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Larry
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 Posted: Fri Apr 25, 2008 9:02 pm Post subject: Biopsy? |
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Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an increase in
PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked
him why not repeat PSA, just in case? He said the labs don't make
mistakes. Should I push him on this or just accept the biopsy?
Larry |
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ron
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| Posted: Fri Apr 25, 2008 9:02 pm Post subject: Re: Biopsy? |
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On Apr 25, 10:02 am, Larry <la...@nospam.net> wrote:
| Quote: |
Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an increase in
PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked
him why not repeat PSA, just in case? He said the labs don't make
mistakes. Should I push him on this or just accept the biopsy?
Larry
|
Hi Larry...A PSA increase of 0.75 ng/ml, some say 0.50, in a year
suggests further evaluation. A repeat of the PSA test is a good idea,
IMO. Better yet might be a retest after a 2-3 antibiotic regimen to
see if prostatitis might be the real culprit (unfortunately not all
prostatitis responds to antibiotics)...ron |
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whoknew
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| Posted: Fri Apr 25, 2008 9:21 pm Post subject: Re: Biopsy? |
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"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
| Quote: |
Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an increase in
PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked him
why not repeat PSA, just in case? He said the labs don't make mistakes.
Should I push him on this or just accept the biopsy?
Larry
|
First off if your doctor thinks labs don't make mistakes he's a fool.
Second, to my knowledge biopsies are not usually considered until PSA is
usually up around 4.
Personally I'd find anohter uro. It sounds more like he just bought a new
BMW and need someone to make payments for him |
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Larry
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| Posted: Fri Apr 25, 2008 9:28 pm Post subject: Re: Biopsy? |
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LOL! Thanks!
I just think he's looking to CYA. BTW, PSA over 4 is not the only
criteria used. The rate at which it increases is also a consideration.
Larry
whoknew wrote:
| Quote: |
"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an increase in
PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked him
why not repeat PSA, just in case? He said the labs don't make mistakes.
Should I push him on this or just accept the biopsy?
Larry
First off if your doctor thinks labs don't make mistakes he's a fool.
Second, to my knowledge biopsies are not usually considered until PSA is
usually up around 4.
Personally I'd find anohter uro. It sounds more like he just bought a new
BMW and need someone to make payments for him
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Alan Meyer
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| Posted: Fri Apr 25, 2008 10:38 pm Post subject: Re: Biopsy? |
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"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
| Quote: |
Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an
increase in PSA from 1 to 1.8 over one year. My uro is ordering
a biopsy. I asked him why not repeat PSA, just in case? He said
the labs don't make mistakes. Should I push him on this or just
accept the biopsy?
Larry
|
I'm not a doctor but it is my understanding that prostatitis
does elevate PSA levels. Furthermore, I suspect that PSA tracks
flareups. When you're having a bout of prostatitis the PSA may
go up during that period and then come back down if the
inflammation recedes.
Apparently, PSA levels can go up due to a number of different
factors. If you had sex the night before the blood draw, or if
you had a digital rectal exam shortly before the blood draw, that
could elevate PSA levels (again, I'm not a doctor, but those are
the conventionally accepted views.) The theory is that there
should be no stress on the prostate for 48 hours before the blood
draw in order to get an accurate reading.
It is commonly held that people with prostatitis should get a
round of antibiotic treatment to see if it goes down. From my
reading, I think that the majority of prostatitis cases are not
in fact due to bacterial infections and won't respond to
antibiotics. I know that I've suffered from prostatitis and had
no response to antibiotics except a queasy stomach for 28 days.
I personally don't believe in taking antibiotics unless you
really need them, and would ask the uro to do a urine culture to
find out if there are higher than normal levels of bacteria in
the urine - which might indicate that an antibiotic would do some
good and not just wipe out beneficial bacteria in your body and
help breed antibiotic resistant organisms.
As for labs making mistakes, well, I'm sure it's true that
mistakes are pretty rare. But no matter what systems they have
in place to prevent them, there are still human beings running
the labs. I would have liked your doctor's statement better if
he had said that mistakes are rare rather than that they don't
happen. Still, the odds are high that the reading is correct.
The main issue is, is this increase in PSA really due to cancer?
Did the uro feel anything on his digital rectal exam? If he did,
then I think he's right that a biopsy should be done.
If not, then I like your idea of repeating the PSA rather than
getting a biopsy.
