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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2007Seeking opinions/advise
I realise that this is a newsgroup is for about prostate cancer, but hopefully you would not mind if I seek your opinions/advise. I am 65 years old and my PSA reedings over the years are as follow: 2004-2.6 2005-3.6 2006-3.4 March 2007-6.3 July 2007-6.7 My general practitioner doctor has sent me to an Urologist. (Yet to make an appointment) What must I prepare myself for and what is the usual procedure? Are there any pitfalls in getting the right urologist? What question should I ask and what test/procedures should I expect/ask for? Apologies if my questions sound naïve. John (snip) > My general practitioner doctor has sent me to an Urologist. (Yet to make an > appointment) > > What must I prepare myself for and what is the usual procedure? The uro will probably do a DRE (digital rectal examination) and request another PSA blood draw. Caution: Make sure that the blood is drawn *before* the DRE, as the latter will stress the gland and could cause an abnormally high blood test result. Also do not undertake any other activity within 48 hours that could stress the gland. This includes ejaculation, even riding a bike. > Are there any pitfalls in getting the right urologist? Well, as usual, we all want the best-qualified and most experienced medic. It might be possible to check something of his record via the 'net, especially the local medical licensing authority. > What question should I ask and what test/procedures should I expect/ask for? See above. He might, depending upon the DRE and PSA results, want to do a biopsy. Or he might want to try a course of antibiotics in case there is an infection or other irritation. I recommend: (1) Insist upon anesthetic for a biopsy. Some say it is not painful, others say it's agonizing. Why take a chance? This is no time to be macho. (2) Get a copy of the pathology report! As well as all other documents. (3) If the diagnosis is prostate cancer (PCa), require that the specimens be sent to a specialist lab for a second opinion. This is undoubtedly covered by insurance and is only about $350 anyhow. Cheap insurance, as everything that is done depends upon the accuracy of the Gleason score, which is the measure of the aggressiveness of the cancer. Here is a list of such labs: Bostwick Laboratories [800] 214-6628 Dianon Laboratories [800] 328-2666 (select 5 for client services) Jon Epstein (Hopkins) [410] 955-5043 or [410] 955-2162 David Grignon (Michigan) [313] 745-2520 Jon Oppenheimer (Tennessee) [888] 868-7522 UroCor, Inc. [800] 411-1839 (4) Objective and reliable information is available on the website of the Prostate Cancer Research Institute (PCRI) at: http://prostate-cancer.org/index.html ....start at "Undiagnosed." > Apologies if my questions sound naÔve. No apology necessary. Everyone here began knowing nothing. Regards, Steve J "What are the facts? Again and again and again -- what are the facts? Shun wishful thinking, ignore divine revelation, forget 'what the stars foretell,' avoid opinion, care not what the neighbors think, never mind the unguessable 'verdict of history' -- what are the facts, and to how many decimal places? You pilot always into an unknown future; facts are your single clue. Get the facts!" --Lazarus Long > (snip) > [quoted text clipped - 68 lines] > your single clue. Get the facts!" > --Lazarus Long as to the anesthetic for the biopsy: absolutely insist on it. They used to take 6 needle biopsys now it 12 or more. My urologist said no one should have to tolerate this amount of discomfort. ever notice that doctors always refer to your pain as discomfort? I was totally unconscious during the procedure. Seeing the results, blood in urine and semen, is bad enough. j. >as to the anesthetic for the biopsy: > [quoted text clipped - 11 lines] > >j. I would insist on anesthetic beyond the internal injection of the numbing agent. Ask for Vicodin or Percocet to take an hour before the biopsy. I took a Xanax prior, which helped with the anxiety. But despite the lidocaine, I still wished I had taken a Vicodin instead of the Xanax. > I realise that this is a newsgroup is for about prostate cancer, but > hopefully you would not mind if I seek your opinions/advise. [quoted text clipped - 23 lines] > > John Steve has pretty much covered it. Don't put off making an appointment with a urologist too long. Prostate cancer tends to grow slowly, even in aggressive cases, so you don't have to worry about a few weeks or more, but don't let it go for months. As Steve indicated, given your PSA history, it is possible you are just suffering some prostatitis, but prostate cancer is also a possibility. Make