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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2005biopsy or not
I am 54 years old with a psa level under 1.0. My doctor told me i have one nodule and wants to do a biopsy. He also told me that the biopsy is like trying to find a seed in a grapfruit so I am not to interested in going thru the pain for a 50/50 shot or less to find possible or not possible cancer cells. Can anyone shed any light on this dilema? thank you DB Not all prostate cancers produce a lot of PSA. How will you know if the nodule is a cancer or not without the biobsy? The idea is to stick the biopsy needle in the nodule. The biopsies are uncomfortable, but not as bad as having a nodule and not knowing if it is cancer or not. Good luck. I hope it turns out to be a false alarm. Steve U > I am 54 years old with a psa level under 1.0. My doctor told me i have > one nodule and wants to do a biopsy. He also told me that the biopsy [quoted text clipped - 4 lines] > thank you > DB First, if you do have Prostate Cancer (PCa) and your doctor finds it at 1.0, he is one hell of a doctor. It is important to know, and for you to know, what your PSAs were last year and the year before. If they were, .2, then .6, then 1.0, then your 'PSA velocity' indicates the possible presence of cancer. A biopsy is not painful for most people. Albeit, it is painful for some. If you are squeamish, have him give you some happy juice before performing the biopsy. I had happy juice and don't remember a thing. If you get a biopsy, no cancer is found and your next PSA is 1.3, then he will ask for another biopsy. Again, I don't know if he has good reason to believe you have cancer. I need to know what your previous PSAs were. But, if he suspects, by all means get the biopsy. It's nothing.  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > I am 54 years old with a psa level under 1.0. My doctor told me i have > one nodule and wants to do a biopsy. He also told me that the biopsy [quoted text clipped - 4 lines] > thank you > DB >I am 54 years old with a psa level under 1.0. My doctor told me i have > one nodule and wants to do a biopsy. He also told me that the biopsy [quoted text clipped - 4 lines] > thank you > DB IMO the biopsy, while not a pleasant experience, was not bad at all. I have had many much more unpleasant medical and dental procedures. A sigmoidoscopy I had a week ago was much worse. IT DOES NOT HURT! If you're worried about it, take a Tylenol before you go in, even if just for that evening's ache. If your doc didn't announce each pinprick, you'd just think he'd flinched or MAYBE slightly snapped you with a rubber band. Just do it! Nodes can kill, man; a barely perceptible pinprick (I could not feel mine, and didn't take a Tylenol 'til evening) is a yawner. Take a good magazine and you won't notice he's doing more than rooting around in yer wazoo. I.P. > I am 54 years old with a psa level under 1.0. My doctor told me i have > one nodule and wants to do a biopsy. He also told me that the biopsy [quoted text clipped - 4 lines] > thank you > DB > I am 54 years old with a psa level under 1.0. My doctor told me i have > one nodule and wants to do a biopsy. He also told me that the biopsy > is like trying to find a seed in a grapfruit so I am not to interested > in going thru the pain for a 50/50 shot or less to find possible or not > possible cancer cells. > Can anyone shed any light on this dilema? If the doc knows that there is a nodule, that should be the very first location he samples. Nowadays, the usual biopsy takes specimens from 12 sites, six on a side. It can still miss a tumor, though, so maybe the medic should take more in DB's case. If the palpable nodule is in fact PCa, the low PSA is a possible sign of an aggressive tumor, so I believe that it is imperative that DB learns what is going on. Aggressive tumors (such as mine) tend not to produce high amounts of PSA. The medic should be able to locate the nodule via TRUS (Trans Rectal UltraSound). I have had two biopsies. In both cases, I requested and received anasthesia and they were no problem at all. A patient has an absolute right to pain relief; DB should not let anyone tell him otherwise. If the uro refuses it, fire him; it's as simple as that. Please let us know how it goes. Regards, Steve J __ "Never give in--never, never, never, never, in nothing great or small, large or petty, never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.'' --Sir Winston L. S. Churchill >I am 54 years old with a psa level under 1.0. My doctor told me i have > one nodule and wants to do a biopsy. He also told me that the biopsy [quoted text clipped - 4 lines] > thank you > DB Has your doctor offered any other possible explanation for what he felt? If the only thing he knows that can cause that nodule is cancer, or if cancer is the most likely cause, then a biopsy certainly seems to be called for. If you're not sure about it, you could go to another doctor and have him or her do their own digital rectal exam. But make sure it's a doctor who does a lot of prostate exams, i.e., a urologist or radiation oncologist. As others have said, biopsies just aren't that bad. Mine was uncomfortable, but not seriously painful. It was not nearly as bad, say, as a toothache, a bad headache, or a