I'm a little reluctant to contradict your uro. He's a
credentialed expert and I'm not. However, your PSA is well
within normal limits, you have an alternate explanation for the
recent rise (prostatitis), a biopsy is expensive and invasive, a
PSA test is cheap and non-invasive, and prostate cancer is
normally a very slow growing disease anyway so that waiting a bit
and re-testing is unlikely to put you at much risk. The usual
theory is that anyone with a PSA below 10 and a Gleason score
(which you can't get without a biopsy unfortunately) below 7, has
a very high probability of successful treatment.
So, I'd schedule another PSA test. I'd be sure there is no sex,
no digital rectal exam, maybe even no bike riding, for 48 hours
before, and see what it says. I think there is a good chance it
will be lower than your last reading. If it's higher, then maybe
you should get a biopsy.
Good luck.
Alan |
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Larry
Guest
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| Posted: Fri Apr 25, 2008 11:27 pm Post subject: Re: Biopsy? |
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Thanks, Ron. So I wonder why this guy is so anxious to do a biopsy
before trying antibiotics, especially given I have a history of
prostatitis?
Larry
ron wrote:
| Quote: |
On Apr 25, 10:02 am, Larry <la...@nospam.net> wrote:
Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an increase in
PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked
him why not repeat PSA, just in case? He said the labs don't make
mistakes. Should I push him on this or just accept the biopsy?
Larry
Hi Larry...A PSA increase of 0.75 ng/ml, some say 0.50, in a year
suggests further evaluation. A repeat of the PSA test is a good idea,
IMO. Better yet might be a retest after a 2-3 antibiotic regimen to
see if prostatitis might be the real culprit (unfortunately not all
prostatitis responds to antibiotics)...ron |
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Larry
Guest
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| Posted: Fri Apr 25, 2008 11:29 pm Post subject: Re: Biopsy? |
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Thanks, Alan. The only thing he noted upon DRE is the left lobe bigger
than the right. He said sometimes that means something and sometimes
not. And in fact, I am having a bit of dull pain on the left side, so
I'm thinking it could be the prostatitis.
Larry
Alan Meyer wrote:
| Quote: |
"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an
increase in PSA from 1 to 1.8 over one year. My uro is ordering
a biopsy. I asked him why not repeat PSA, just in case? He said
the labs don't make mistakes. Should I push him on this or just
accept the biopsy?
Larry
I'm not a doctor but it is my understanding that prostatitis
does elevate PSA levels. Furthermore, I suspect that PSA tracks
flareups. When you're having a bout of prostatitis the PSA may
go up during that period and then come back down if the
inflammation recedes.
Apparently, PSA levels can go up due to a number of different
factors. If you had sex the night before the blood draw, or if
you had a digital rectal exam shortly before the blood draw, that
could elevate PSA levels (again, I'm not a doctor, but those are
the conventionally accepted views.) The theory is that there
should be no stress on the prostate for 48 hours before the blood
draw in order to get an accurate reading.
It is commonly held that people with prostatitis should get a
round of antibiotic treatment to see if it goes down. From my
reading, I think that the majority of prostatitis cases are not
in fact due to bacterial infections and won't respond to
antibiotics. I know that I've suffered from prostatitis and had
no response to antibiotics except a queasy stomach for 28 days.
I personally don't believe in taking antibiotics unless you
really need them, and would ask the uro to do a urine culture to
find out if there are higher than normal levels of bacteria in
the urine - which might indicate that an antibiotic would do some
good and not just wipe out beneficial bacteria in your body and
help breed antibiotic resistant organisms.
As for labs making mistakes, well, I'm sure it's true that
mistakes are pretty rare. But no matter what systems they have
in place to prevent them, there are still human beings running
the labs. I would have liked your doctor's statement better if
he had said that mistakes are rare rather than that they don't
happen. Still, the odds are high that the reading is correct.
The main issue is, is this increase in PSA really due to cancer?
Did the uro feel anything on his digital rectal exam? If he did,
then I think he's right that a biopsy should be done.
If not, then I like your idea of repeating the PSA rather than
getting a biopsy.
