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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2006Biopsy Scheduled
We finally got in to see the new uro today. I really like the guy and Paul liked him more importantly. He is doing the biopsy on Sept. 7th. He said Paul has a 50/50 chance at this point of having pca. Colleagues in his office perform the da Vinci robotic surgery if life leads us down that path. Paul and I have been and continue to research options and devour all the knowledge we can regarding pca. I find it so helpful to come and read about others that are going through or have been through what we are going through. I am learning to live one day at a time and have patience. I thought I would update you all. Thanks to you all that have responded to my previous post. I will keep you updated. > We finally got in to see the new uro today. I really like the guy and > Paul liked him more importantly. He is doing the biopsy on Sept. 7th. > He said Paul has a 50/50 chance at this point of having pca. Ah, he's much better than my doctor. I was told I had a 1 in 3 chance of having cancer. Now that I know what I know, considering my PCa was palpable and my PSA was 16, I almost certainly had cancer. Your doc's 50/50 means he just doesn't know. Your husband's PSA just isn't giving him enough clues. By the way, did the doctor feel anything on the DRE? I've forgotten. And September 7? Geesh. My PSA was 10/17. My biopsy was 11/1. You've been messing with this since, what? June? You must be frazzled. > Colleagues > in his office perform the da Vinci robotic surgery if life leads us > down that path. Kinda putting the horse before the cart, but at Age 51, assuming a 7 or less Gleason and T2 Stage, then I think robotic surgery is a good choice. It was not available to me in 2000, but if I were dx'd now, I think that would be my choice. Of course, the surgeon is still the most important component. Look for a good man. Don't settle for "colleagues in his office." > Paul and I have been and continue to research options > and devour all the knowledge we can regarding pca. Fantastic, Lisa!!! I cannot tell you how much better you will feel, for the next several years, knowing that you made a decision based on facts and research.  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, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum Steve, thank you so much for you feedback. The Dr. thought Paul's prostate was slightly enlarged but nothing else was felt. > > We finally got in to see the new uro today. I really like the guy and > > Paul liked him more importantly. He is doing the biopsy on Sept. 7th. [quoted text clipped - 40 lines] > Casodex added daily 07/06 > Non Illegitimi Carborundum RocSam: Your story sounds just like mine (BTW, my husband's name is also Paul, age 64). My Paul went to the VA in late May (Their meds are cheaper) and had a whole series of blood work done. Everything was find except that the PSA had jumped from 1.8 in November 2005 (taken at our regular lab) to 2.77 on June 1. We had it retested at our regular lab and it was 2.6. We went to one urologist to whom we were "pushed" by our primary physician (He's new in town) and didn't like him. Despite that, we scheduled a biopsy for July 12. When Paul found out that uro #1 didn't use anesthetic during the biopsy he cancelled the appointment. A friend had used uro #2 last year and recommended him. We saw him on July 19 and Paul asked him about a new urine based test instead of a biopsy. The doc agreed but the first sample size was insufficient. We did it again and the test came back positive. Here's the website for the test: http://www.bostwicklaboratories.com/about/PCA3.html He's had four DRE's since June and nobody felt anything. We later found out that the PCA3 test (not yet FDA approved) has a high number of false positives. We're hoping Paul is one of them. A biopsy is scheduled for next week, 8/24. BTW, we're also leaning toward robotic prostatectomy if the biopsy results are positive. Good luck. CW89134 ________________________________________________________ > We finally got in to see the new uro today. I really like the guy and > Paul liked him more importantly. He is doing the biopsy on Sept. 7th. [quoted text clipped - 8 lines] > I thought I would update you all. Thanks to you all that have responded > to my previous post. I will keep you updated. Hi CW, thanks for sharing. I am wishing you and your husband luck at his biopsy next week. I am hoping for the best. Thanks for the link. I have not had a chance to visit it yet. > RocSam: > [quoted text clipped - 41 lines] > > I thought I would update you all. Thanks to you all that have responded > > to my