Three newbie questions about biopsy & reversing psa

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same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 3/10/2007 8:10 PM (GMT -7)   

I just joined this Healing Well web site this evening.  By no co-incidence, yesterday at my first meeting with a urologist, I am now scheduled for a biopsy on 3/23/07.  This was due to my having a psa of 5.8 six months ago and 6.9 two weeks ago.

 

If you don’t mind, here are some questions that hit me since I am really new to this:

 

Shouldn’t the biopsy be done in a hospital rather than the urologist’s office?

 

Can’t a CT scan or MRI detect what they want to find out with a biopsy?

 

Is there anything that can reverse the PSA reading; therefore, reduce the chance that I may have pc?

 

I would really appreciate any help or guidance that any of you may care to offer.  Needless to say I am not real comfortable or pleased that this is happening at all.  I was really glad to find this forum, which looks like a lot of us will be traveling similar paths.


Walt


SJC
Regular Member


Date Joined Jul 2006
Total Posts : 113
   Posted 3/10/2007 8:27 PM (GMT -7)   
Walt:

I'm going to answer your questions:

1. No. It's not a big deal and does not take long. You're fine when it's over....you walk out of the office the same way you walk into the office.

2. No. You will have an ultrasound and needle biopsy. The tissue will be sent to the pathologist who will put them on slides and render a report.

3. There's nothing you can do. You have an elevated PSA times two during the past six months; therefore, prudence requires you undergo the biopsy. Your urologist is following good urologic medicine by ordering the biopsy.

By the way, I had four biopsies over an eight year period and know what I am talking about. Hope comments from a veteran of biopsies eases your anxiety.

Post Edited (SJC) : 3/11/2007 4:16:24 AM (GMT-6)


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 3/10/2007 8:44 PM (GMT -7)   

Hi  ~ Walt  & Loved Ones,

 

             A   “Special”  Warm Welcome  to  You!   

 

I know we can “all” make Your Journey smoother while you are waiting for answers ~ just by being here for you! 

Thank you for reaching out!!! 

 

You’ve just made your own journey a lot smoother.  There are a lot of Helping Hands here… and just by reaching out like you did ~ you will have a much easier time.  We’ve been where you are now…. Knowing you aren’t alone… makes a big difference in psyche and spirit.

 

We will always be here for you… This is truly a great forum!!! ~ You have joined! You are now part our forum family ~ a group of wonderful individuals who are so willing to share their journey with you! 

 

It helps “all of us” ~ to help you ~ if we know where you are on your path.

So ~ Please stay with us and take our hand when you need it!  Keep posting.... OKAY!!   

 

 

KNOWLEDGE IS POWER... and POWER conquers fear

 

 

We invite you to visit our personal thread in the signature area below.

Our thoughts and prayers will be with you as you continue to search for answers.

 

In Friendship ~ Lee & Buddy

 

“God Bless You”

 

It's a little prayer  ~  "God Bless You"

...but it means so much each day,

It means may angels guard you

and guide you on your way.

 

 

 

(Direct Link ~ just click on the title below and a new window will open!  

Reminder … click on the REFRESH icon once you get there)

Click Here…>  Helpful Hints for New Members... Hope this helps you! :)


mama bluebird - Lee & Buddy… from North Carolina

Link to our personal journey…>>>     Our Journey ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

2nd PSA 02-06-2007 Less than 0.1 Non-Detectable :)


same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 3/10/2007 8:47 PM (GMT -7)   

SJC,

Thanks very much for your direct answers to my questions and concerns.  Your response was exactly the type that I needed.

I have been taking some over-the-counter stuff for more than three months that promised to keep my psa in the healthy range.  Now that that failed, I am doubling up on it between now the Biopsy only because that is the only path that offers any other recourse.  For the small cost and large possible payoff, I am going with it.  When the time for the biopsy arrives, I will let you know my results.

So my future for the next two weeks is to get the biopsy at the urologist's office, and come back to this forum for some more guidance. 

