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Medical Forum / Diseases and Disorders / Prostate Cancer / July 2005My Nephew's biopsy horror
My nephew is 55 yrs old. About two months ago he went to a urologist because he had difficulty urinating. The urologist diagnosed him with an enlarged prostate and prescripted Uroxotral 10 mg. The medication worked fine. While my nephew was at the doctor's office they gave a PSA blood test. The PSA was 4.0. The doctor recommended a biopsy which my nephew took. The results of the biopsy were negative for prostate cancer. However, my nephew found the biopsy very painful. My nephew developed an infection about a month after the biopsy which the urologist attributed to the test. My nephew has been given an antibiotic(bactrim ds). Everytime he waits more than a halfhour to urinate my nephew has a very hard time going and accompanied with burning and excuriating pain. My nephew cannot sleep and has lost 10 pounds. He has to force himself to urinate every 10 minutes to avoid pain. If you have a borderline PSA , I would think twice about taking a biopsy. My nephew is suffering terribly. He swears he'll never take another biopsy no matter what. Sorry to hear about your nephew. Think about all those who will not take bio, because of your story and will wake up a few years later with bone cancer. Yes - that is where the prostate cancer is going to. > My nephew is 55 yrs old. About two months ago he went to a urologist >because he had difficulty urinating. The urologist diagnosed him with an [quoted text clipped - 11 lines] >would think twice about taking a biopsy. My nephew is suffering >terribly. He swears he'll never take another biopsy no matter what. Hi Dolores. Horror story indeed. The main thing right now is to get your nephew well. If not the uro...maybe his internist or GP should treat this very tough infection. That's paramount. I agree with the other guys about the biopsy. Mine used lidocaine injections and was not terrible at all. Dental work is worse. The office told me (and they were right) that I would be able to walk out and drive, go to a ball game or movie, or whatever. David is correct...there is a little blood in the urine and semen for a short time but that's it. Lurkers shouldn't be discouraged from having a biopsy because of the pain. All the best to your nephew, Ron B. Chicago > Hi Dolores. > [quoted text clipped - 27 lines] > > Chicago I agree, I haven't had it done, of course, but Curt said it hurt but it wasn't that bad. it must be done. Lori IMO the uro jumped the gun a bit on the biopsy. Defensive medicine. Enlarged prostate = more prostate tissue; more prostate tissue = more PSA; more PSA under these conditions does not necessarily = PCa. The real damage here may be that this guy will not have a biopsy some day when he really needs one. Bill Denton RP 2/12/02 PSA .45 Memphis Dolores: I agree the biopsy may have been premature. One would think they would have done a PSA Free test first at least, not to mention what others have said about elevated PSA due to the enlarged prostate. However, again as one of the others has pointed out, it is important to keep in mind that there are probably dozens, maybe hundreds, of lurkers out there reading these posts and we have to be careful about frightening them unnecessarily. In my case the biopsy did not hurt at all. The urologist took ten specimens and I felt nothing as I heard the loud "click" of the tool used to take the biopsy. I had some blood in the urine and ejaculate for a week or so afterwards, but that was it. At this point the biopsy is the only way they have to determine if cancer is present, so it is a critical step in finding the presence of disease and starting the process to determine a method of treatment. Believe me, the long term ramifications of not finding the cancer in time is far worse than the pain one may suffer going through the diagnostic steps. I would consider a different doctor, however, going forward. Good luck to your nephew. I hope he gets over the infection and the enlarged prostate. Thank you. David S. > My nephew is 55 yrs old. About two months ago he went to a urologist > because he had difficulty urinating. The urologist diagnosed him with an [quoted text clipped - 11 lines] > would think twice about taking a biopsy. My nephew is suffering > terribly. He swears he'll never take another biopsy no matter what. On June 30, Dolores Brewer wrote: (snip) > The PSA was 4.0. The doctor recommended a biopsy which my