Hermaturia/0.9 PSA/DRE found a nodule....... need advice

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capamando
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 10/28/2010 8:50 AM (GMT -6)   
Hello to all,

I am a 58 year old Hispanic male in relatively good health. I have been riding my roadbike for over a year on weekends and my diet is better than most. The first time that I had to consider problems with my renal system was when I applied for life insurance six years ago and the urine test showed red blood cells. I spent over a thousand dollars at an urologist office for an examination that included a PSA/DRE and that flexible scope that went up my penis etc. The result of that uncomfortable procedure was negative . The PSA was 0.6 and the DRE was negative. That was the end of my first experience. In 2008 I took advantage of a free screening and had a PSA and DRE done..... PSA was 0.8 and the DRE was negative. A couple of months ago I took advantage of the same screening during Prostate Cancer Awareness and the result was a PSA of 0.9 but the DRE found a nodule. Since then I had a second DRE done by another urologist/oncologist who is supposed to be an expert on Robotic surgery. He also found a nodule and a urine analysis showed traces of blood. He recommended a TRUST Biopsy/twelve samples done in his office for what I considered relatively cheap ($600)...his consultation was ($100) that is around one third of what most urologist charge in my area. Of course, my natural skepticism told me that this is a way for him to promote his Robotic surgery but since I only have catastrophic insurance with a high deductible, I could not ignore the opportunity for a second opinion. So there you have it! Like so many in this forum I find myself searching for answers... I have spent long hours researching my situation and my hope is that I can make the most informed decision available. I would appreciate any advice you can share.

Thank you and best wishes to all.

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 10/28/2010 9:04 AM (GMT -6)   
Welcome to the site and sorry you have to be here.
 
I too went to a free mens health screen. PSA was 1.3 and I had nodules. Second opinion confirmed both. I waited also a year before getting a biopsy...then had surgery a few months later.
 
I went for surgery due to not likeing the 30 to 40 trips for radiation...
 
Good lucjk with your decissions..
Age 55 - 5'11" 215lbs
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
11/20/09 - 18 Month PSA -> less then .01
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
Growing old is mandatory; growing up is optional..

Burlcodad
Regular Member


Date Joined Nov 2009
Total Posts : 254
   Posted 10/28/2010 9:24 AM (GMT -6)   

I also started my journey with blood in the urine.  Mine was an extensive amount for a day that went away.  Thankfully I did not ignore the warning sign.  Went thru the cystocopy (the worst test ever for a male - lol) and the DRE - doc found a firmness on one side.  Did follow up DRE and then biopsy which confirmed cancer.  My PSA was never higher than 1.5. 

Opted for surgery mainly because of age and life expectancy. 

There are many options out there and you've found a great forum to hear some first hand experience on many of them.  Best of luck.

 

Ray

 


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 10/28/2010 10:38 AM (GMT -6)   
My journey was very similar to yours but my PSA was always higher..Most urologists are also surgeons but to be an oncologist also is pretty rare..Urologists have been trained to detect and diagnose urinary cancers including prostate cancer and in many cases to perform prostate surgery..

While your PSA of 0.9 is very low for someone with PC, it is indeed possible and with your other red flags, blood in urine and an "abnormal" DRE, a biopsy might be a wise move..A biopsy can easily miss PC when it's in it's very beginning stages, so make sure your Urologist focuses on the area where he felt the nodule even if it means taking a couple of extra cores...(12 is standard, but they can take 14 or 15 if they want to)..That way you can have some confidence in the biopsy report..

Just a note. Bike riding can cause microscopic amounts of blood in your urine if the sample was taken within 48 hours of a ride...It can also elevate your PSA reading..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
age 61: 5.2
age 64: 7.5, DRE "Abnormal"
age 65: 8.5, " normal", biopsy, 12 core, negative...
age 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
age 67 4.5 DRE "normal"
age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2667
   Posted 10/28/2010 12:19 PM (GMT -6)   
Capamando, I think you're being very smart for trying to get a medical assessment of what's going on.  Your situation reminds me of my friend, age 64, who recently had a company-sponsored health fair that included a PSA test and a DRE.  The examining doctor said he felt a "calcification" during the DRE, but the PSA came back quite low.  I told my friend that he should see a urologist to have this checked in greater detail, but he hasn't done so.  I don't know how one can tell a calcification from a tumor and haven't seen this discussed.  I'm not saying he needs a biopsy, but wouldn't the smart thing be for guys like him to do like you and have a competent urologist make the call on whether this "calcification" is something to worry about?