I'm a little reluctant to contradict your uro. He's a
credentialed expert and I'm not. However, your PSA is well
within normal limits, you have an alternate explanation for the
recent rise (prostatitis), a biopsy is expensive and invasive, a
PSA test is cheap and non-invasive, and prostate cancer is
normally a very slow growing disease anyway so that waiting a bit
and re-testing is unlikely to put you at much risk. The usual
theory is that anyone with a PSA below 10 and a Gleason score
(which you can't get without a biopsy unfortunately) below 7, has
a very high probability of successful treatment.
So, I'd schedule another PSA test. I'd be sure there is no sex,
no digital rectal exam, maybe even no bike riding, for 48 hours
before, and see what it says. I think there is a good chance it
will be lower than your last reading. If it's higher, then maybe
you should get a biopsy.
Good luck.
Alan
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Felmer Dingle
Guest
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| Posted: Sat Apr 26, 2008 12:54 am Post subject: Re: Biopsy? |
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Don't forget to examine your family history. I found out after my
diagnosis that my grandfather had pCa. If I and my doc knew that before
I probably would have had a biopsy many months earlier when my PSA was
under 4. And I possibly may have had negative margins instead of
positive margins to go along with my aggressive Gleason which can
influence a lower PSA.
FelmerDingle
Larry wrote:
| Quote: |
Thanks, Alan. The only thing he noted upon DRE is the left lobe bigger
than the right. He said sometimes that means something and sometimes
not. And in fact, I am having a bit of dull pain on the left side, so
I'm thinking it could be the prostatitis.
Larry
Alan Meyer wrote:
"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an
increase in PSA from 1 to 1.8 over one year. My uro is ordering
a biopsy. I asked him why not repeat PSA, just in case? He said
the labs don't make mistakes. Should I push him on this or just
accept the biopsy?
Larry
I'm not a doctor but it is my understanding that prostatitis
does elevate PSA levels. Furthermore, I suspect that PSA tracks
flareups. When you're having a bout of prostatitis the PSA may
go up during that period and then come back down if the
inflammation recedes.
Apparently, PSA levels can go up due to a number of different
factors. If you had sex the night before the blood draw, or if
you had a digital rectal exam shortly before the blood draw, that
could elevate PSA levels (again, I'm not a doctor, but those are
the conventionally accepted views.) The theory is that there
should be no stress on the prostate for 48 hours before the blood
draw in order to get an accurate reading.
It is commonly held that people with prostatitis should get a
round of antibiotic treatment to see if it goes down. From my
reading, I think that the majority of prostatitis cases are not
in fact due to bacterial infections and won't respond to
antibiotics. I know that I've suffered from prostatitis and had
no response to antibiotics except a queasy stomach for 28 days.
I personally don't believe in taking antibiotics unless you
really need them, and would ask the uro to do a urine culture to
find out if there are higher than normal levels of bacteria in
the urine - which might indicate that an antibiotic would do some
good and not just wipe out beneficial bacteria in your body and
help breed antibiotic resistant organisms.
As for labs making mistakes, well, I'm sure it's true that
mistakes are pretty rare. But no matter what systems they have
in place to prevent them, there are still human beings running
the labs. I would have liked your doctor's statement better if
he had said that mistakes are rare rather than that they don't
happen. Still, the odds are high that the reading is correct.
The main issue is, is this increase in PSA really due to cancer?
Did the uro feel anything on his digital rectal exam? If he did,
then I think he's right that a biopsy should be done.
If not, then I like your idea of repeating the PSA rather than
getting a biopsy.
I'm a little reluctant to contradict your uro. He's a
credentialed expert and I'm not. However, your PSA is well
within normal limits, you have an alternate explanation for the
recent rise (prostatitis), a biopsy is expensive and invasive, a
PSA test is cheap and non-invasive, and prostate cancer is
normally a very slow growing disease anyway so that waiting a bit
and re-testing is unlikely to put you at much risk. The usual
theory is that anyone with a PSA below 10 and a Gleason score
(which you can't get without a biopsy unfortunately) below 7, has
a very high probability of successful treatment.
So, I'd schedule another PSA test. I'd be sure there is no sex,
no digital rectal exam, maybe even no bike riding, for 48 hours
before, and see what it says. I think there is a good chance it
will be lower than your last reading. If it's higher, then maybe
you should get a biopsy.
Good luck.
Alan
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NB
Guest
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| Posted: Sat Apr 26, 2008 1:57 am Post subject: Re: Biopsy? |
|
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"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
| Quote: |
Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an increase in
PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked him
why not repeat PSA, just in case? He said the labs don't make mistakes.