nephew > took. The results of the biopsy were negative for prostate cancer. So what explanation has he been given for the elevated PSA? The generally-accepted upper limit of normal is 2.5. > However, my nephew found the biopsy very painful. Yet another case of a uro who is not concerned with the well-being of his patients. Every man here has had at least one biopsy. I have had two. I demanded and got anesthesia is both cases. Piece of cake. Dolores's nephew must learn that *he* is in charge of his case, not the medic. > My nephew developed an infection about a month after the biopsy which > the urologist attributed to the test. My nephew has been given an > antibiotic(bactrim ds). Was Dolores's nephew given Cipro before the biopsy? It is commonly used as a prophylactic against infection arising from such procedures. I wonder why the uro prescribed Bactrim DS for the infection. Cipro is used for that, too. It would be instructive to check on the meds at www.rxlist.com It appears from a quick read of the site (for Septra, same thing as Bactrim) that in urinary tract infections the drug is used only against certain strains of certain organisms. Which leads me to wonder whether the uro checked whether the problem was caused by one of those strains. I'm willing to bet that he did not. > My nephew cannot sleep and has lost 10 pounds. He has to force himself > to urinate every 10 minutes to avoid pain. If you have a borderline PSA , I > would think twice about taking a biopsy. My nephew is suffering terribly. > He swears he'll never take another biopsy no matter what. Seems to me that it's long past time to seek another medic. And with a PSA of 4.0 at age 55, I think I can pretty well guarantee that he will have to have periodic PSA tests (after the infection, if that's what the problem is, is cured) and, if it doesn't improve, another biopsy. On that occasion, he should simply *require* that he receive anesthesia. And have the biopsy specimens sent to a specialist lab for evaluation. There are several around the country. The cost is ~$350, and I understand that insurance will cover the expense. The labs can be found, along with a wealth of other information, at the website of the Prostate Cancer Research Institute, http://prostate-cancer.org/index/html He can contact his uro and *instruct* him to send the specimens (including the paraffin block) to a specialist lab. Here's another bet: the uro knows about these labs but doesn't bring up the subject with this patients because it's not profitable enough for him. BTW, I understand that the biopsy specimens are the property of the patient, not the medic, not the lab. Regards, Steve J "'MD' does not mean 'Medical Deity.'" -- Stephen B. Strum, MD > ... > Was Dolores's nephew given Cipro before the biopsy? It is commonly used > as a prophylactic against infection arising from such procedures. > ... I was wondering about that too. My uro gave me an antibiotic to take for two days before and two days after the biopsy procedure. One also hopes that the doctor sterilized his instruments properly, did the usual scrub up before hand, wore the face mask, cleaned the perineum with disinfectant, etc. I know that s**t happens, but I can't help wondering how many infections due to medical procedures are preventable by more careful preparation. Incidentally, my biopsy was done with no anaesthetic. It was unpleasant and uncomfortable, but not unbearable. However I will admit that I was counting snips, anxiously awaiting when he'd get to 12 and be done with it. Alan >I was counting snips, anxiously awaiting > when he'd get to 12 and be done with it. I wish mine had kept his mouth shut, rather than saying 11 times, "Here's another one". How about just, "I'm all done" while I was still puckered in anticipation of the first one? I.P. on 6/30/2005 6:24 PM I. P. Freely said the following: >>I was counting snips, anxiously awaiting >>when he'd get to 12 and be done with it. > > I wish mine had kept his mouth shut, rather than saying 11 times, "Here's > another one". How about just, "I'm all done" while I was still puckered in > anticipation of the first one? Ain't it the truth? I told my uro that should I need a second biopsy, I was planning on bringing a pair of headphones and a book on tape. All he needed was me laying on my side and being still. I needed to hear the cocking of the damn instrument and, "Okay, here's another one" like Custer needed a couple hundred more Indians at his last party. Listening to him was by far the