it comes to tolerating pain and it wasn't that bad.

I have a friend who had a biopsy in 2003 and the Uro didn't use anesthetic and he experienced a lot of pain, but I just assumed things progressed since then and all Uros were managing the pain better now.

Good luck

Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10.......waiting for post op biopsy

Posted 6/7/2010 10:45 AM (GMT -6)
With that PSA, you probably need a biopsy.
But you might want to do a PCA-3 test first (urine test). That is more specific for PC.
 
I had sedation and that worked perfectly.
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

Update: since late March all is well in that area. I would say 99.9% continent (a spurt here and there, maybe 5 spurts per week).

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.

Posted 6/7/2010 10:48 AM (GMT -6)
I had a most 10 minutes between meeting my uro for the first time and getting a biopsy. He read my PSA, grabbed a feel, and we headed down the hall. Not a whole lot of time to wait, worry, or wonder beforehand. I then took my Cipro and went to work for the day. I imagine I got a local at the time but I was in sensory overload and don't remember what now seems like a minor detail.
Diagnosed at 54
PSA 8.7 Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7 Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09 Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5 T3b
Catheter out at 2 weeks no nighttime incontinence Pad free week 5
PSA 6/6/09 <0.1; 9/10/09 <0.1; 3/11/10 <0.1

Posted 6/7/2010 10:56 AM (GMT -6)
Waitman,

You could also ask for a free psa-my husband had no symtoms, normal DRe and a psa of 4.7. His free psa was the clue to the urologist that he needed a biopsy. Good thing he had one because he has cancer. It's definately better to know than wonder.

Renee
Husband diagnosed 3/10
Age 56, PSA 4.7, free 7.6%
Biopsy 5 of 10 cores positve-all right side-25% to 57%
Gleason 6
DaVinci surgery with Dr. Vip Patel scheduled 8/9/10
 

Posted 6/7/2010 10:58 AM (GMT -6)
My doc said he would be using a needle and taking 12 samples. Did I understand that they have an instrement that takes multiple samples with one pop? Troy
Posted 6/7/2010 11:05 AM (GMT -6)
You folks are great. I have dicussed the PSA and biospy with my wife but no one else. It helps to have someone to talk to. Troy
Posted 6/7/2010 11:07 AM (GMT -6)
They take the samples one at a time in different parts of the prostate. Twelve separate 'snaps'. It takes about 10 minutes.

I think from the time I arrived at the Uro to the time I left was 45 minutes.

I think I was on the exam table for 15-20 minutes.

The whole procedure had me pretty nervous beforehand, but in my experience, the procedure had much less discomfort and pain than I had anticipated.

Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10.......waiting for post op biopsy

Posted 6/7/2010 11:12 AM (GMT -6)
You could ask your urologist for some sort of sedation. For example, versed or a versed/fentanyl combination. (This is the sort of "conscious sedation" often given by GI docs during colonoscopies). There are some studies showing greater patient satisfaction with this method than with lidocaine. I have linked to an abstract of one such study below. Some paitents and doctors will say "it is not necessary." But really I think that is an individual decision, and in my view one that should be made by the patient rather than the doctor. It will probably add to the cost, and may not be covered by your insurance. GI docs are often comfortable giving versed/fenanyl on their own -- without an anesthesiologist -- but your uroglogist may not be comfortable doing this, and may require an anesthesiologist or at least a nurse anesthetist. Anyway, if you think you want sedation, I would talk with the urologist about it. It is CERTAINLY not an inappropriate think to raise.

On whether to get the biopsy, I would do it. Only way I might not is if your free psa percentage is very high AND your PCA3 test results show cancer very unlikely.

http://www3.interscience.wiley.com/journal/120748100/abstract?CRETRY=1&SRETRY=0
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 

Posted 6/7/2010 11:22 AM (GMT -6)
Waitman,

My doc had me take a Valium one hour before the procedure. My wife drove me in and they had their way with me. I watched the whole thing on the monitor along with the doc. The Valium and the local they gave me seemed to do the trick. No pain, no discomfort and no worries. The miracles of modern medicine and recreational pharmaceuticals.

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -scheduled
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.

