furious with urologist

worriedabouthubby

Hubby went for his biopsy this morning. Wouldn't let me go. Said it wouldn't be bad, nothing I could do, etc. OK. No problem.
He came home and said the urologist told him (and showed him on the ultrasound) that he had cancer. Urologist did 6 cores. He had told us Tuedsay that he would do 12+! I AM FURIOUS that he only did 6. Of course hubby took that as a good sign- must not be bad, etc. I wanted to tell him, but didn't- that it might NOT be such a good sign. Hubby said it looked to him like about 30 % of the prostrate was affected and that it couldn't have spread because it didn't look 'spider-like'. I told him that didn't indicate anything. Prostrate cancer can spread via blood and lymph, etc and not 'look' bad. Urologist did say that the bladder 'looked good'. Oh- and the urologists said once he got the pathology report he'd see if he needed to order bone scans, ct scans, etc. Hubby took that as good ,too, because Tuesday the urologist had said he WOULD be ordering them. I don't want to discourage hubby- and won't say anything- I want him to keep positive. But I am afraid he is being a bit too optimistic and not realistic at all. Now he's saying no need for a second opinion.... etc.
I guess it's just my thought processes. I'd rather get as much info as possible. Prepare myself for the worst- then if it's better, great. If not, I'm prepared to handle it.
Still wish they had done more than 6 cores. Just doesn't seem prudent to do so few.

hopeful and optimistic

Well it's done
Hopefully your husband misunderstood, and he did six on each side.

Time to start shopping around for specialists in your area. Don't do any tests with the urologist. Most hospitals like to do their own, and do not trust tests from the local doctors.

Your husband needs to do research and be informed so he will not continue to be a victim.

As you now realize, you need to accompany your husband.

worriedabouthubby

hopeful and optimistic said:

Well it's done
Hopefully your husband misunderstood, and he did six on each side.

Time to start shopping around for specialists in your area. Don't do any tests with the urologist. Most hospitals like to do their own, and do not trust tests from the local doctors.

Your husband needs to do research and be informed so he will not continue to be a victim.

As you now realize, you need to accompany your husband.

I tried
I tried to go. Hubby didn't want me to. When he got home I tried to explain a bit, but he says I'm being too negative. He wants to be too positive in my opinion- but I don't want to discourage him. The urologist has to order the bone scans, cts, etc- but he won't do them. They will be done at Presyberitan Hospital or one of its area offices. Dr. Watson (Urology Specialists of the Carolinas) is supposed to be one of the top in the southeast. But i'd like hubby to consider going to Cancer Treatment Center of America's new facility in Atlanta. They do an integrated approach. More my style than his-- but maybe I can talk him into it. Like someone else said- when all you have is a hammer- everything looks like a nail...

And to top it all off- our daughter-in-law had to take our son to the ER last night with his asthma. They finally admitted him about 5:30 this morning. They are having problems getting his O2 saturation up. And son-in-law lost his job (company going bankrupt)....
life goes on......

Kongo

Urologist
Worried,

Of course your husband is trying to put a positive spin on this. I'm sure he is very worried at many different levels.

First a couple of things to note. Usually the ultrasound that is done on the prostate does not provide enough clarity and resolution to make a positive cancer diagnosis. That he could see the cancer on the ultrasound is an indication that your husband has a large volume of cancer in his prostate.

The 6 verse 12 or 18 (or more) core biopsy really becomes somewhat moot if they are confident of the cancer's location. The typical 12-core biopsy only samples about 1% of the prostate volume. With such a tiny area actually sampled, the urologist targets areas that he considers likely for the presence of prostate cancer. If they can see the cancer on the ultrasound, then they don't need to take so many and will guide the biopsy needle to those areas they can see on the ultrasound. I hope this makes sense. If they didn't see any anything on the ultrasound he probably would have taken more samples. Fewer samples means fewer penetrations of the prostate.

The next step is to have the samples read by a pathologist who will make a subjective evaluation of the Gleason score. This is a subjective evaluation and depending upon the report may warrant a second opinion.

Diagnosing prostate cancer doesn't really need a second opinion. The biopsy will either show it or not. What he needs second opinions on are the treatment options the urologist recommends and perhaps getting a second opinion on the biopsy slides.

We often search for what we want to hear in innocent remarks made by our doctors. For example, saying that the bladder "looks good" only means that he didn't see anything abnormal using an ultrasonic probe. That doesn't mean much. Besides, the high PSA your husband exhibits has nothing to do with the bladder unless the cancer has spread there which seems purely speculative at this point.

Don't see anything inconsistent with the conversation about the scans. As I mentioned earlier in another post, bone scans rarely show anything unless there is a very advanced cancer that has metastasized to the bones. A CT scan may show something but there are other imaging techniques that may be more accurate. It all depends on what the Gleason Score is.

Between now and when the pathology report comes back, I suggest you research the Gleason grading system and what treatments are appropriate for the different ratings of low risk, intermediate, high risk, prostate cancer.

Best,

K

VascodaGama

Kongo said:

Urologist
Worried,

Of course your husband is trying to put a positive spin on this. I'm sure he is very worried at many different levels.