Post Edited (clocknut) : 10/28/2010 12:25:48 PM (GMT-6)


ejn
Regular Member


Date Joined Jun 2010
Total Posts : 87
   Posted 10/28/2010 12:43 PM (GMT -6)   
15 cores??  My 2nd biopsy he took 36 cores.  He knew it was there and made sure he found it.  Recovery from the biopsy was much worse the 2nd time, but at least we found it and dealt with it.  I am thankful.
Age 53
Pre OP PSA: 1/2008=5.9, 2/2010=6.0 (free=9%)
Biopsy, 4/10/2010 This was my 2nd Biopsy. The Uro put me out and took 36 samples. 3 samples positive 1%, 2%, 2% no evidence of perineural invasion. T1c

Dx April 2010
Gleason: 3+3=6
CT Scan: Neg
DaVinci: 8/11/10, Dr David Bryan, SSM DePaul-St Louis
Post Op Path:
Gleason 3+3=6
Tumor involves left lobe only
Tumor constitutes less than 5% of gland volume
No vascular or neural invasion detected
No capsular invasion detected
Distal urethral margin of resection free of tumor
Proximinal urethral margin of resection free of tumor
Radial margin of resection free of tumor
Seminal vesicles uninvolved by carcinoma
TM stage T2a (unilateral less than 1/2 of one side), NX, MX
ALL Margins uninvolved
Extra Prosatic extension: Absent
PSA: 9/10 <.1,

JerseyG
Regular Member


Date Joined Feb 2009
Total Posts : 65
   Posted 10/28/2010 12:44 PM (GMT -6)   
Capmando, I to had a PSA of 0.9 and a positive DRE during my annual physical. I saw a specialist for a second opinion. The specialist also felt a small bump on my prostate. Biopsy found 3 out of 12 positive for PCa. Better to be safe than sorry. I had Davinci back in Aug of 2008 and now I am good to go.

Age now 45 (43 when dx)
Pre-op PSA: 0.9
DRE: +
Biopsy:3/12 cores pos 20% 30% 50%
Gleason 3+3=6
Robotic RP: Aug 2008 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report:Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes
ALL POST OP PSAs UNDETECTABLE
2 YEAR PSA UNDETECTABLE
No ED after 18 month mark

capamando
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 10/28/2010 1:57 PM (GMT -6)   
Thank you all for sharing your experience. I am considering traveling to Michigan so that Dr. Lee can perform the Color Doppler and a biopsy if necessary. My research here and in other sites speak very highly of using the Color Doppler Ultra sound, especially by someone with the experience of Dr. Lee. What are your thoughts on this?

Again thank you very much.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 10/28/2010 3:51 PM (GMT -6)   
If you can get in to see Dr. Lee then pack your bag and go!

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 10/28/2010 7:43 PM (GMT -6)   
I second Fairwinds thought!!!Definitely see Dr Lee,well worth the time and effort,he will be able to clarify some issues for you. My husband saw him this past summer,excellent doctor!!

alf203
Regular Member


Date Joined Jun 2010
Total Posts : 52
   Posted 10/28/2010 8:12 PM (GMT -6)   
  36 cores is the new numbers they want to pull now less chance of missing pc alf

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 10/30/2010 11:32 AM (GMT -6)   
Referring to the 36 core biopsy, since everyone insists on its benefits -
 
Obviously fewer cores sample less area, and if there is question, a saturation biopsy gives more chance of finding something.
 
Downside is that many major (U.S.) insurance companies (according to my recent experience and comments from my uro/surgeon, who deals with most major companies) pay for only 6 cores. I was fortunate in that my uro uses Bostwick, and they wrote off the "extra" 6 that my insurance refused as "excessive" after I begged a bit.
 
I've mentioned before that if only 6 cores had been taken per the approved scheme, I would have still had a positive core, but would have gotten a G 3+4 at the worst. My real biopsy results were much worse. Had I done what insurance would pay for, I would have chosen less aggressive treatment, and would have missed the fact that there was EPE.
 
I learned at that point that checking for pre-certification and understanding the vagaries of your coverage at each step will reduce the "excessive" stress of having hours of calls with billing departments and debt collectors even before you can think about what comes next. I've been there and done that - although only after learning the hard way. An extra letter from the doctor would have avoided many problems.

capamando
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 10/30/2010 1:05 PM (GMT -6)   
I would like to hear what alf203 and 142 think of using a color doppler instead of "carpet bombing" your prostate.

Thank You.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 10/30/2010 1:30 PM (GMT -6)   
I did not consider the color doppler scan, as I was not aware of it. As I mentioned, I did not find this site until some months after my surgery.
 
I depended on the suggestions of my uro/surgeon, and several other surgeons I talked to, or communicated with. None of them suggested it as something I should ask for. I know that my biopsy was ultrasound guided, but could not tell you the equipment involved (it was not color, I did see the screen). I did obtain the Walsh book, and others, but did not find any that listed this as a must-have test.
 
I am one of those folks who went through the first part of the PCa experience alone, figuratively and literally.
 

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 10/30/2010 1:42 PM (GMT -6)   
I think a opinion from JohnT would be valuable!! He has had numerous biopsies and has posted he would not have one that wasn't with color doppler! Cooper

capamando
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 10/31/2010 6:46 AM (GMT -6)   
Hello,

I have an appointment to see Dr. Lee in mid November....... we will see..... I want to thank all of you for sharing your thoughts and experiences. All the best to you all.
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