previous post. I will keep you updated. > When Paul found out that uro #1 didn't > use anesthetic during the biopsy he cancelled the appointment. Good idea. Why not use the happy juice? > Paul asked him about a new urine based test instead of a biopsy. > The doc agreed but the first sample size was insufficient. We did it > again and the test came back positive. Don't know much about it, but biopsies give you much more information that you need to make treatment decisions. Gleason and Stage to name two biggies. > A biopsy > is scheduled for next week, 8/24. Our Dr. told us he does not use anesthetic to do biopsy at the office. He said most men tolerate it just fine and the actual time for the biopsy would be about 10 mintues. He said the would numb him up. Paul, not knowing any differnt agreed. Is this something we should be concerned about? I mentioned giving him a valium but Paul said he did not need one. > > When Paul found out that uro #1 didn't > > use anesthetic during the biopsy he cancelled the appointment. [quoted text clipped - 11 lines] > > A biopsy > > is scheduled for next week, 8/24. > Our Dr. told us he does not use anesthetic to do biopsy at the office. > He said most men tolerate it just fine and the actual time for the > biopsy would be about 10 mintues. He said the would numb him up. > Paul, not knowing any differnt agreed. Is this something we should be > concerned about? I mentioned giving him a valium but Paul said he did > not need one. Most men tolerate it just fine. I've heard it described as rubber band snapping. Of the hundreds here, I believe half a dozen might have had a bad time of it. Speaking for myself, without a thought, I'd go into a burning building or stand in front of a gun to save women and children. But, when it comes to dental work, butt work, etc., I opt for painless. I don't need pain to prove anything and I don't frequent doctors who couldn't care less. 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, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum "Numbing him up" sounds like the doc is going to inject some numbing agent such as novacaine - the same stuff used by the dentist. I was given two shots, no more painful than the same type of shots the dentist gives. I felt no pain at all during the procedure. Someone here said correctly that taking each sample feels a little like flicking your finger on your arm. During my entire prostate cancer treatment, my greatest fear was the biopsy. I was so scared I could hardly walk into the room. Turned out to be nothing. Dave Perry > Our Dr. told us he does not use anesthetic to do biopsy at the office. > He said most men tolerate it just fine and the actual time for the [quoted text clipped - 18 lines] > > > A biopsy > > > is scheduled for next week, 8/24. Sorry if I confused anyone. When I said that uro #1 didn't use anesthetic, I didn't mean anesthesia. I meant local anesthetic - as in some kind of numbing agent. Apparently he doesn't use anything! We'll never know. Uro #1 did say it was a 10 minute procedure. Before Paul made the initial appointment with uro #2, he asked his assistant if he used anesthetic during biopsy. The answer was yes. We'll see exactly how accurate that answer was next week. ___________________________________________________________________ > Our Dr. told us he does not use anesthetic to do biopsy at the office. > He said most men tolerate it just fine and the actual time for the [quoted text clipped - 18 lines] > > > A biopsy > > > is scheduled for next week, 8/24. When my husband went for his biopsy the nurse asked if he'd taken his meds as directed. "What meds?" "Oh, the meds to relax you? Didn't you get your Rx?" "No-o-o" "Oh, okay, let me ask if we can do this anyway." By this time my husband was furious as he had taken the day off from work and we had driven 2 hours to get there yet he had that deer in the headlamps look on his face. (He is such a chicken about some things.) I did get to stay with him until they were about to start the procedure. I can't say he calmed down he just wanted it over with. They did say he was not going to feel much as they would use something (never said exactly what) that would lessen the sensation. When they were done he stood up, got dressed, walked out, and drove the car. Said he felt like they used a gallon of KY jelly on him. He also said it wasn't fun but there wasn't any real pain. Bev > Our Dr. told us he does not use anesthetic to do biopsy at the office. > He said most men tolerate it just fine and the actual time for the [quoted text clipped - 18 lines] > > > A biopsy > > > is scheduled for next week, 8/24. There is much interest in coming up with a better test than