The strangest thing during all of this was that I could not get a recommendation from my primary care physician (pcp) for an excellent urologist.  He was willing to give me several to choose from, but would not rate any with high marks.  I live in Pittsburgh PA, which has a large number of urologists.  My pcp has been affiliated with Shadyside Hospital for more than ten years so he has experience with many.  Are there any urologist in Pittsburgh that some of you may like to recommend?  The one I am seeing was a recommendation from a neighbor.

 


Walt


myman
Veteran Member


Date Joined Feb 2007
Total Posts : 1219
   Posted 3/10/2007 8:55 PM (GMT -7)   
Walt - welcome & sorry you have to be here...you know how I mean that!
I have a concern about the OTC stuff you're taking...you don't want anything to mask what your actual PSA may be...you want the most accurate results possible. Did you mention taking this to your doc? Just a thought.

All the best,
Susan
Husband Diagnosed 11/17/05 Age: 63 No Symptoms
PSA: 7.96, Positive DRE
Biopsy Right: 6 of 6 Cores Positive Biopsy Left: 1 of 6 Cores Positive
Gleason: 4+3 = 7 Stage: T2B N0 MX
2/09/06: LRP Restage: T3A NX MX
3 mo. PSA Post Surgery: 11.8, 12.9, 13.9 Bone scan, CT scan, Endorectal MRI, Chest XR - neg.
9/06/06: 6 mo. PSA: 18.8 CT shows lymph node involvement Start HT Lupron 3 mo. shots
12/06/06: PSA 0.8
03/07/07 - PSA 0.3


B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 3/10/2007 9:20 PM (GMT -7)   
Dear Walt,

Not too long ago B and I were in the same boat. B had been taking herbs ever since his PSA started rising. It rose over 4 years, but the spike from 3.2 to 4.3 in one year caused the primary care physician to recommend a biopsy. Boy, that was not something we wanted to do! But, as he told us, PCa in a man of 51 years old can be fatal. So, we did a few things prior to biopsy. First, we went on a trip to Europe! Then we started some alternative therapy in the form of Reiki. Several sessions a week created a sense of calm, re-vitalization and helped both of us prepare for the procedure. Besides that, it can cure you, and we wanted to give it a chance. Once the biopsy was taken, with positive for cancer in 5-10% of 4 out of 12 samples in one lobe, we got serious about lowering PSA while we researched our options. We turned to a vegan diet. Check out the study done at SF State University and (I think) Sloan Kettering (or Johns Hopkins). They took 95 men who would not do regular treatment for PCa and put half of them on a vegan diet (no dairy, meat or fish), whole grains, fruits and vegetables, had them do moderate exercise, meet in support groups and do meditation. After one year, the protocol stopped or reversed evidence of cancer in the half to the extent that they followed the regimen. Of the other half, the control group, some had to go to conventional therapies due to the spread of the disease, and none had a reversal. Studies are now definitive in showing a link between PCa and high dairy fat and/or red meat intake. Nevertheless, if the mind/body connection, coupled with genetics and environmental factors caused this present situation, did B have the muster to try and radically change the progress of the disease without the aid of modern medical science with complete faith in the desired outcome? Even though his PSA lowered to 3.9 before surgery, as one kind person said in one of these rooms, "It doesnt matter what your PSA is if you have cancer!" In the end, we decided to make healthy changes and use the "insurance" of modern medicine. He had a robot assisted, laparascopic prostatectomy on Feb 27 at a "teaching hospital" and has had an optimal outcome. The biopsy did not show all the cancer; after all, biopsies are somewhat like finding needles in a haystack. But his Gleason stayed at 3+3 and we are happy we got it out. All in all, we took about six months from PSA to surgery, with lots of research and careful consideration. Best of luck to you,

Becky

Post Edited (B&B's World) : 3/10/2007 9:25:02 PM (GMT-7)


hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 3/10/2007 10:03 PM (GMT -7)   

Walt

You're doing the right thing in researching your condition and joining this forum.  You'll find a ton of information on the internet and here, showing all the treatment procedures and personal feelings concerning prostate cancer.  I know I was very ignorant about it until referred to a urologist and had the biopsy.  Knowing what I do now, I would have had pushed for a biopsy when my PSA rose to 3.2 a year and a half ago.