Posted 6/7/2010 11:42 AM (GMT -6)
First, welcome to the Forum. The biopsy 'gun' will take what can be called a core sample of different areas of the gland. It will remove a core of tissue, say from front to back of the gland, which gives the path lab a cross section of the particular sample. This explains why guys have thier samples listed as say- 6 out of 12 cores, 3 at 5% and 3 at 80%. This means that the single one of the 6 samples core had, say, a total length of 1 inch. The composition of cancer cells found would be - in the inch sample - 5% of the first sample, 5%. of the next sample, 80% of the third sample, and 80% of the fourth. etc, etc. Or another way 5%, 5%, 80%, 80%. The biopsy needle is really a hollow needle that takes the core sample. The snap guys mention is the sound of the spring releasing the needle to take the sample. Here's a link to more detailed info on the procedure:

a recording in detail, maybe more info than you want to know.... smilewinkgrin

www.muschealth.com/gs/TandPcontent.aspx?Pageid=P07710

more info:

www.upmccancercenters.com/cancer/prostate/biopsyneedle.html

another of general interest concerning the biopsy and later Gleason scale staging of any found cancer.

www.cancer.org/docroot/cri/content/cri_2_4_3x_how_is_prostate_cancer_diagnosed_36.asp
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 110 gms., margins clear
3 Years: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN

Post Edited (James C.) : 6/7/2010 10:51:38 AM (GMT-6)

Posted 6/7/2010 11:59 AM (GMT -6)
Most doctor's won't do sedation because it costs more and takes a lot more time. They are usually reimbursed the same amount with or with out sedation. I think this is a valid point. A 12 core biopsy is well tolerated if a vicodine is taken about 1 hour before and the doctor uses lidocane.
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

Posted 6/7/2010 12:11 PM (GMT -6)

Dear Waitman:

Welcome to our forum....hopefully your stay will be brief and you will not have PCa.  But, if that turns out to be the case you will find this is a caring place with lots of folks willing to give educated advice (but none of us are doctors...at least not ones that specialize is prostates).

First of all, don't let the fact that you do not have symptoms fool you.  Most of us were diagnosed with no symptoms.  If fact if you had symptoms that could be a bad sign that a cancer might be advanced.  Secondly, you said "doctor".  I assume you are seeing a urologist as that would be appropriate. If you are hesitant to have the biopsy I suggest you discuss two other tests with your urologist, just as medved advised.  I assume your second PSA test also tested for % free PSA...if not, shame on your doctor.  You can easily google "percent free PSA" and understand that can be an indicator of cancer.  You can also google then discuss the PCA3 test with your urologist.  This is often given after a first biopsy shows no signs of cancer but a high PSA remains and the question of another biopsy is at hand but some docs do it pre-first biopsy. Finally you should discuss non-cancer causes of a high PSA, e.g. prostatitis. 

Once you are satisfied with the answers to the above you may decide to go forward with a biopsy.  A 12 sample biopsy is the minimum these days. We have had a number of threads on this forum where the subject of biopsy pain has been discussed.  For some men it was "no big deal" and for others it was "excruciating pain".  My urologist used IV sedation (think colonoscopy).  This was peformed on an outpatient basis at a surgical center.  My urologist's philosophy on this is (1) why cause a patient unnecessary pain and (2) he wants to take his time and do it right without a squirming patient wanting to get the he** out of there.  Also his protocol was 16 samples.

Hopefully this is helpful.  Please let us know what you decide and how you progress.  Good luck.

Tudpock (Jim)


Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!
Posted 6/7/2010 1:02 PM (GMT -6)
For me, the worst part was the shot for the local. While the rest was uncomfortable, it really wasn't as bad as rubber band ligation treatment for hemorrhoids. (If you have never had that, consider yourself fortunate.)
_______________

Current age: 56
Palpable tumor found during DRE
PSA then: 5.9
One of twelve cores positive 10%
da Vinci 4//09 City of Hope
Final Gleason score: 7
Staging: pT2 organ confined
PSA now: 0.10
Posted 6/7/2010 2:57 PM (GMT -6)
I'll agree with the comments about symptoms of a problem - I had none at all.
It was just a randomly added PSA test that flagged a problem (7.4 at age 56). They retested, then did the "free %" test, which flagged worse.
Then a DRE - finger in the arse - found rough and unexpected texture.
Then the 12 core biopsy. I did the prep, drove up, had it done under the local anesthetic, and drove back to the office for the rest of the day at work.
A general anesthesia of Valium would have been a problem for me - no one to help drive -

I didn't like it, but it was not near as bad as my last crown.