stubbed toe. I don't think you should be afraid of it. If you've got cancer, and the biopsy finds it, you are in the wonderful position that many of us wish we had been in - namely finding the cancer when it was truly very small and easily treatable. If it is cancer, you're lucky to have a doctor that was knowledgeable enough to find it this early. Alan Hello DB, when a nodule is found it is suspicious...It is supposed to be soft and spongy...hum. The Dr. is telling you that he found an irregularity.... With a 1.0 it does not seem right. I understand the confusion. Can you get another DRE from yet another Dr. to confirm this irregularity? with a 1.0? I would do that before I got a biopsy.... Just my idea. Good wishes, John Loomis >I am 54 years old with a psa level under 1.0. My doctor told me i have > one nodule and wants to do a biopsy. He also told me that the biopsy [quoted text clipped - 4 lines] > thank you > DB > I am 54 years old with a psa level under 1.0. My doctor told me i have > one nodule and wants to do a biopsy. He also told me that the biopsy > is like trying to find a seed in a grapfruit so I am not to interested > in going thru the pain for a 50/50 shot or less to find possible or not > possible cancer cells. Which doctor told you that? Have you yet been referred to a urologist? A nodule could be anything, e.g., a cyst, but it would be prudent to have it biopsied. It would seem that if your doctors can feel something, then they should know where to look, and the chances should be pretty good they will find out just what it is. Most men don't find the biopsy procedure particularly unpleasant. Mine was about as bad as a typical dental procedure, but it didn't last as long. If the doctor gives you a local anesthetic before probing for samples, it helps avoid any discomfort. > Can anyone shed any light on this dilema? Have the biopsy. > thank you > DB I would like to thank everyone who replied to me today. All your comments were very informative to me and helping me to make further decisions. The DRE I previously mentioned was done by a urologist, just so everyone knows this. I have decided to get a 2nd opinion with another urologist and check my previous PSA tests to see if there a "velocity" increase. I will keep you all advised in a few weeks or so. Thank you all very much! DB Just so everyone understands that I took my email address out of the heading and using the name William. DB Of all the comments you've gotten so far, William, Steve's is the most vital: "If the palpable nodule is in fact PCa, the low PSA is a possible sign of an aggressive tumor, so I believe that it is imperative that DB learns what is going on. Aggressive tumors (such as mine) tend not to produce high amounts of PSA." What he says is true, and if you've got an aggressive tumor, your best chance of killing it, rather than it killing you, is detecting it and killing it ASAP. If that's what it is, it's pumping aggressive cancer cells directly into your bloodstream as you read this. If I had anything palpable on my prostate, I'd get a biopsy just for the sheer joy of it. Why? Just look at 5 and 10 year survival charts and nomograms, and see what difference the steps from Gleason 6 to Gleason 7 and from Gleason 7 to Gleason 8 make in the odds of survival. Then realize that Steve's last sentence above applies more and more as Gleason grades climb. In fact, if a biopsy was negative, I'd get another one ASAP (I think the waiting period is several weeks), because I suspect the odds of missing a tumor with a biopsy are greater than the odds a nodule is benign. I'd use that waiting period for a couple more pokes, in case some specialist with a golden finger guarantees me the nodule is just a garden-variety whatsit, instead of cancer. Then I'd get that second biopsy anyway. I'm PISSED that my PC is a Gleason 8; the son of a bitch will very likely kill me just BECAUSE it's an 8 and snuck into one seminal vesicle before my idiot initial doctor woke up. I.P. > I have decided to get a 2nd opinion with > another urologist and check my previous PSA tests to see if there a > "velocity" increase. Thank you for your help and insight. I am definately going to get the biopsy in a few weeks and I will keep everyone posted on the results. I appreciate your time and advise! DB William, I am a radiologist who does prostate biopsy in my practice. A PSA of 1.0 does not eliminate the possibility of malignancy. The digital rectal exam, PSA, and ultrasound are complementary procedures, not exclusionary. There are other explanations for prostate nodules, most commonly a cyst. That said, you should know that I personally have biopsied a 40 year old with a PSA of 1.0 and a small palpable nodule. He had prostate cancer. Do not rely on the PSA alone to make your decision. My PSA was 3.2 when I was diagnosed. Many, many cancers are diagnosed in men with "normal" PSA levels. Do you happen to know what your previous PSA was, or was this the first one? Good luck. CPW Here is the history of my previous PSA tests. 