Couple of thoughts: remember that the PSA level is an indicator and that because you had it tested, may save your life!  If there is cancer in there, taking something to lower the PSA won't get rid of the cancer that's there.  Even hormone therapy will just stop the cancer from growing, not get rid of it.  Let the biopsy show you if you have anything, and then make a decision on what's next.  Also, be careful when you read about natural methods and "watchful waiting" to cure prostate cancer.  While our western lifestyle has probably contributed to our increased levels of this disease, trying to cure it on your own can be deadly.  After my biopsy, I thought that I was being overly aggressive in my choice of treatment, only to find out that the cancer was a lot more than we all thought.  I thank God that I had my prostate removed, and didn't think about trying natural methods on my own.  Medical science has come a long way, and while all of the "professional" treatments for prostate cancer have side effects, the amount of extension of your life span is well worth it.

Good luck on your biopsy, and keep reading.


PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006
1 of 10 cores positive 5% LEFT Side
2 others questionable (small gland proliferation)
Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology
     Stage T3a, Gleason 3+4, positive margins and
     capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01


same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 3/10/2007 10:21 PM (GMT -7)   

Hello Becky,

 

Thank you very much for writing.  What you described helps me enormously. 

 

Here is the message that I am getting from your experience.  I would have opted for that vegan life style in a heart beat; however, this is a little late to expect short term results.  With my psa at 6.9 my options are strictly within conventional medicine.  If by some small miracle my biopsy is negative, that would be a wonderful second chance to go with the vegan life style.  My 32 yo son has been a vegan since he was 15, and he would help put me on that track.  If the biopsy turns out that the big C is present, then I am back to review my results with you kind people here for some guidance. 

 

The urologist that I have seems very black and white about what he intends to do and seems to delight in dismissing all of my questions.  You touched on one of my questions to him about the effectiveness of a biopsy.  It seemed to me that since he described the biopsy as a 0.1 area sample from an area of 40, there was little chance the biopsy would detect any cancerous material unless it was far along.  My math says that 1 in 400 is a very small sample.  He claimed that the results were 40 samples yielding a 40% certainty of showing any cancer present.  Ok, 40 in 400 is still only a 10% sample.

 

I don’t really need a “Bedside manner” from him, and he is the only one who I could come by from recommendations.  At this point there seems to be only one option for me, and that that is to go ahead with my biopsy scheduled for March 23.

 

It is so very considerate of you to write with your surgery being as recent as Feb 27.  I hope you and B are enjoying complete recovery with little to no after affects.  Thanks again for being so helpful.

Walt


same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 3/10/2007 10:31 PM (GMT -7)   

Dear hawkfan75,

 

You hit what may be the core of what I don’t know.  I have been focusing on lowering my PSA; yet, PSA could not possible measure anything about cancer.  Can anybody explain to this layman what does PSA measure?  And even further, why would that be an indicator of cancer?

 

I have a lot to learn.

 

Walt


Walt


B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 3/10/2007 11:03 PM (GMT -7)   
Dear Walt,

I am so happy that our experience is of help to you. I too wanted B to avoid the discomfort of an "inadequate" biopsy, and read studies on PET scans, ready to spend the money to get a complete "picture" of the prostate. The problem is, there is no reliable isotope for the prostate cancer marker, and even though there is one kind, it cannot distinguish the kind of cancer, when evident. And grading is so important to diagnosis and treatment.

My opinion, after our experience, is that the advances in prostate cancer treatment have left some local and small town urologists in the dust. Despite a generally forgiving attitude, we had to leave our local urologist after experiencing poor, and probably inadvertantly uncaring, handling. With PCa, nothing is black and white, and any urologist that is not ready to get into a lengthy discussion is not, in my opinion, worthy of walking down this path with you. If you end up with the diagnosis, and I HOPE NOT!, in my opinion, full caring support is essential to your recovery, from the appointment scheduler on down the line. One of the reasons this website was so helpful was for the support. I learned a lot here while gathering my facts.

