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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2005nodule on prostate: first visit to urologist
[Sorry for cross-posting, but I just realized this was probably the right place for this message] My husband is 57, white, good health, history of prostate cancer in his mother's brother; father died at age of 63 of other causes. Last week, during my husband's annual physical, his internist said he detected a pea-sized nodule on his prostate. He also took a PSA test, but I am pretty sure that it was after the DRE, and I've learned that might not have been optimal. We don't have the results of that back yet. We have an appointment with a urologist on Friday. I realize that we are very early in this process, but I want to make sure I ask the right questions when we meet with the urologist. Other things I know. My husband has had symptoms from an enlarged prostate for serveral years but no elevated PSA (it's checked annually). (Also, last year, during a routine colonoscopy, the doctor said he felt an enlargement; the internist confirmed this with my husband, but there wasn't any follow-up). Over Christmas, my husband had some kind of infection. He ran a high fever. I thought it was the flu, but he's since told me that he also has painful urination. He was given an antibiotic which didn't do anything for the flu symptons. He had fever again yesterday. (I realize none of this may not be connected.) When the internist did the DRE, my husband said it didn't feel "right," that it felt more crowded than it had before. I'm assuming the urologist will schedule a sonogram and biopsy. My question is what should we ask the urologist at this visit, especially in preparation for a biopsy? As you may guess, I am the one who needs and seeks out as much information as possible. My husband is more of the "let's just wait and see what he says." thanks very much in advance for any help you can offer. Charlotte > [Sorry for cross-posting, but I just realized this was probably the > right place for this message] I only saw this in sci.med.prostate.cancer. You should probably be directing future queries to alt.support.cancer.prostate. > My husband is 57, white, good health, history of prostate cancer in his > mother's brother; father died at age of 63 of other causes. Let me first say that the people you encounter here are not generally physicians, and even if any were, they couldn't ethically give you medical advice over the internet. You really need to listen to your doctors first. Having said that, I'm willing to say what I can say, but keep in mind that I am not a physician. > Last week, during my husband's annual physical, his internist said he > detected a pea-sized nodule on his prostate. He also took a PSA test, > but I am pretty sure that it was after the DRE, and I've learned that > might not have been optimal. That is correct. Sometimes a DRE can raise PSA levels, as can sexual activity. > We don't have the results of that back > yet. We have an appointment with a urologist on Friday. I realize [quoted text clipped - 6 lines] > said he felt an enlargement; the internist confirmed this with my > husband, but there wasn't any follow-up). I believe that enlargement is not unusual as men age. If the PSAs were "normal", then there wouldn't ordinarily be any further followup. But they do take seriously uneveness or other unusual findings on DRE. > Over Christmas, my husband had some kind of infection. He ran a high > fever. I thought it was the flu, but he's since told me that he also > has painful urination. He was given an antibiotic which didn't do > anything for the flu symptons. He had fever again yesterday. (I > realize none of this may not be connected.) He could easily have had prostatitis, and it could have caused the "nodule". > When the internist did the DRE, my husband said it didn't feel "right," > that it felt more crowded than it had before. > > I'm assuming the urologist will schedule a sonogram and biopsy. My > question is what should we ask the urologist at this visit, especially > in preparation for a biopsy? First of all, keep in mind that your husband probably doesn't have prostate cancer. Even if he does, he is in no immediate danger from it. And in the large majority of cases starting off this way, it can be cured without really life altering side effects. There are lots of misconceptions about treatments for prostate cancer. One is that incontinence and impotence are inevitable. Serious incontinence is quite rare. Impotence is more common, but it can be treated and doesn't mean the end of a normal sex life. As to the biopsy, it is a fairly simple procedure, quite safe and not specially painful. The main possible complication is infection, but they usually give the patient an antibiotic and that prevents it. There is usually blood in the semen for several weeks afterwards, but it is of no consequence. One thing you might ask the urologist is what he considers "normal" PSA values. There have been some recent evaluations of that. > As you may guess, I am the one who needs and seeks out as much > information as possible. My husband is more of the "let's just wait > and see what he says." A good attitude. I can see why you are worried, but as I said above, he most likely doesn't have prostate cancer, and even if he does, it is very likely that it can be dealt with. > thanks very much in advance for any help you can offer. > > Charlotte first try ALFUZOSIN Charlotte wrote...snip... > My question is what should we ask the urologist at this visit, > especially in preparation for a biopsy? Hi Charlotte...The following questions come to mind: * How many samples will the urologist collect? Since the biopsy is looking for the proverbial needle in the haystack, at least 12 samples is usually advised. * Will the uro provide an antibiotic for both before and after biopsy? * Will the uro label each specimen so that if the biopsy is positive, the location(s) of the tumor can be ascertained? * Will the uro provide some sort of pain relief? It is quite common (and preferred) to begin by applying a topical anesthetic, followed by an injection of a local anesthetic to eliminate or dull the pain. * What's the uro's experience in terms of bleeding post-biopsy, where, how much, for how long? * What kind of ultrasound imaging does the uro use? B&W is pretty much the norm, but color and particularly color doppler imaging is more detailed and informative and is beginning to be used more commonly than before. * Do you want the uro to do another DRE before the biopsy? They're much more skilled at this than a GP. ...Best wishes and good health, Ron <snip> >As you may guess, I am the one who needs and seeks out as much >information as possible. My husband is more of the "let's just wait >and see what he says." <snip> I am NOT a Doctor and relating below what's happened to me so far plus what I've learned on various informative websites. Any information below may not be applicable to his unique case, but only a guide. An enlarged prostate can indicate BPH (Benign Prostate Hyperplasia), sometimes causing stricture in the Urethra and retention of Urine. This can be confirmed by a simple External Ultrasound examination. Some doctors will do a TURP to ream this out. (I had one over 12 yrs ago). It could also be Prostatitis, which can be treated by drugs and other means.. However if you suspect there is something else going on, he should have a few PSA tests over a few wks, and then, if warranted a DRE by a Urologist. If he feels palpable lump/s on the lobes, he will get him to have a TRUS Biopsy of 10-12 needles. From that report (if they get it right first up) he will have the sample cores Gleason Staged to determine the extent of any malignancy. He then should undergo further Blood Tests, X-Rays, CT Scan and Full Body Bone Scan. From there, dependent on Age, Pre-existing Medical Conditions and whether there is evidence that the Tumour is contained or has spread,some Treatment Options will be put on the table for both of you to consider. NB: Everything I've written above is, at best, derived from a chain of "Fuzzy Data", which is all anyone has to work with. I suggest you visit as many informative websites as you can, before making any rash decisions: You may wish to start here: http://www.nlm.nih.gov/medlineplus/prostatecancer.html and then fan out. -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC
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