Biopsy Tomorrow

JohnO62

Hello Everyone,

I am new to this site and have found it extremely helpful! Hopefully, I'm not jumping the gun by this posting since I have not been diagnosed with PC. However, last week my Urologist found a couple "suspicious" bumps on my prostate and said it was hard to the touch as well. But, it was not enlarged as I had been told by my GP doctor. My research indicates that bumps generally turn out to be cancerous 50% of the time. My routine PSA's have been as follows: 1.5 in Jan. 2015, 1.5 in Nov. 2013 and 2.23 in Apr. 2012. A scan & biopsy procedure is scheduled for tomorrow and I have been educating myself as much as possible in one short week about PC so if the test comes out positive I can better understand what I'm told about the results and hopefully not get too freaked out!

By studying posts on this site as well as the Internet, I have learned how to understand a Gleason score. In addition, I have a book about PC which describes the stages of PC and their meaning. I intend to ask the following two questions if the test results are positive: What pathologist did the analysis/report and is he/she a specialist in PC or a general pathologist? And, what treatment does the Urologist believe is best? Can anyone suggest additional questions I should ask at that point?' If the results are positive, I hope to have a second opinion done by Bostwick Labs in Richmond, Va. as suggested by Dr. Sheldon Marks in his book on PC.

I understand the need for me to learn as much as possible about treatments and to be intimately involved in decisions on treatment if results are positive. However, my main concern at this point is to be prepared as best as I can to understand the results should they be positive and know the appropriate questions to ask.

Thanks,

John

Max Former Hodgkins Stage 3

Excellent Start

John,

You are to be commended for the self-study that you have already undertaken. It will make getting results and then dealing with them much easier as you walk this prostate journey, regardless of what those results are.  Many guys here, like me, had prostate issues for years prior to any cancer diagnosis, such as BPH, chronic inflammation, and other things.  And, virtually all seem very well-read and informed.

Conversely, I have a dear friend in my neighborhood, now 73, who was diagnosed with mild (indolent) PCa about five years ago. He has been on "Watchful Waiting" since, and has had no issues, and no clinical progression of the disease (no increase in PSA or worsening biopsies) during those five years. 

But, this friend knows very little: I asked him his initial Gleason Score, and he replied that he has no idea what a "Gleason Score" is, for instance.  He does what the doctor suggests, when the doctor suggests it.  No further discussion or concern on his part.   Emotionally perhaps a better way to live, but not one that I could ever get comfortable with myself.  I have personally known one guy who had encyclopedic knowledge of the disease ("Ed"), and another who knew almost nothing ("Gary").  The clinical progression of the disease in the genius and the ignoramius were identical, as if all the study was meaningless to the disease itself !  Both began with aggressive, late stage disease, and both lived exactly 13 years after diagnosis. Go figure.

I would say that hard spots felt during a digital exam certainly suggests that a biopsy is justified, but as your doctor noted, it is no proof of cancer.  I have had a lot of medical trauma and diseases in my life (run over by a car, for instance), and I must rate the prostate biopsy as one of the most painful proceedures I have undergone, but the discomfort is brief, and very much worth it. 

I hope your experience is forgetful and minor, with good results,

max

 

 

VascodaGama

Biopsy should include the "bumps"

J

Welcome to the board. As you set it, you are not yet a member of our “prestigious” PCa club. But you’re doing it well in educating on the matters related to the prostate.

You have not shared any comment in regards to symptoms or age, or the existence of a family experience with cancer (hereditary), or about the arrangements done with your doctor but I think it important for you to request or discuss on the details of the procedure. Some doctors simple request the biopsy to be done by a specialist in a separate clinic because this has became nowadays standard, typical including 12 cores mapped to six zones of the gland. However, I hope they (your doctor or someone at his instructions) have directed a couple of needles to those bumps.

Regarding your PSA histology, you may know by now that some factors other than cancer can increase the PSA level. This could justify the decrease from your initial 2.23 (2012) to the latest of 1.5 ng/ml (2015).