sure your urologist is board certified and trained at a reasonable facility. If it turns out you do have prostate cancer and you decide to have surgery, you will want a urologist who is skilled in the procedure and has done it many times, so you may need to find someone else. But the basic diagnosis is pretty straight forward and doesn't usually require special skills. I agree that some degree of anesthesia would be very helpful. My urologist used a local on my rectal wall before retrieving 12 samples. The whole thing was about as unpleasant as a typical dental procedure. Don't be frightened by the prospect of having prostate cancer. It is a serious disease, but in the great majority of cases like yours, it can be treated successfully. Side effects of treatment can't be ignored, but for most men, there are ways to deal with them. > I realise that this is a newsgroup is for about prostate cancer, but > hopefully you would not mind if I seek your opinions/advise. [quoted text clipped - 19 lines] > > What question should I ask and what test/procedures should I expect/ask for? John, no apologies needed. I was diagnosed last year and have RT treatement earlier this year. If I were in your shoes (before treatment or diagnosis) I'd probably try to contact two or more reserach studies that are looking for prostate cancer markers. Currently I know of two studies being done that claimed to have 90% certainty of determining prostate cancer. If I hadn't had my treatment, thats what what I would have done, just to make sure that I do have cancer before committing to a prostate surgery/radiation. Find out who is doing EPCA-2 (early prostate cancer antigen) and HCA (human carcinoma antigen) research and contact them. Wouldn't be ironic of you went through surgery or radiation because of high PSA and erroneous Gleason but turned out that you don't have cancer? My uro told me most men barely notice the biopsy sampling process with nothing more than the topical gel he swabs on the rectal wall. One such patient rode a bicycle to the procedure, and -- much more gingerly -- rode it home. Colons have no nerves to perceive cuts or punctures; I wouldn't have noticed my 12 "shots -- core samples -- if the uro hadn't said before each one, "And here's the next one", at which point I felt a weird instantaneous twinge I otherwise would probably not have distinguished from the rest of his probing. A routine dental cleaning hurts me more. I bopped into his office, got poked 12 times, and bopped home ... as he said most patients do. I was little tender that evening -- not worth a Tylenol -- and had dark semen for a week or three. Anesthesia, OTOH, has all sorts of hassles you may wish to avoid. You cannot legally drive the rest of the day, and complex mental function is impaired for a day or three and in rare cases weeks. Anesthesia for routine dental work is banned in the UK for those reasons. If they concern you, Google it. I.P. I.P. is correct with regard to anesthesia. My mother had a routine breast biopsy under total anesthesia and it took her six weeks to get back to normal. She was plagued by indecision and bad decisions and a general aura of "not herself." I had 12 biopsy cores taken under local anesthetic, two novacaine-type shots to the prostate, and felt no pain. Similar to a dental procedure as others have indicated. I was so scared going in, I could hardly walk but it turned out to be nothing. Kind of a dull ache that night, rootbeer colored semen for a few weeks, no blood in urine. Dave Perry On Jul 31, 11:57 am, "I.P. Freely" <fuhgheddabou...@noway.nohow> wrote: > My uro told me most men barely notice the biopsy sampling process with > nothing more than the topical gel he swabs on the rectal wall. One such [quoted text clipped - 15 lines] > > I.P. On July 31, Dave wrote, in pertinent part: > I had 12 biopsy cores taken under > local anesthetic, two novacaine-type shots to the prostate, and felt > no pain. Similar to a dental procedure as others have indicated. I > was so scared going in, I could hardly walk but it turned out to be > nothing. Kind of a dull ache that night, rootbeer colored semen for a > few weeks, no blood in urine. Novocaine is an anesthetic, and that's the sort of anesthetic to which I referred. Totally putting the patient under would of course be rather gilding the lily. It didn't occur to me that anyone would have the latter in mind for this procedure. It's also the type of anesthetic that I had, including for the second one, a trans-urethral. Yow. Regards, Steve J I personally would not _insist_ on getting an anaesthetic. I had a 12 needle biopsy without it. It was unpleasant, but nowhere near unbearable. I guess a lot depends on you as to whether this