First a couple of things to note. Usually the ultrasound that is done on the prostate does not provide enough clarity and resolution to make a positive cancer diagnosis. That he could see the cancer on the ultrasound is an indication that your husband has a large volume of cancer in his prostate.

The 6 verse 12 or 18 (or more) core biopsy really becomes somewhat moot if they are confident of the cancer's location. The typical 12-core biopsy only samples about 1% of the prostate volume. With such a tiny area actually sampled, the urologist targets areas that he considers likely for the presence of prostate cancer. If they can see the cancer on the ultrasound, then they don't need to take so many and will guide the biopsy needle to those areas they can see on the ultrasound. I hope this makes sense. If they didn't see any anything on the ultrasound he probably would have taken more samples. Fewer samples means fewer penetrations of the prostate.

The next step is to have the samples read by a pathologist who will make a subjective evaluation of the Gleason score. This is a subjective evaluation and depending upon the report may warrant a second opinion.

Diagnosing prostate cancer doesn't really need a second opinion. The biopsy will either show it or not. What he needs second opinions on are the treatment options the urologist recommends and perhaps getting a second opinion on the biopsy slides.

We often search for what we want to hear in innocent remarks made by our doctors. For example, saying that the bladder "looks good" only means that he didn't see anything abnormal using an ultrasonic probe. That doesn't mean much. Besides, the high PSA your husband exhibits has nothing to do with the bladder unless the cancer has spread there which seems purely speculative at this point.

Don't see anything inconsistent with the conversation about the scans. As I mentioned earlier in another post, bone scans rarely show anything unless there is a very advanced cancer that has metastasized to the bones. A CT scan may show something but there are other imaging techniques that may be more accurate. It all depends on what the Gleason Score is.

Between now and when the pathology report comes back, I suggest you research the Gleason grading system and what treatments are appropriate for the different ratings of low risk, intermediate, high risk, prostate cancer.

Best,

K

Difficult times
I am sorry for the positive diagnoses. As Kongo comments the ultrasound is not accurate to identify cancer but it can differentiate spots and other info that could rule the presence of cancer. Probably he saw a normal size gland ruling out BPH. In such setting the PSA may be due only to cancer.
Most probably the biopsy was directed to the spots revealed by the ultrasound. 6 needles would be enough to diagnose the cancer and verify for extra capsular extensions. The CT will look for any spread at the bones.

Hopefully we are all wrong and the pathologist finds no cancer.
In any case your presence will be important when your husband visits the doctor again to receive the path report. It will be helpful to bring along a list of questions.
You could do some researches in advance on treatments, their risks and side effects so that you will understand better the doctor’s comments.
At the end your husband will be the one choosing and deciding on what to do.

Try to be positive too. There is no need of rushing. Any commitment should be done only after knowing exactly what the diagnoses are.

This is a difficult moment in your life, with so many things happening at the same time.
Be strong.
Wishing you peace of mind.

VGama

hopeful and optimistic

VascodaGama said:

Difficult times
I am sorry for the positive diagnoses. As Kongo comments the ultrasound is not accurate to identify cancer but it can differentiate spots and other info that could rule the presence of cancer. Probably he saw a normal size gland ruling out BPH. In such setting the PSA may be due only to cancer.
Most probably the biopsy was directed to the spots revealed by the ultrasound. 6 needles would be enough to diagnose the cancer and verify for extra capsular extensions. The CT will look for any spread at the bones.

Hopefully we are all wrong and the pathologist finds no cancer.
In any case your presence will be important when your husband visits the doctor again to receive the path report. It will be helpful to bring along a list of questions.
You could do some researches in advance on treatments, their risks and side effects so that you will understand better the doctor’s comments.
At the end your husband will be the one choosing and deciding on what to do.

Try to be positive too. There is no need of rushing. Any commitment should be done only after knowing exactly what the diagnoses are.

This is a difficult moment in your life, with so many things happening at the same time.
Be strong.
Wishing you peace of mind.

VGama

congratulations, Vasco
on reaching 1000 posts...1000 life changing good deeds....thank you.........

Trew

Test Scores?
Were you given the PSA and gleason scores?

The bone scan is a positive for your husband. After he drinks that drink they have him drink anything else he drinks will seem like a good drink.

I was glad to get the CT and bone scans done- gave me a more positive outlook, and I had a new prospective on what a good drink and bad drink were.

If its any consolation, by wife seemed much more concerned about the Dx at first than I was. I think it took me about 2- 3 months to comprehend I was actually a CA patient. In fact I asked the PA who was seeing me 2 or 3 times, am I really a CA patient?

I didn't like the PA at all and left that doctor because of the PA. If you are not comfortable with our doctor, get another one. the doc who did my biopsey was not the one I had do the surgery, and I left the doc who did the surgery because of his PA and went to a 3rd doc that told me 1 yr of hormone therapy was adaquate and there were no studies to indicate 2 yrs where any more effective then 1 yr. That was my conclusion after searching the web for answers and I was delighted the new urologist took me off that terrible eligard.

Now, all that said, I drink to your health- the health of both or you- physically, mental and spiritual. It can be a wild ride for some.