In these links you can find ideas of typical questions to the doctor;

http://www.mayoclinic.org/diseases-conditions/prostate-cancer/basics/preparing-for-your-appointment/con-20029597

http://www.pcf.org/site/c.leJRIROrEpH/b.5835175/k.B015/Questions_to_Ask.htm

 

Best wishes,

 

VGama

JohnO62

VascodaGama said:

Biopsy should include the "bumps"

J

Welcome to the board. As you set it, you are not yet a member of our “prestigious” PCa club. But you’re doing it well in educating on the matters related to the prostate.

You have not shared any comment in regards to symptoms or age, or the existence of a family experience with cancer (hereditary), or about the arrangements done with your doctor but I think it important for you to request or discuss on the details of the procedure. Some doctors simple request the biopsy to be done by a specialist in a separate clinic because this has became nowadays standard, typical including 12 cores mapped to six zones of the gland. However, I hope they (your doctor or someone at his instructions) have directed a couple of needles to those bumps.

Regarding your PSA histology, you may know by now that some factors other than cancer can increase the PSA level. This could justify the decrease from your initial 2.23 (2012) to the latest of 1.5 ng/ml (2015).

In these links you can find ideas of typical questions to the doctor;

http://www.mayoclinic.org/diseases-conditions/prostate-cancer/basics/preparing-for-your-appointment/con-20029597

http://www.pcf.org/site/c.leJRIROrEpH/b.5835175/k.B015/Questions_to_Ask.htm

 

Best wishes,

 

VGama

Biopsy Tomorrow

Thank you Swingshiftworker, Max and VGama for your helpful replies!

In regards to questions asked by VGama.....I'm 67 yrs. old and my symptoms have been difficulty in starting to urinate (primarily at night ), frequent urination at night, slow/weak flow, and not fully emptying my bladder but no pain associated with urination. I believe my Mom's dad died of prostate cancer; however I was too young to remember and nobody is still alive to ask.

My GP referred me to a nephrologist and urologist. Kidney concerns were ok except an ultrasound test revealed I retained 52mls. of fluid in my bladder post test urination. My biopsy is being done today at my urologists facility by a person on his staff. I will ask him to biopsy those bumps if he hasn't already been instructed to do so and ask about the number of cores he will be taking. 

Hopefully, I will get results next week and will post them at that time.

Thanks again,

John 

Swingshiftworker

Lots to Learn

You may want to send your slides for a 2nd Opinion to Dr. Jonathan Epstein at Johns Hopkins instead.  He is a renowned expert in PCa slide analysis and will actually do examine slides himself; he did mine.  I chose Johns Hopkins over Bostwick because I felt that I would get personalized service there (which I did); Bostwick just seemed like an anonymous lab (which it is, which no idea who would be analyzing my slides).

You can ask your urologist what treatment he recommends, but specialists usually recommend the treatment that they perform.  For urologists, that's usually surgery - open or DaVinci.  I am an outspoken critic of surgery -- too many risks and side effects to justify the procedure given the advnaces in radiation treatment, particuarly SBRT/Cyberknife. 

Your tretament choice will depend on your diagnosis but, before you get the diagnosis, you can start doing research on the options out there.  Bascially, you've got: 1) surgery -- open or DaVinci, 2) radiation -- IMRT or IGRT, SBRT & Brachytherapy (high dose and low dose; high dose is better IMO) and 3) active surveillance.  There's also cyrosurgery and HIFU (hi intensity frequency ultrasound) but they are not commonly used -- cyro because it can be more damaging than surgery and is normally only used as a salvage treatment after surgery or radiation has failed and HIFU because it's not covered by insurance.

Lots more to learn before you make a treatment decision, assuming that you have PCa, which has not been determined yet.  Many knowledgable "survivors" on this forum.  Just let us know what the results of the biospy are and we can go from there. 

Good luck!