Kindest Regards,

Becky

biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 3/10/2007 11:15 PM (GMT -7)   
Hi Walt,

Welcome to the forum nobody wants to join. You have all the same questions that we all had when the possibility of PCa entered our lives. Stop - take a deep breath and get organized.

First, read some of our posts on this forum. We all came here for help and ended up helping each other so there is a lot of information in these pages.

Second, in these pages you will find references to some excellent books that you can probably get locally that will answer all your technical questions about PSA, biopsies and treatment options if you have cancer.

Third, stay with us for reassurance and help. We will do anything we can to make your journey easier. Do not try to do this thing alone! We share our mistakes as well as our succeses so you don't have to repeat our failures.

Keep reading, researching and coming back here...

Jim
Age 72. Diagnosed 11/03/06. PSA 7.05. Stage T2B Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Pathological stage: T2B. Gleason 3+4. Cancer confined to prostate.
PSA on 1/3/07 - 0.04.  Next PSA on 4/4/07.
 
 "Cancer feeds on fear - starve it to death."


jetguy
Veteran Member


Date Joined Sep 2006
Total Posts : 741
   Posted 3/11/2007 6:44 AM (GMT -7)   

Greetings Walt,

Yeah, you need to do the biopsy and the uro's office is the place to do it.  It's unpleasant, but tolerable.  I described it in a thread I posted.  I'll bump it to the top so you will know what to expect.  Be advised that each doc does things his own way.  In my case, the biopsy caught cancer when it was very treatable. 

Regards,

Bill


Gleason 3+3=6, T1c, one core in twelve, another pre-cancerous.
62 years old and good health.  Married 37 years.  To same woman!
Began IGRT January 23, 2007. 


kziz
Regular Member


Date Joined Feb 2007
Total Posts : 242
   Posted 3/11/2007 9:34 AM (GMT -7)   
Hi Walt,

My husband had his biopsy done at the hospital as an outpatient procedure. The doc who did the biopsy told us that insurance companies will actually pay the docs more if they perform the procedure in their office instead of the hospital, but he chooses to go the hospital route as the patient is knocked out. It seems like most of the others had theirs done in their docs office. Good luck to you.

Courtney
Kurt & Courtney
47 year old
Great Health prior to dx
Dx on 1/29/07
PSA 4.1
Gleason 3+3=6, both lobes
Stage T2c, I believe
Tumor involves 20% of cores, both lobes
Live in OK
Da Vinci scheduled 3-15-07 in Austin


hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 3/11/2007 11:37 AM (GMT -7)   
Besides the internet, one of my main sources has been Dr. Patrick Walsh's book "Guide to Surviving Prostate Cancer."  While it was printed in 2001, and doesn't discuss a lot about the Da Vinci Robotic procedure, it gives a lot of the basics about prostate cancer.  I wish I had read this once I turned 50, and I may have looked into a biopsy earlier, when my PSA was rising but before it hit 4.  (He recommends a biopsy for:  40's - >2.5;  50's - >3.5; 60's - >4.)  Even so, there are those out there who feel we treat this too aggressively - I'm definitely not one of those!  He mentions that high PSA may not indicate PC, and other factors can effect it as well.  Even sexual activity should be curtailed two days prior to the test - I never know that!
Overall, my advice is to get informed, and find a urologist you feel comfortable with and can trust.  I have been very happy with the "team" that I have been dealing with at Virginia Mason in Seattle.  From some of these postings I've read here, it appears that there are some out there that aren't so good.  Good luck and keep your spirits up.
PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006
1 of 10 cores positive 5% LEFT Side
2 others questionable (small gland proliferation)
Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology
     Stage T3a, Gleason 3+4, positive margins and
     capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01


same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 3/11/2007 1:50 PM (GMT -7)   

Dave,

 

     Thanks for mentioning “Pre-op” and Ultrasound.  My uro mentioned neither, so your post is the first I ever heard of this associated with my biopsy.  Looks like I will be phoning my current uro on Monday and asking him as you were kind enough to suggest, “How any suspect tissue is located in the prostate before the core sample is taken.”  Then I will ask him to switch the location to Pittsburgh’s largest hospital since he is affiliated with them.  If he balks at that, I will immediately seek another uro.

