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1st Biopsy negative - Doc says no to 2nd?

tonic683
Posts: 12
Joined: Jun 2012

Here is a quick summary. January 2011 Husbands' PSA was 1.1; March 2012 up to 5.3. 2nd bloodwork done in April - 4.7 psa with a free psa of 2%. Had a DRE which indicate possible enlargement. Doc said need biopsy to determine what was going on. Husband has been having lower back pain, groin pain, leg pain.

Doctor took 10 cores and also diagnosed him with urethral stricture. (Noticed during biopsy his bladder was full, surgery is scheduled)

Biopsy report comes in - NO CANCER. Prostate is 21gm in size. I believe this is normal. I asked Dr. what may be cause of rise in PSA - his response was not sure could be BPN.
Do what?? The results showed normal size of prostate.

I inquired about a 2nd biopsy and he said, and i quote "I don't think anyone would recommend a repeat biopsy at this point. I am comfortable with the recommendation of a repeat PSA in 6 months".

Everything I have read says there is a high probability that the first biopsy will come back negative.

Am I stupid or has this doc lost his mind???? Can someone please weigh in?

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Tonic,

Your doctor may not have expressed everything he is taking into account by prescribing this course of action. Many medical bodies recommend that with a free PSA is present and the biopsy is negative that a second biopsy is in order. Since your husband only had 10 cores done (vice the more usual 12 samples) this even seems like more of a prudent course of action. However, your husband's PSA score did decline over a month and BPH is less likely an issue given the relatively small size of his prostate. The possible mitigating factor is that your husband's urethral stricture can be causing prostatitis which is known to reduce the free PSA score.

Why not just get a second opinion?

Best,

K

http://suite101.com/article/free-psa-test-a91713

tonic683
Posts: 12
Joined: Jun 2012

He has surgery this week. I will wait and see how he does. The urethra has always been an issue for him and his law has always been low. if doctor thought it was prostatitis wouldn't he have prescribed an antibiotic?

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Tonic,

There are different types of prostatitis and some are caused by bacteria which are treated with antibiotics such as cipro. Other types of prostatitis are not caused by bacteria. Most prostatitis is NOT caused by bacteria.

There is a condition which is quite common that is known as chronic abacterial prostatitis or chronic pelvic pain syndrome. It lasts for at least three months. Most cases of prostatitis fall into this category. For some men, symptoms remain about the same over time. For others, the symptoms go through cycles of being more and less severe. Symptoms sometimes improve over time without treatment.

Hope this helps.

K

hopeful and opt...
Posts: 1293
Joined: Apr 2009

If I am not mistaken, Cipro is an antibiotic, so your husband had an antibiotic at the time of his biopsy.

laserlight's picture
laserlight
Posts: 165
Joined: May 2012

There is always a second opinion. It might be worth seeing another doctor and see what they say. It is good to hear that for the time being there was no cancer found. There are other medical conditions that will cause a rise in psa levels. Maybe another doctor can find out what is going on. I donot think that the doctor has lost his mind. He might not be skilled enough to look into this deeper. I would try to locate a urologist that has a high standing. You are not stupid, just take a second and look for a second opinion. Another psa test is good way to go. Hope this helps.

hopeful and opt...
Posts: 1293
Joined: Apr 2009

PCA3 test
This test is a new investigational ( only an indicator) urine gene test that is available. The test is a molecular biologic assay. This test has a specificity of 75% and a sensitivity of 57%. (What that means is that among 100 bad tumors, for example, they only can identify 75 of them. And among 100 good tumors, they identify them as bad in 57). The test is done by a doctor who does a DRE and vigorously massages(the fun part...my doc is very experienced, has muscles on his finger, and can make a grown man cry) the prostate; the patient gives urine and the results are sent to Bostwick Laboratories(the only laboratory that does this) for analysis. It is a pretty expensive test, at I think about $500 however the test is medically approved soI beleive that it is covered by medical insurance

So the way the results work, 35 is the magic number, so the less one score is below 35 the better. Mine was 8.3 "Prostatic cells are present but do not over express the PCA3 gene", "value of 35 or greater suggests a high likelihood of prostate cancer", and if that occurs a second biopsy is warranted.

It is also stated that only a prostate biopsy can diagnose prostate cancer. The test's preformance has been established by Bostwick Laboratories

.....................................

You did not mention your husbands age........PSA is related to some degree....also, sometimes the psa rises due to other conditions such as sex, exercise especially bike riding , hard stool, etc...also I have been told that sometimes the psa rises erradically to various levels which is normal.

tonic683
Posts: 12
Joined: Jun 2012

He is 51. .

hunter49
Posts: 200
Joined: Oct 2011

wow same story as someone I work with. # months after surgery PSA returned to uner 1. However, I am always of the opinion of getting second opinions. If his PSA does not drop I would request a saturation biopsy ( that is one with about 25-30 cores) and I would possibly look to getting another doctor. Good luck

hopeful and opt...
Posts: 1293
Joined: Apr 2009

Just a thought

Can it be that your husband has a spine issue? In these cases there is referred leg pain, additionally , I believe that I've read, that in advanced cases there is groin pain

tonic683
Posts: 12
Joined: Jun 2012

I am hoping that his surgery will correct a lot of issues. I won't wait until December though to get PSA checked again. If it is still elevated, I will get a second opinion and a new doctor.

Thank you everyone for your wonderful insight.

Swingshiftworker
Posts: 626
Joined: Mar 2010

Exactly what kind of surgery is your husband having done tomorrow and what issues is it supposed to address?

tonic683
Posts: 12
Joined: Jun 2012

He has urethra structure and Will have catheter inserted foe seven days to open him up.

VascodaGama's picture
VascodaGama
Posts: 1533
Joined: Nov 2010

Tonic

I hope that your husband gets a relief from the stricture. The above survivors have given you excellent opinions and advices. In fact, the negative biopsy, spike PSA histology and a case of urethra stricture, tends to indicate that the problem is a benign issue. Waiting for the next PSA (3-month after catheter removal) is the rightful way to follow at the present, before committing to a second biopsy.
Many get into panic when confronted with similar situation; however, not all cases are related to cancer. Risk cases at 51 are often related to hereditary issues (close family member with PCa) or to constant increases (behaviour) in PSA results. Saw-like curves in PSA are usually related to BPH.

Here is a link to Johns Hopkins site in regards to BPH with information on symptoms.
http://urology.jhu.edu/prostate/BPH_diagnosis.php

Prostatitis may be the cause of the pain in to lower back too. Periodical testing is the only way to follow the case. I believe that his doctor have done already a urinalysis (with added urine culture) to determine the type of bacteria, if any. Hopefully his doctor registers digitally the cystoscopy (bladder and urethra) at the time of operation so that you can get a second opinion from other specialist if the problem does not subside.

You could inquire in having a lower abdominal CT or MRI after treatment so that your husband would have more precise diagnosis now and the results will serve as a basic image study for future references (comparative results) if worried about cancer.

Wishing you peace of mind.

VGama

Swingshiftworker
Posts: 626
Joined: Mar 2010

What caused the stricture?

Prior radiation treatment for PCa -- low dose rate brachytherapy (LDR BT) in particular -- is often associated w/urethra stricture -- but is also associated w/prior injury, surgery or disease.

Hope the procedure to clear the blockage goes well.

Good luck!

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