12/08/2000: psa 1.0 12/20/2002: i had test but need to get from doctor this week as i lost my copy 01/03/2005: psa 1.1 Is this slight increase over 5 years a significant velocity that Steve Kramer mentioned in earlier reply? thanks DB > Here is the history of my previous PSA tests. > 12/08/2000: psa 1.0 > 12/20/2002: i had test but need to get from doctor this week as i lost > my copy > 01/03/2005: psa 1.1 A difference of .1 is well within the typical measurment error. It doesn't mean anything. The usual rule about PSA "velocity" is that if the PSA increases at an average rate of over 0.75 ng/ml each year for over two years, then some followup such as a biopsy is called for. > Is this slight increase over 5 years a significant velocity that Steve > Kramer mentioned in earlier reply? > thanks > DB Has anyone experienced soreness for 4 days after a DRE? I had mine on Thursday and I still have soreness. I am wondering if this urologist is a little aggressive and if he can cause this kind of soreness from a DRE then I wonder about the biopsy he does? Really I am still sore. Is that normal? thank you DB > Has anyone experienced soreness for 4 days after a DRE? I had mine on > Thursday and I still have soreness. I am wondering if this urologist [quoted text clipped - 3 lines] > thank you > DB This is only my experience, but I have had a stretch of problems after some DRE's. I believe I have an anal fissure (is being checked out), and I actually had bleeding for a couple of days. Also, I would imagine hemorrhoids could get irritated. Your doc probably spent more time manipulating the prostate, given the fact that he felt a nodule yet your psa's were low. Never. However, it is possible that your prostate is sore, especially if it has a nodule that was irritated. And, that may be good news. Cancer is usually painless. But a cyst might be painful. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > Has anyone experienced soreness for 4 days after a DRE? I had mine on > Thursday and I still have soreness. I am wondering if this urologist [quoted text clipped - 3 lines] > thank you > DB > Has anyone experienced soreness for 4 days after a DRE? I had mine on > Thursday and I still have soreness. I am wondering if this urologist > is a little aggressive and if he can cause this kind of soreness from a > DRE then I wonder about the biopsy he does? Really I am still sore. > Is that normal? > thank you The only thing that comes to mind is that you have some hemmorhoids. They could be excacerbated by the probing. Other than that, there isn't much reason why a DRE should producing any lasting discomfort. > DB Go to several experienced urologists and make sure there is some abnormality in your prostrate, my experience is that less experienced practiconers often identify irregularities that more experienced people don't find. >I am 54 years old with a psa level under 1.0. My doctor told me i have >one nodule and wants to do a biopsy. He also told me that the biopsy [quoted text clipped - 4 lines] >thank you >DB > I am 54 years old with a psa level under 1.0. My doctor told me i have > one nodule and wants to do a biopsy. He also told me that the biopsy [quoted text clipped - 4 lines] > thank you > DB If he found something on a DRE then I would follow his recommendation. The biopsy is not bad at all, about like going to the dentist. Get it done. Why would you not want to find a cancer early? Dale j. SignatureEmail: dalej2@mac.com > I am 54 years old with a psa level under 1.0. My doctor told me i have > one nodule and wants to do a biopsy. He also told me that the biopsy [quoted text clipped - 4 lines] > thank you > DB The biopsy is not painful. It can be embarrassing as you are fully conscious and there will probably be two or more people working around you. The doc will be navigating a probe and once every few minutes there will be a small snap or mechanical sound. He will have one or two nurses or techs assisting him with the ultrasound, keeping track of the samples, etc. The downside is that there will be blood in your semen and possibly urine. Even if you have a big tumor, it can be missed. A friend of mine clocked a PSA 20+ and it took three biopsies to confirm the cancer. Just go in and do it. It's not bad, you walk out of his office and can have lunch or work right afterward. "Someone" -- it matters not who because this is about modesty and medicine, not personalities -- offered > The biopsy is not painful. It can be embarrassing as you are fully > conscious and there will probably be two or more people working > around you. Anyone embarrassed by a bunch of strangers of all genders gawking at his crotch better not get PC. It seemed as though more strangers -- at least 10 daily -- stared at my totally naked, bloody, crusty, stapled, stinky, purple, stubby, bloated, en-tubed jewels in that one week in the hospital than have seen my shining, beautiful FACE in the last decade. Three entourages of people in white coats -- plus janitors and the cable guy for all I know -- paraded into my room every morning, threw off my sheet (which is all I was wearing unless you count the catheter), spread my legs, woke me up, and interrogated me . . . before we even got breakfast. I quit worrying about privacy when my initial urologist brought in his secretary and clerk (a young woman and a middle-aged woman) to observe my biopsy -- with my permission. They seemed much more uncomfortable than I was. It's an a.s, folks, a hairy, aging a.s. Very few people even WANT to see it, let alone have prurient thoughts about it. You make some