 

     Now I can agree that it is not just a random 1 in 400 for each biopsy from the way you describe the biopsy.  It would really be nice to have a uro with some kind of successful track record with biopsies to take that a step further.  It seems like the doc with an ear for that is the one I want.  You mentioned 12 and my uro said 40 samples.  That difference really causes me to think that he does not use anything to determine where to take the sample.

 

     Since it is possible to use ultrasound to detect where to draw a biopsy, why don’t they use ultrasound a few days before the biopsy just to let the patient know what they expect to find?  Seems to me that if an ultrasound could not detect anything wrong, that should be the end of the ball game (no pun intended).

 

     At this point, I am not a happy camper.  Why are talented urologists so difficult to find???

 

Walt


Walt


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 3/11/2007 6:22 PM (GMT -7)   

    Hey Walt,  Sorry to welcom you to our club.  I have a detailed description of my biopsy on my journal page called "KW's Journey".

    As long as you follow your pre-biopsy cleansing instructions, and followup care you should be fine.  It was easy to do it in the office.  It was a bit uncomfortabe and humbling it isn't all that bad.

    You have to do what is right for you.  I just wanted to let you know we are all on your team here.

    You should think about clicking the chat button at the top of the page and join us in the chat room sometime. 

    Good Luck.  KW 


    43
    PSA 5.7 - Discovered during Annual Physical with Family Practice Dr.
    Gleason 7
    Biopsy - 3 of 12 positive (up to 75%) all on left side of prostate
    RRP on Oct. 17, 2006 - Nerves on right side saved.
    All Lab's clear.  No Cancer outside prostate
    Cathiter in for 3 weeks due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00
    Office visit on Jan. 19th due to continued excessive urine leakage.
    Feb.20th Cystoscope and 2nd Post Op PSA. Another 0.00.....:)
     Dr. said everythign looks fine.  Continue to work Kegeal's. Leaking appears to have improved  after Cystoscope?!?!?!  Down to 3-4 pads per day!
    March 1st  Leaking has crept back up to 6 - 8 pads a day ??????? 
    May 22nd Follow up (unless incontenance does not improve by mid March) and 3rd Post Op PSA
   


same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 3/11/2007 6:25 PM (GMT -7)   
Dave,
 
     Thanks for offering me your uro's name.  Making the trip across PA doesn't appeal to me compared to finding a decent uro here in the 'burgh.
 
     I will try to put together some kind of survey on this site to ask that question, and will put a post here when it is ready.   I really appreciate you and everybody else who has been so kind in offering me help.
 
Walt
Walt


same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 3/11/2007 6:35 PM (GMT -7)   
Hi KW,
 
     Thanks for your welcome.  I would like to read your journal page called "KW's Journey".  This newbie does not know how to find it.  Would you mind stepping me through whatever I need to do to see it?
 
Thanks,
Walt
Walt


SJC
Regular Member


Date Joined Jul 2006
Total Posts : 113
   Posted 3/11/2007 9:13 PM (GMT -7)   
Walt:

Remember me....the one who's been through four biopsies. You're getting a lot of responses that I think are causing you a lot of confusion.

First, most guys have the biopsy done at the uro's office. In my case, a technician and his equipment used perhaps exclusively for prostate biopsies assists the urologist during the procedure. I was given a numbing drug for the area, but otherwise was wide awake during the procedure. While it was a bit uncomfortable, IT DID NOT HURT. As I mentioned above, I walked out of the urologist's office the same way I walked in. While I was somewhat anxious for the first biopsy, I knew what to expect for the next three, immediately following which I returned to my office for completion of the work day.