PSA. PSA is lousy because it is elevated in so many non-cancer situations.. but ultimately, even if a "better" urine or blood test was discovered, it would still probably require a biopsy. We're a long way from any kind of blood or urine test that will say "you have cancer". We are just trying to improve the accuracy (specificity & sensitivity) of screening tests to try and minimize the unneeded biopsies. As to biopsy technique, the use of anesthetic peri-prostatic block is somewhat new. In general, some older docs may not know the technique or feel it is necessary. I disagree. My biopsy patients get a pre-biopsy mild oral sedative, lidocaine lubricating jelly for the ultrasound, and directed lidocaine peri-prostatic injection (like the dentist). I probably can't make the biopsy a "picnic", but in general, my patients seem pretty comfortable. === http://www.DrYew.com http://www.SanDiegoRoboticProstatectomy.com > > When Paul found out that uro #1 didn't > > use anesthetic during the biopsy he cancelled the appointment. [quoted text clipped - 11 lines] > > A biopsy > > is scheduled for next week, 8/24. > My biopsy patients get a pre-biopsy mild oral sedative, > lidocaine lubricating jelly for the ultrasound, and directed > lidocaine peri-prostatic injection (like the dentist). Wish I had known you when I had mine by the old fart on Center Drive in La Mesa. And a second one by the fellow who retired last December. Dr. Yew: As I mentioned in an earlier post, http://tinyurl.com/h64h7 my husband recently took Bostwick Lab's PCA3 test. The result was 27.2. The report says anything over 10 is considered "positive". Bostwicks' own statistics http://www.bostwicklaboratories.com/about/PCA3.pdf (second page) show a specificity of 39.6 and a positive predictive value of 56.7. I interpret these numbers to mean that there are a relatively high number of false positives. Specifically, out of 100 patients who received a positive result, 56.7 were true positives and 43.3 were false positives. Am I interpreting these numbers correctly? If so, would you care to comment on the usefulness of this test? Thank you, in advance. _________________________________________________________________ > There is much interest in coming up with a better test than PSA. > PSA is lousy because it is elevated in so many non-cancer situations.. [quoted text clipped - 37 lines] > > > A biopsy > > > is scheduled for next week, 8/24. Dr. Yew: As I mentioned in an earlier post, http://tinyurl.com/h64h7 my husband recently took Bostwick Lab's PCA3 test. The result was 27.2. The report says anything over 10 is considered "positive". Bostwicks' own statistics http://www.bostwicklaboratories.com/about/PCA3.pdf (second page) show a specificity of 39.6 and a positive predictive value of 56.7. I interpret these numbers to mean that there are a relatively high number of false positives. Specifically, out of 100 patients who received a positive result, 56.7 were true positives and 43.3 were false positives. Am I interpreting these numbers correctly? If so, would you care to comment on the usefulness of this test? Thank you, in advance. _________________________________________________________________ > There is much interest in coming up with a better test than PSA. > PSA is lousy because it is elevated in so many non-cancer situations.. [quoted text clipped - 37 lines] > > > A biopsy > > > is scheduled for next week, 8/24. Dr. Yew: As I mentioned in an earlier post, http://tinyurl.com/h64h7 my husband recently took Bostwick Lab's PCA3 test. The result was 27.2. The report says anything over 10 is considered "positive". Bostwicks' own statistics http://www.bostwicklaboratories.com/about/PCA3.pdf (second page) show a specificity of 39.6 and a positive predictive value of 56.7. I interpret these numbers to mean that there are a relatively high number of false positives. Specifically, out of 100 patients who received a positive result, 56.7 were true positives and 43.3 were false positives. Am I interpreting these numbers correctly? If so, would you care to comment on the usefulness of this test? Thank you, in advance. _________________________________________________________________ > There is much interest in coming up with a better test than PSA. > PSA is lousy because it is elevated in so many non-cancer situations.. [quoted text clipped - 37 lines] > > > A biopsy > > > is scheduled for next week, 8/24. Dr. Yew: As I mentioned in an earlier post, http://tinyurl.com/h64h7 (I hope this comes out right) my husband recently took Bostwick Lab's PCA3 test. The result was 27.2. The report says anything over 10 is considered "positive". Bostwicks' own statistics: http://www.bostwicklaboratories.com/about/PCA3.pdf (second page) show a specificity of 39.6 and a positive predictive value of 56.7. I interpret these numbers to mean that there are a relatively high number of false positives. Specifically, out of 100 patients who received a positive result, 56.7 were true positives and 43.3 were false positives. Am I interpreting these numbers correctly? If so, would you care to comment on the usefulness of this test? Thank you, in advance. ________________________________________________________ > There is much interest in coming up with a better test than PSA. > PSA is lousy because it is elevated in so many non-cancer situations.. [quoted text clipped - 37 lines] > > > A biopsy > > > is scheduled for next week, 8/24. Hello RocSam It is most important to feel good about a Dr. In one way it is easier to diagnose, and have a comfort zone with the one diagnosing.. Good wishes for your husband, and remember early diagnosis, is better than late.... The Biopsy will help you and your husband and the Dr. with evidence as how to proceed. I had Dr. early in my diagnosis that scared the heck out of me!. I decided to find a "Prostate Cancer Specialist" They are out there, and are better at Prostate Cancer ahan a Uro... Anyway, I went from hot to cold....Was going to get radiation, and had RP....That was 1999, I was 49. Now it is 2006, I am glad I made that change of treatments.... I am fine, need a PSA for #7 years.......Hoping for -00.1 John Loomis > We finally got in to see the new uro today. I really like the guy and > Paul liked him more importantly. He is doing the biopsy on Sept. 7th. [quoted text clipped - 8 lines] > I thought I would update you all. Thanks to you all that have responded > to my previous post. I will keep you updated. Thanks John...I will see if I can find a "Prostate Cancer Specialist" I am wishing you good luck with your # 7 psa. It has been a comfort to hear your stories of how you came out of this okay...It has given me hope. In the beginning of this journey I was freaking out. I am still scared but taking one day at a time. > Hello RocSam > It is most important to feel good about a Dr. [quoted text clipped - 24 lines] > > I thought I would update you all. Thanks to you all that have responded > > to my previous post. I will keep you updated. BTDT, I think the waiting and trying to get through these early stages is the hardest part of it. I think not knowing but suspecting was the worst. We both tried to keep things normal and act normal but when my husband would give me a kiss on his way to work I'd just break down and start crying. It was so hard! When my husband was given the official word that it was indeed cancer we already had some idea of the route he wanted to take for treatment. Then it was wait for the appointment, and then wait for the treatment to start. Too many waits for me. Since my husband had brachytherapy it was then a long wait to see how far the PSA would fall. It was 4 years this past May and his PSA was once again 0.01 I can't say we will ever completely put it behind us. Maybe in another ten years I'll feel differently about it but right now it is still very much in my mind. Although my husband has taken the attitude that it was just a speed bump in life that he needed to overcome and now, he doesn't give it too much thought. Just remember that this is a very treatable cancer. Take the time to enjoy one another while you can. Biopsies will produce bloody ejaculate - from pale pink to OMG it's ketchup, and that is normal. You can't cross bridges until he has the biopsy but you can learn as much as possible in the meantime. And maybe your husband will be one of the lucky ones and it will not be cancer. Bev > Thanks John...I will see if I can find a "Prostate Cancer Specialist" I > am wishing you good luck with your # 7 psa. It has been a comfort to > hear your stories of how you came out of this okay...It has given me > hope. In the beginning of this journey I was freaking out. I am still > scared but taking one day at a time. Thanks Bev, my husband's job is so busy right now that I think this helps keep it off his mind. I am working very hard not to let myself worry too much. I am doing quite well so far....I have amazed myself. At times I wonder if I am in denial or I am really doing good...thanks for all your words...today is a good day! > BTDT, I think the waiting and trying to get through these early stages is > the hardest part of it. I think not knowing but suspecting was the worst. We [quoted text clipped - 28 lines] > > hope. In the beginning of this journey I was freaking out. I am still > > scared but taking one day at a time. |
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