jokes, you ignore it, you fuhgedaboutit. Heck, at least it's not a continuous 25-minute fart like the colonoscopies during which we're carrying on a conversation with 3-4-5 strangers at the other end of the roto-rooter. Anyone with a prostate or testicles or an ovary or a colon or a breast better learn to save their embarassment for truly stupid social blunders, or they'll have a hell of a time confronting The Beast and discussing every last aspect of their private lives with strangers in white coats. I.P. > > I am 54 years old with a psa level under 1.0. My doctor told me i have > > one nodule and wants to do a biopsy. He also told me that the biopsy [quoted text clipped - 20 lines] > Just go in and do it. It's not bad, you walk out of his office and > can have lunch or work right afterward. I would not be worried about an embarrassing situation, everybody is built the same on this planet. I don't know about the Andromeda Galaxy though. You'll do fine. Dale J. SignatureEmail: dalej2@mac.com I do not have any problem with being embarrased. Is that bare assed? I just wanted to make sure there was a valid reason to do it and now after reading everyones comments I can see that I had better get it done. So next week I have an appointment with a 2nd urologist just to see if he finds the same nodule or whatever he may find or not find. If the 2nd opinion confirms the 1st doctor then I will set up a date and get it done by the doc I find the most comfort with. If the 2nd opinion says there is nothing unusual then I will be back to the drawing board on this decision. I have had a colonoscopy & liver biopsy so it is not that I am scared of the pain. I just want to make sure there is a valid reason for the procedure. You guys have all be very helpful and thank you all very much! DB I do not have any problem with being embarrased. Is that bare assed? I just wanted to make sure there was a valid reason to do it and now after reading everyones comments I can see that I had better get it done. So next week I have an appointment with a 2nd urologist just to see if he finds the same nodule or whatever he may find or not find. If the 2nd opinion confirms the 1st doctor then I will set up a date and get it done by the doc I find the most comfort with. If the 2nd opinion says there is nothing unusual then I will be back to the drawing board on this decision. I have had a colonoscopy & liver biopsy so it is not that I am scared of the pain. I just want to make sure there is a valid reason for the procedure. You guys have all be very helpful and thank you all very much! DB I've had all three in the past few months. I'd rate the liver biopsy and colonoscopy -- both wide awake -- as uncomfortable nuisances plus a couple of nasty twinges, and the prostate biopsy as no more noticeable than a prolonged DRE with snappy sound effects. I.P. > I have had a colonoscopy & liver > biopsy so it is not that I am scared of the pain. I just want to make > sure there is a valid reason for the procedure. >Subject: Re: biopsy or not >From: "william" d3ea2n1@san.rr.com [quoted text clipped - 14 lines] >very helpful and thank you all very much! >DB Hopefully the doc uses a sonogram guided needle- he has a better chance of seeing the nodule and getting a sample out of it. The PSA and DRE give you strong reason to believe you have PCa, but you don't want to do anything as radical as kill or cut out the prostate before it's confirmed by biopsy. I went to a 2nd urologist who said i was fine; he did not find anything. So now I have one doc saying i need a biopsy and the other doc saying i am fine.?? With my life at stake (varies with age), I'd play it safe, since the biopsy is less hassle and no more painful than changing the oil in your car. I.P. > I went to a 2nd urologist who said i was fine; he did not find > anything. > So now I have one doc saying i need a biopsy and the other doc saying i > am fine.?? I agree with Mr. Freely. Look at it this way, by having the biopsy you will establish a baseline for future reference and if they do find cancer you are set to deal with it. Not finding out, and waiting, will just let it grow and put you at greater risk. Also, have the PSA and PSA Free done again in a few months even if the biopsy does not find anything. Unfortunately it sometimes takes more than one try to find the cancer, so a clean biopsy is not 100% proof that you do not have PCa. Follow up with the labs over time to see if that indicates trouble. Good luck to you. > With my life at stake (varies with age), I'd play it safe, since the biopsy > is less hassle and no more painful than changing the oil in your car. [quoted text clipped - 5 lines] > > So now I have one doc saying i need a biopsy and the other doc saying i > > am fine.?? That's not always true. We've had people here who had biopsies more equivalent with changing a Ford 3-bolt starter. But, I concur with the playing it safe. Did the 2nd doc feel the nodes? That's what this is really all about. > With my life at stake (varies with age), I'd play it safe, since the biopsy > is less hassle and no more painful than changing the oil in your car. [quoted text clipped - 5 lines] > > So now I have one doc saying i need a biopsy and the other doc saying i > > am fine.?? |
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