Here's what you should anticipate: A probe is inserted in the rectum (this does not hurt at all). This is the ultrasound probe. Around 12 needle samples are generally taken (sometimes less...just depends) also through the probe. When the probe is over the target, quite often the technician will tell the doctor, "That's it". When that comment is made, the tech is simply telling the urologist the probe is over the next quadrant site...go ahead and take the sample. The next sound you hear is the snap of the device sending the needle into the tissue for the sample. I promise...that's what all of the commotion Dave mentioned he overheard during his procedure was about. Nothing more, nothing less. I heard similar comments. I bet just about everyone does.

The ultrasound is used to measure the size of the prostate and also to help guide the urologist to the quadrants of the prostate where the cores are taken. Urologists have become more strategic in where they fish for cancer: they know the cancer is most likely to be hiding in the prostate's peripheral zone. They also know it's likely to spread laterally like a thin sheet-thus it is easy to stick the needle too deep and overshoot the target area. Urologists know to guide the needle so it catches the edge of the prostate for a higher yield of cancer cells. The ultrasound is the tool that allows the urologist to make sure the sample is taken in the correct location of the prostate. The ultrasound itself does not indicate if you have PCa or not. Only the patholgist after reviewing the tissue can make that determination.

I hope I have straightened things out for you.

same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 3/12/2007 5:23 AM (GMT -7)   

Hello SJC,

     Many thanks.  Here is the main thing that you may have cleared up.  I was under the impression that the ultrasound detected in some way the suspect areas for pc, and that helped determine where to take the biopsy sample.  If I am wrong about that, then there appears to be no advantage to the ultrasound.

     Can anybody help me out by letting me know what the benefits and drawbacks  are with the three types of biopsies?

Walt


Walt


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 3/12/2007 5:50 AM (GMT -7)   

Walt,

SJC described the procedure I had to a tee --- didn't know there were diiferent types of biopsies....I've seen different core samples taken (some are 8, some are 12)....

The only advice I can add is don't be shy in asking for drugs if you're nervous about the procedure--- I took a valium and a seconol before mine, and REALLY didn't feel a thing.  Looking back, a non-event...

GOOD LUCK!

 


Sterd82
Age 46
Initial PSA march of 2006: 28
PSA May of 2006: 39
8 of 12 cores malignant
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
Post surgury PSA fluctuated between .04 and .09
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sesions of IMRT Ended Feb 1, 2007


TonyB
Regular Member


Date Joined Mar 2007
Total Posts : 37
   Posted 3/12/2007 8:08 AM (GMT -7)   
Hi gang;

I'm a newbie too..

I was surfing this forum and had to join and ask some questions about this topic...

I live in a very small town. In recent years my local doc routinely finds abnormal PSA numbers when I get blood work done. He keeps sending me to the urologist. Our nearest urology practice is about a 2.5 hour drive. They do my biopsy in the office. Not fun! I had to come back for a biopsy five times in the past two years because they could not find a positive result. Yet, my numbers keep gradually creeping up. This urology practice is very small (one urologist and one internist). They never mentioned anything about "ultrasound". Your discussion here is the first time I ever heard that term in relation to having a prostate biopsy. I just thought they went in and took a bunch of samples and hoped for an accurate result. From the sounds of your discussion, it's more like a "crap-shoot". Why else would I need this procedure done so repeatedly? Even SJC had four done himself! I'm beginning to worry that my current urologist may not be using (maybe can't afford) the most modern equipment.

Two questions:

1) What specifically should I ask my current urologist concerning the instrument that he uses for the biopsy procedure to be sure it's the most current?
2) If given the opportunity, should I travel to a large city where this procedure is done much more often and where they use the most modern equipment, and have the biopsy done there?

Any suggestions? confused

Post Edited (TonyB) : 3/12/2007 9:11:22 AM (GMT-6)


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 3/12/2007 9:36 AM (GMT -7)   
TonyB,

It would be difficult to believe that your urologist is not using an ultrasound instrument to perform the biopsy. The only way that he can know where to take the samples from is by seeing the ultrasound image and where the needle is at. In general the biopsy takes 5 or 6 samples from each half of the prostate and these samples are spread from top to bottom to get as much even coverage of the prostate as possible. I believe this is the basic protocol that is used by all urologist. In some cases they will do a saturation biopsy consisting of many samples(20 or more) for situations such as the one you have with a rising PSA but nothing found in numerous PSA's.