Should I push him on this or just accept the biopsy?
Larry
|
Hi Larry. Get the biopsy. I'm 45 years old, had a normal PSA, but a lump was
found during my annual physical. I was sent off for a consultation with a
urologist and they repeated the DRE. As a result, I had a biopsy done right
on the spot. My test results came back positive for prostate cancer. My
surgery was on March 20th and I'm recovering slowly.
A PSA test is not the definitive answer as to whether there is a problem or
not. Get a DRE and get a biopsy just to make sure. The biopsy is unpleasant
but releatively painless and it will take about 10 to 15 minutes depending
on how many samples need to be taken. Waiting for the results is actually
worse.
If you have any questions, feel free to ask. |
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Larry
Guest
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| Posted: Sat Apr 26, 2008 4:20 am Post subject: Re: Biopsy? |
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Thanks, I can appreciate your story and why you would recommend it.
Actually, I just verified that my PSA went from 1 to 1.6 to 1.8 over 2
years (not 1 year). I am still going to question him about it again.
Regarding the biopsy, can you provide any sense for what "unpleasant"
means to you re the biopsy? I mean, a biopsy needle goes through the
intestinal wall and about an inch into the prostate. That is only
"unpleasant"? What exactly do you feel? Pressure? Pain? Very quick? How
would you describe it?
Thanks!
Larry
NB wrote:
| Quote: |
"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an increase
in PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I
asked him why not repeat PSA, just in case? He said the labs don't
make mistakes. Should I push him on this or just accept the biopsy?
Larry
Hi Larry. Get the biopsy. I'm 45 years old, had a normal PSA, but a lump
was found during my annual physical. I was sent off for a consultation
with a urologist and they repeated the DRE. As a result, I had a biopsy
done right on the spot. My test results came back positive for prostate
cancer. My surgery was on March 20th and I'm recovering slowly.
A PSA test is not the definitive answer as to whether there is a problem
or not. Get a DRE and get a biopsy just to make sure. The biopsy is
unpleasant but releatively painless and it will take about 10 to 15
minutes depending on how many samples need to be taken. Waiting for the
results is actually worse.
If you have any questions, feel free to ask.
|
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Steve Jordan
Guest
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| Posted: Sat Apr 26, 2008 5:36 am Post subject: Re: Biopsy? |
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On April 25, Larry wrote:
(snip)
| Quote: |
Regarding the biopsy, can you provide any sense for what "unpleasant"
means to you re the biopsy? I mean, a biopsy needle goes through the
intestinal wall and about an inch into the prostate. That is only
"unpleasant"? What exactly do you feel? Pressure? Pain? Very quick? How
would you describe it?
|
Well, my anecdote is this: I felt almost nothing. Why? Because I
required that I be administered anti-pain drugs.
Some here will claim that it's not so bad; others will claim that it was
horrible without drugs.
I claim that no one knows what will happen and that only a self-styled
macho fool would decline pain prevention.
One thing I have wondered about and has not been answered by anyone is
this: if the patient does not experience pain and tense up, the uro
should have a more convenient task. Hello?
Regards,
Steve J |
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I.P. Freely
Guest
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| Posted: Sat Apr 26, 2008 6:38 am Post subject: Re: Biopsy? |
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Larry wrote:
| Quote: |
Regarding the biopsy, can you provide any sense for what "unpleasant"
means to you re the biopsy? I mean, a biopsy needle goes through the
intestinal wall and about an inch into the prostate. That is only
"unpleasant"? What exactly do you feel? Pressure? Pain? Very quick? How
would you describe it?
|
If my doctor hadn't said, "here goes another one" before each needle
jab, I'm not sure I would have realized he was doing anything beyond
jamming hardware where it doesn't belong. Since he did, I noticed a
twinge of "unpleasantry" each time. He said that's about how
the vast majority of his patients perceived it. I'm sure some gay men
have had far rougher experiences which, overall, they enjoyed.
Our intestine wall nerves perceive only stretching, not cutting (I've
watched them snip bumps from my intestine walls during colonoscopies,
and it was as though it was just a video of someone else's intestine.)
All I actually felt during colonoscopies was the introduction of enough
gas to inflate the intestine significantly, and we've all felt that many
times; they're called gas pains.
A few men say their biopsies were very painful. I have no idea whether
that's physiological or psychological.