worst part of the procedure and he's a pretty funny guy and a great doctor to boot. Bob RRP 03/16/2000 and current PSA <0.1 as in undetectable! My first 7 or 8 "snips" were incredibly painful; the last 4 or 5 were barely noticeable, which leads me to believe my uro didn't wait long enough for the lidocaine (or whatever anesthetic he used) to take effect before he started. I had two biopsies. The first was completely painless like that of David S. The second was quite uncomfortable. My Uro, who did both biopsies, explained that ultrasound does not allow him to be as precise as he would like to be in targeting the novacane(sp?) shots. Apparently he was somewhat off target with the second biopsy. It was the second biopsy, however, that unveiled my cancer, so the discomfort was a small price to pay. It may well make the difference for me of completely curable cancer vs. one that metastasizes and lingers for years, perhaps painfully so. For that I am indeed grateful. Michael K Gleason score 6 (3+3=6?) One core 5% to 10% of "moderately differentiated invasive adenocarcinoma of intermediate nuclear grade having architectural features of Gleason's pattern 3." "No perineural invasion is identified." PSA: 3.23 High grade PIN in 2 cores Age: 60 in otherwise excellent health > My nephew is 55 yrs old. About two months ago he went to a urologist > because he had difficulty urinating. The urologist diagnosed him with an [quoted text clipped - 11 lines] > would think twice about taking a biopsy. My nephew is suffering > terribly. He swears he'll never take another biopsy no matter what. And don't forget that most patients, at least according to my uros, hardly feel the biopsy even without any form of pain control. I felt virtually nothing, while ON nothing. Colon nerves perceive only distension (i.e., gas pains), not punctures (my colonoscopy doc tried to excise a 34 mm tumor with a wire snare with no analgesia of any sort, knowing I wouldn't feel it even though I was watching it on screen). Dolores' nephew had a horrible but rare experience, still far better than undetected cancer. I.P. My biopsy was, by far, the most unpleasant medical procedure I've ever had, quite painful during and for a few hours after. That said, I'm very grateful that I had it when I did and found the PCa in time to have the "it" completely exised and to be well on the way to being 100% cured. If I'd waited or not agreed to a biopsy at all the uro told me there was a good chance that I'd be heading for a pretty unpleasant end within 10 years. Just my $0.02 worth. Dave Dec 03 Age 51, PSA 10.8 Jan 04 Dx PCa T2a Gleason 5 Mar 04 RRP, post op path good, all contained May 04 cystoscopy & BNI now pi**ing like racehorse PSA June < 0.01 PSA Nov < 0.01 PSA Feb < 0.01 PSA May < 0.01 > And don't forget that most patients, at least according to my uros, hardly > feel the biopsy even without any form of pain control. I felt virtually [quoted text clipped - 7 lines] > > I.P. Just for the record I did not have "anesthesia" exactly. They put a jelly with something in it on the anus before inserting the ultrasound probe. I could feel what he was doing down there but the only part that was uncomfortable was after the probe was in there and he was positioning it. I did feel that. I would not call it "painful", but it was uncomfortable for sure. When I said before that I had no pain what I was referring to was when the doctor took the biopsy specimens. I heard the loud snap of the device he was using, but I did not feel anything as it took the tissue. Thank you. David S. > My biopsy was, by far, the most unpleasant medical procedure I've ever > had, quite painful during and for a few hours after. That said, I'm [quoted text clipped - 27 lines] > > > > I.P. I was given happy juice and don't remember a thing. I was give Cipro immediately afterwards and, asided from shooting a few clots to the back of a urinal, never had a symptom.