Tamu
Diagnosed 7/6/06
1 of 10 core samples, 40%
Stage T1c, Gleason 3+3
Da Vinci on 11/01/06
Catheter out on 11/13/06
56 Years Old
Post Op Path
Gleason 3+3
Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06
No more pads as of 1/13/07


BooMan
Regular Member


Date Joined Oct 2006
Total Posts : 27
   Posted 3/12/2007 9:57 AM (GMT -7)   

Walt and TonyB,

I think one good thing you guys can do is get either the Patrick Walsh or Peter Scardino books on Prostate Cancer.  Or better yet, check them both out.  They're doctors, we're not.  We'll talk to you all the time - they won't.  Combined you can come up with some good info, but most importantly, get a doctor (uro or other) that you are comfortable with.  Having issued the medical disclaimer, I'll add my two cents to the questions you've asked.

Most of us have what is known as a Trans Rectal Ultrasound (TRUS) and Prostate Biopsy. The ultrasound probe is like a guidance system so that it's not truly a stab in the dark.  The ultrasound will guide the needle for the biopsy.  Most uros use a "sextant" pattern.  They divide the prostate in half lengthwise and then into thirds going across.  Some take just one sample in each zone, some take two or more.  If they found a suspicious area during the DRE (Digital Rectal Exam) they may take a few extra snips there.  I had 18 cores the first time and 24 the second.  As to other types of biopsies, I've read of going through the urethra when reaming out an enlarged prostate (ouch) or through the perineum (ouch, ouch) to access a different area of the prostate.  I'll stick with the back door.  My next one is in May.  I go the outpatient route but you can see that a lot of guys here have no problem with going in the doctors office.

PSA is Prostate Specific Antigen.  It's a protein.  It's produced in the prostate whether you have cancer or not.  It's part of the goo in ejaculate that helps your swimmers survive their journey through the hazardous environment of the vagina and cervix (hazardous to them ladies, not me.  I love you).   PSA can be measured in your blood stream (serum level).  "Normal" ranges are what spills out of the prostate due to normal production.  Elevated levels can have many causes.  Cancer is one, but so are BPH (Benign Prostate Hyperplasia), infection, irritation (physical not mental), and recent ejaculation (no roll in the hay before the blood test).  Some docs like to eliminate possibilities like infection before going further.  Do what the doctor you trust wants.  You can have a low PSA level and still have cancer.  Many of those are found through the DRE.  Personally, I wouldn't be as concerned about lowering the PSA levels as finding out what has elevated them.  When that is addressed, the levels should go down.

If you are displaying 25 topics per page, KW's Journey is on page 3 (this morning anyway).  There's also a search function on the menu bar. Good luck to both of you.

Boo   


TonyB
Regular Member


Date Joined Mar 2007
Total Posts : 37
   Posted 3/12/2007 1:50 PM (GMT -7)   
Thanks Tamu;

So, whether you travel a 1000 miles to New York City and get your procedure done in the most modern up-to-date outpatient facility there is, or...

Whether you hop a bus and go over to Mayberry RFD where Gomer Pyle is doing prostate biopsies in the back room of the General Store...

It does not matter because as you say, "I believe this is the basic protocol that is used by all urologist."

After 5 tries at this my butt is getting just a little tired and sore (Sorry SJC, no bravado here, it does hurt!) and I'm beginning to think that Gomer had better get a sharper pen knife!

All joking aside, my basic question is this...

Is it at all possible that maybe these small town (Mayberry RFD) urologists are not completely and totally up to speed with the latest equipment and methods and maybe just by traveling a little bit further to where this procedure is much more routine, I might be able to access better care?

From what you are saying Tamu, we must assume that all urologists are equal in talent, experience, methods and equipment.

Right? confused
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