I.P. |
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J. Veil
Guest
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| Posted: Sat Apr 26, 2008 7:24 am Post subject: Re: Biopsy? |
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The first biopsy was without pain medication and unbearable to the point
that I passed out after the Uro announced the eleventh probe.
Due to this newsgroups existence and advise from contributors, I told my Uro
at the second biopsy that I wanted to be sedated or whatever. He performed
the procedure whilst I was under a short spell of anastatic.
In response to I.P.'s comment...I am a masochist and know what pain is, but
can assure you that the acute pain I felt at my first biopsy was NOT
psychological!
John |
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NB
Guest
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| Posted: Sat Apr 26, 2008 7:43 am Post subject: Re: Biopsy? |
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"Larry" <larry@nospam.net> wrote in message
news:481266fe$0$11635$607ed4bc@cv.net...
| Quote: |
Thanks, I can appreciate your story and why you would recommend it.
Actually, I just verified that my PSA went from 1 to 1.6 to 1.8 over 2
years (not 1 year). I am still going to question him about it again.
Regarding the biopsy, can you provide any sense for what "unpleasant"
means to you re the biopsy? I mean, a biopsy needle goes through the
intestinal wall and about an inch into the prostate. That is only
"unpleasant"? What exactly do you feel? Pressure? Pain? Very quick? How
would you describe it?
Thanks!
Larry
|
Well..... the biospy was done with the assistance of an ultrasound probe. A
desensitizing gel is applied to the probe and also applied to your anus.
The probe is then inserted. A needle with freezing medication is inserted
and you feel some of the pressure and poke of the injection into the
prostate. If your doctor is gentle and not in a rush, you shouldn't feel
much of anything beyond that once the freezing sets in. You will hear a
"SNAP!" sort of sound as each sample is being taken. I guess everyones
tolerance to pain is different, but trust me, this isn't nearly as bad
as it sounds. The entire procedure takes about 10 to 15 minutes. Side
effects are minimal in most cases. You can expect to bleed for a few
hours or days afterwards and will need to wear a pad so that you don't
stain your underwear or clothing. Also, you will pass blood in your urine
and semen for some time. It can take several weeks for this to stop.
They encourage you to have as much sexual activity as you can handle
afterwards. It helps clean things out. Other than the wait time to get your
results, the second worst thing about this is the first urination or
ejaculation following the biopsy. It is quite shocking to see blood where
there was none before.
If they know what they are doing, they will give you an information sheet
of things to watch out for following the biopsy. You could develop an
infection in which case you will need antibiotics. Signs to watch out for:
fever, heavy bleeding (soaked pad ).
Feel free to discuss this procedure with your doctor. You will probably also
be offered a sedative or pain medication or both. I went with the sedative
but didn't require anything beyond the freezing injection. Also, you will
be given some antibiotics (or you should be given some antibiotics) as a
preventative measure so that you do not develop an infection.
Unfortunately, I did get some prostatitis following the procedure and I
had to go on antibiotics for several weeks thereafter. Not to worry. It
doesn't happen to everyone.
I hope that answers some of your questions. If you have any others, fire
away. Best of luck,
Nick |
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Leonard Evens
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| Posted: Sat Apr 26, 2008 10:07 am Post subject: Re: Biopsy? |
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whoknew wrote:
| Quote: |
"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
Hi.
I'm 51 y/o with history of chronic prostatitis. Just had an increase in
PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked him
why not repeat PSA, just in case? He said the labs don't make mistakes.
Should I push him on this or just accept the biopsy?
Larry
First off if your doctor thinks labs don't make mistakes he's a fool.
Second, to my knowledge biopsies are not usually considered until PSA is
usually up around 4.
|
That is way out of date. For a 51 year old man, a much lower threshold
would be appropriate. But it is the rate of change that is important
rather than the actual value., and if the trend shown in the last test
continued, it would be reasonable to go to biopsy.
It is possible, on the other hand, for PSA to vary for a lot of reasons
other than prostate cancer, even assume the labs anever make mistakes.
Many doctors would wait a few months and take another reading to see if
the trend were continued.
Did your doctor suggest any other reason for concern, such as a
suspicious DRE?
If you are really concerned about the matter, you could seek another
opinion,
| Quote: |
Personally I'd find anohter uro. It sounds more like he just bought a new
BMW and need someone to make payments for him
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