After surgery, mine was upgraded to a Gleason 4+5. All things considered, I didn't have much longer to wait before it would have become a much bigger problem. And I would not have known until it was too late in the game.

My personal, non-medical opinion is to suggest that you get all the information you can now instead of later.
Posted 6/7/2010 3:15 PM (GMT -6)
Waitman,,,,,

First and foremost, welcome. The guys on this forum are truley helpful. I to am new as of about two weeks ago. And as some of them can tell you, along with reading my past posts and replies that I received, I was out of my mind about getting a biopsy. I have not had ANY invasive procedure, minimally or otherwise since I was 5 years old. These guys got me through mine. I can tell you from my experience 2 weeks ago. I went in thinking it was going to be a painful ordeal.... I received 3 lidocaine shots. On a scale of 1 to 10.... my whole experience was about a 3. Everyone is different obviously and your result will vary.... (wow, I sound like a commercial). But seriously... the only discomfort I had was the last 2 samples taken. My PSA was 2.75, DRE was negative as was my ultrasound. Also no symptoms, but one of the coars was positive for cancer. I for one am glad I didn't wait. My Doc gave me some Zanax which I took about 1 hour before and that seemed to take the edge off.

Hope this helps!
Diagnosis June 1, 2010 @ age 50
PSA April 2010 2.75 up from 2.14 in Sept. 2010
Biopsy May 25, 2010
1 of 12 cores positive;  Gleason 3+4 = 7  25%;   Stage T1c
CT and Bone scan -SCHEDULED
Da Vinci Surgery end of July

Posted 6/7/2010 7:54 PM (GMT -6)
Waitman, you are very wise asking a lot of questions here on this great web site. My Uro Doc wanted to do the biopsy and of course I agreed. I thought it'd be performed in his office under a local but found out a couple days prior to the procedure that he does his in our local hospital and in the OR. I was totally out during the entire procedure. Correct, it is more expensive having it done in the OR but since my insurance picked up most of the cost, I'm happy that it was performed in that facility. Since I was totally "out" for the biopsy, naturally my discomfort was truly a zero on a zero to ten rating. Do have your biopsy and don't worry too much about it, just git er done. Please do keep us posted.
Bob, down in Southern Colorado

Posted 6/7/2010 8:40 PM (GMT -6)
Waitman, I am a total wimp when it comes to pain (even getting my teeth cleaned scares me!!). But, my experience with the 12 core biopsy was exactly the same as April6th. The only time I jumped was when the first core was taken - the "gun" makes a snapping sound. Has your uro put you on antibiotics first to see if your higer PSA is possibly due to prostatitis? It seems like a lot of uros try that first, before the biopsy. Anyway, if you have any doubts, or a family history of prostate cancer, go for the biopsy. Hopefully it will be negative and you can just keep watching annual PSA results. Squid.
*Age 63, PSA July 2009 5.66
*Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
*MRI and Bone Scan Negative.
*open Surgery October 22, 2009
*Prostate, both nerve bundles, seminal vessels, and lymph nodes removed during surgery.
*Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
*Still slightly incontinant after 3 months - 1 pad per day (light). Dry at night. 1-2 trips to toilet.
*ED - Yes (will start Levitra possibly in January)
*30 day PSA (ultra-sensitive) .07
*90 day PSA (standard) <0.15
*01/10 - bladder neck stricture. opened during cysto exam. Cath #2 in for 5 days.
*03/01 - bladder neck stricture. Dilated during cysto exam. Cath #3 in place.
*03/11 - Bladder neck surgery. Cath #4 in place.
*03/15 - Cath #4 out. Great urine stream. Unfortunately, incontinence back to post surgery level.
*04/14 - Six month PSA - .21.
*05/15 - Incontinence basically under control.  99% dry.  Wear pad daily at work "just in case".
*06/10 - Started IGRT.   39 treatments scheduled.
 

Posted 6/7/2010 10:36 PM (GMT -6)
Your PSA numbers bracket mine, and you are close enough in age, a year, and also no symptoms, so I have some idea what you are going through.

You need a local anesthetic, not a general (generals actually carry their own set of risks) and you need the biopsy.
Wish I had a better answer for the last part, but even being an amateur doc, I have no hesitancy here.
If the Gleason numbers come out too high, like mine did, at least you know and then you take a deep breath before you select an option.

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