is important to you or not. Here are some other things I recommend: 1. If the uro wants you to take a course of antibiotics to find out if your elevated PSA is caused by an infection, ask him if he can do a urine culture instead. It's not invasive and will have no side effects, as antibiotics can. He may say that won't tell anything. If he does, I defer to his judgment - he's a doctor and I'm not. 2. If the uro recommends a biopsy, ask him how he does the imaging, how many samples he will take, and how often he does that procedure. Report back to this group about it. There are people here who can say whether the guy is proposing old or new techniques. I mention this because a "urologist" isn't necessarily a guy with lots of experience in prostate issues. He'll have much more experience than the general practitioner, but the urologist my HMO sent me to turned out to specialize in female incontinence. 3. Notice how he does his digital rectal exam. If he's in and out in 3 seconds, I wouldn't consider him a good doctor. My female incontinence specialist did that and said he didn't feel anything. But other doctors I went to took their time and did feel it. Best of luck. Alan Isn't the ultimate intent of these markers to be better detectors of PCa than the PSA test? If so, their only value is in avoiding a biopsy. Beyond that, I doubt they're better than a biopsy with a resulting Gleason score in finding cancer. I've never heard of a Gleason that was so erroneous that it indicated cancer when there was none. Maybe a Gleason 6 should have been a 7 but there's never been a Gleason 6 that really is a zero. John may indeed want to give these tests a try but with his PSA's and PSA velocity, he's destined for a biopsy. Dave Perry > > I realise that this is a newsgroup is for about prostate cancer, but > > hopefully you would not mind if I seek your opinions/advise. [quoted text clipped - 34 lines] > > - Show quoted text - You already received a lot of great information here, John. Such is the norm here. I merely wanted to confirm that you may have a prostate problem and that chances are very good that it is not cancer. Also, you are more than welcome to ask questions regarding things leading up to prostate cancer diagnoses. Hell, we have all been there. >I realise that this is a newsgroup is for about prostate cancer, but >hopefully you would not mind if I seek your opinions/advise. [quoted text clipped - 24 lines] > > John Thank you all for your valued info and advice. Especially Steve Jordan. I feel now much better equipped making an appointment with the Uro. I am in Australia and could not find any info on the Uro my GP referred me too. But on my search, I came across one that specialises in Cancer of the Prostate. Acclaims and qualifications an arm long and one of the first to use Robotic Radical Prostatectomy. So I will see if I can make an appointment. In regards to the biopsy.the difference in one person's pain and another's indifference is astounding. Steve mentioned Novocaine. Is Novocaine a local numbing agent injected into the prostate before the samples are taken? Or is it administered orally? Again gentlemen, thank you for your help in providing the info and taking the time to post. Regards, John > ... I am in Australia ... Hello, John: What part of Australia do you hail from? --charlie > > ... I am in Australia ... > [quoted text clipped - 3 lines] > > --charlie The reason I ask is that we might be able to point you to some nearby resources. For example, if you live in the general Brisbane area, you could check out the Queensland Chapter of the the Prostate Cancer Foundation of Australia. Their website is: http://www.qldcancer.com.au/Prostate/NL_Aug04/Organisations.html They have a tab under Featured Resources that discusses BPH. They also have some links to support groups, some of which might be convenient for you. Andrology Australia, at http://www.andrologyaustralia.org/, also appears to have a lot of information on men's health issues -- I think they're a national organization. Your tax dollars at work. --charlie Thank you Charlie, I will have a look at the website. Regards John ------------------------------------------------------ >> > ... I am in Australia ... >> [quoted text clipped - 20 lines] > > --charlie > Thank you Charlie, I will have a look at the website. > [quoted text clipped - 26 lines] > > - Tekst uit oorspronkelijk bericht weergeven - Here is really interesting and latest findings regarding alternatives for treating prostate cancer : http://www.urosource.com/diseases/prostate-cancer/ Novocaine is administered with a hypodermic needle directly into the prostate. It feels exactly like the needle you get prior to dental work. Unpleasant but not