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > Just for the record I did not have "anesthesia" exactly. They put a jelly > with something in it on the anus before inserting the ultrasound probe. I [quoted text clipped - 44 lines] > > > > > > I.P. And, if his doc did not take a biopsy and your nephew *had* prostate cancer, you would be complaining about why the doc *did not" do a biopsy. I do not mean to be unsympathetic, but from your post I believe that is exactly how *you* would react. If I was 55 and had a psa of 4.0 I would probably demand a biopsy. I think is doc was correct in giving him the biopsy. For the life of me, however, I do not understand how it can be painful. I had six cores taken during my biopsy (ten years ago!) and it did not hurt one bit. It was uncomfortable, yes, but there was no pain. He is being very foolish to refuse future biopsies. Will all of this end up in yet another court of law for malpractice money? Will your post scare other men from getting a biopsy that could save their lives? I certainly hope not. Dave RP 1995 PSA 3.4 Gleason 5 + 4 PSA 0.01 As my Uro said while he had the transducer up my a.s, maybe we should have done a general instead of a local. He was right. I was "too tough", well, I won't be again, lol. > And, if his doc did not take a biopsy and your nephew *had* prostate > cancer, you would be complaining about why the doc *did not" do a [quoted text clipped - 18 lines] > Gleason 5 + 4 > PSA 0.01 > My nephew is 55 yrs old. About two months ago he went to a urologist > because he had difficulty urinating. The urologist diagnosed him with an [quoted text clipped - 11 lines] > would think twice about taking a biopsy. My nephew is suffering > terribly. He swears he'll never take another biopsy no matter what. Dolores: I'd echo what others have said that a PSA of 4.0 at the age of 55 with some urination problems isn't considered a "borderline" PSA by many urologists. That his biopsy was very painful is regretable. Most are not. My own wasn't painful at all. There was some mild discomfort, but no pain. I wouldn't want to think that anyone with a PSA of 4.0 at the age of 55 would choose not to have a biopsy that could detect a treatable cancer that if left untreated could kill him would choose not to have a biopsy because it might be painful or might lead to a prostate infection. Hopefully your nephew's infection will be beaten. If he was not given an antibiotic prior to or after the biopsy then his urologist neglected what I believe is fairly standard procedure. OCL Guys, several of you are ignoring a major piece of evidence here - he has an enlarged prostate! Sure, if a guy comes in at 55 and has a PSA of 4 w/o any explanation for it, you might want to proceed w/ a biopsy forthwith. But that is not the case here. The enlarged gland could have been (and evidently was) responsible for the PSA. If that was his first ever PSA he may just have high PSA. In any event there was no reason to panic; he could (and IMO should) have been treated for the BPH first and had the biopsy after his gland had been reduced and if a follow-up PSA was still high. Furthermore, it is possible that he may have had that infection all along and that the prostatitis contributed to the PSA level. Now he's got an infection and still has the BPH. Bill Denton RP 2/12/02 PSA .45 Memphis I'm right in the middle of most of these posts. I'm 48 with no family history of PC (but lots of other C's) and no symptoms and had my first PSA with my family doctor in May. It was 4.7 with negative DRE. Uro redid test and got 4.3 with 17% free. DRE was neg but PG was enlarged. I almost begged out of biopsy and asked for 3rd PSA (since I had ejaculated within 24 hours of each PSA - never knew that could skew results) but went ahead with it. Before snipping uro measured PG and it was 69.9 cc (20-30 is normal) and said that could explain PSA level but he wanted to snip anyway 'since he was in there already'. Nurse had squirted lidocaine lubricant in there 15 minutes before. I had antibiotic day before, day off, day after (levaquel or something like that, not cipro). 2 of 12 samples were positive (20% and 22% with perineural involvemnt in 1, Gleason 3+3=6, well-differentiated.) and 2 more suspicious. Uro was surprised: he really thought it would be BPH. Most discomfort was at anal opening as he steered probe around. Snipping caused a feeling like someone was poking and pressing PG and wouldn't stop. Felt a lot better when probe came out. Peed before I left office. Minimal blood in urine, semen blood for about 3 weeks but clear now. Felt a little discomfort for about 2 hours but felt well enough 5 hours after to drive wife 50 miles to airport. She loaned me pads and tampons but there was no rectal bleeding. I'm scheduled for RRP on July 25. So in about 2 months I'll go from chubby guy getting overdue physical to cancer patient to hopefully cancer survivor. Partin tables show 80% likelhood of organ containment. I'm sorry your nephew is suffering and I hope he's doing better soon. |
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