really painful. I had two injections prior to my biopsy with no pain or discomfort during the procedure. Dave Perry > Thank you all for your valued info and advice. Especially Steve Jordan. > I feel now much better equipped making an appointment with the Uro. [quoted text clipped - 14 lines] > > John >Novocaine is administered with a hypodermic needle directly into the >prostate. It feels exactly like the needle you get prior to dental >work. Unpleasant but not really painful. I had two injections prior >to my biopsy with no pain or discomfort during the procedure. >Dave Perry Actually it is injected into the hyperechoic notch between the prostate and seminal vesicle bilaterally, or in other tissues surrounding the prostate (periprostatic). > Actually it is injected into the hyperechoic notch > between the prostate and seminal vesicle > bilaterally, or in other tissues surrounding the prostate > (periprostatic). Of course, that's what I meant to say. :>) Dave Perry >> Actually it is injected into the hyperechoic notch >> between the prostate and seminal vesicle [quoted text clipped - 3 lines] > Of course, that's what I meant to say. :>) > Dave Perry That's what we all thought: the crotchal area. I.P. > In regards to the biopsy.the difference in one person's pain and another's > indifference is astounding. The issue isn't indifference. The issue is that the vast majority of prostate biopsies are not painful ... barely uncomfortable according to what I've read, heard, and experienced ... and that general anesthesia, as several have recommended here in previous threads, has numerous threats of small likelihood but sometimes huge impact. Personally, I'm not taking a 0.1% (?) chance (I don't know the odds, but Google does) of lasting mental impairment, or even the 100% chance of one day of legal and practical impairment to avoid something less painful than a tooth cleaning. I think Steve's advice, now that we're clear on it, of a local injection of Novocaine isn't out of line and offers much less risk than the general anesthesia idea. I.P. >> In regards to the biopsy.the difference in one person's pain and >> another's indifference is astounding. > > ...or even the 100% chance of one day of legal > and practical impairment to avoid something less painful than a tooth > cleaning. Yeah, but what about something 'way worse than that? For me, biopsy was far worse than brachytherapy -- severe pain for about 8 hours after the biopsy ended. The stabs were trivial, but each produced an ache and the aches more than doubled after the sixth sample. You can bet I'll insist on local anaesthesia next time. (By contrast, the brachy -- done with a spinal -- was almost painless both during and after the procedure.) The point here is that people differ, and "less painful than a tooth cleaning" is by no means a safe generalization. > I think Steve's advice, now that we're clear on it, of a local injection > of Novocaine isn't out of line and offers much less risk than the > general anesthesia idea. Before I'd read the whole thread I was planning to reply suggesting that a newbie might need to be told that local, not general, anaesthesia is what's being recommended.  SignatureGreg Louis At age 58, PSA 5.4 rising triggered biopsy 2004-06-22, Gleason 3+3, T1c, prostate volume 27 cc. Monotherapy, 55 I-125 seeds implanted 2004-11-16. Nadir 0.59 (8 mo); then 0.62, 0.85, 0.75, 1.7, 3.29, 1.29 (whew!) 28.5 mo > The > point here is that people differ, and "less painful than a tooth > cleaning" is by no means a safe generalization. My initial uro explicitly disagrees with you. Others' painful experiences, however, prompted me to explicitly avoid that generalization by beginning my sentence with the word, "Personally". Sorry if that wasn't clear. > Before I'd read the whole thread I was planning to reply suggesting that > a newbie might need to be told that local, not general, anaesthesia is > what's being recommended. From Steve, correct. But in every such thread a general is at least sugested, as done so in this thread by Cognite Tute ("I was unconscious ..."), and often recommended, with no discussion of its risks, as though it is benign. I.P. > I realise that this is a newsgroup is for about prostate cancer, but > hopefully you would not mind if I seek your opinions/advise. [quoted text clipped - 23 lines] > > John You could also read more info from the website: http://www.urosource.com/diseases/prostate-cancer/ Connor, Maybe you should try this: www.treat-cancer.nl > I realise that this is a newsgroup is for about prostate cancer, but > hopefully you would not mind if I seek your opinions/advise. [quoted text clipped - 23 lines] > > John |
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