Advice needed

Wifesupport1

First off, I'm shocked to be here. My heart goes out to each and every one of you. I'm here for support to my husband and to gather information.

A little history: My husband is 52. He had a physical a month ago that showed a PSA of 4.1. The doctor sent him to a local urologist. The only symptom I've noticed is going to the bathroom more frequently and the urge is stronger to go more frequently. I suspect he may dribble at the end. (He can't hold off as well) No incontinence, no ED, no blood in any fluids.

He had the appointment with the urologist. I was not with him. I only know what I'm typing.

The urologist did a DRE and said the prostate is enlarged. They did a urinary flow test. The nurse said his flow is good but needs to empty his bladder more. Did another PSA. It showed 4.3. Then gave him the choice of an MRI or biopsy.

My husband is very claustrophobic and cannot do the MRI, even with a valium. So he chose the biopsy. Husband said he will take 10 samples through the rectum.

The biopsy is January 10th and will take 2 weeks to get the results.

We are very scared. Any advice moving forward?

Old Salt

We understand your worries; they are natural. But so far nothing has been identified to prove he has cancer. Yes, his PSA is a bit high for his age but he also has an enlarged prostate. Please try to enjoy the upcoming holidays.

With respect to MRIs, there are open MRI instruments. AI tells me that they can be used for prostate cancer imaging, but that they do not provide the same level of detail as a traditional MRI.

With respect to biopsies, the transperineal one is preferred nowadays. There is ample justification for this in some recent threads and, more importantly, the medical literature.

Wifesupport1

Thank you for the response and words of encouragement, Old Salt.
I’ll consider your advice and keep everyone posted on any results.

centralPA

The normal biopsy is 12 samples. Not sure why his would be 10. Might as well follow the norm as long as you are going through the trouble.

It's not MRI or biopsy, it is biopsy steered by a prior MRI or a biopsy going in blind. I had an MRI first, and in my biopsy they did the standard sampling (12) and then 3 to an identified lesion. Only the lesion showed cancer. Without the MRI I would have thought I was free and clear. Tell him to take more valium. :)

I also had urinary problems, which had nothing to do with prostate cancer. That's probably his problem too. A large prostate will lead to urinary problems.

It's nerve wracking waiting to find out results, feeling for you and your husband. Sending strength!

Clevelandguy

Hi,

I would definitely go for the MRI 1st to get the data to sample the right areas for the biopsy. As Old Salt said look for an open MRI machine if your husband is claustrophobic. If you don’t do the MRI 1st there is a greater chance of missing the cancer as the Urologist will be just hitting random areas of the Prostate.

Dave 3+4

Wifesupport1

Thank you CentralPA and Cleveland guy.
I have sat at my desk all day and thought about this. I called by husband and had him get a referral to a much larger Urology Group in a bigger city. It may push this back a little but better to start this process with a group we would feel comfortable doing the surgery if need be.

I’ll go with him to that appointment and see if the doctor will stress how important the MRI is before the biopsy. Going in blind is ridiculous.

Old Salt

https://csn.cancer.org/discussion/comment/1719482#Comment_1719482

I wouldn't say it's ridiculous; it was the way it was done some ten years ago. But technologies have moved forward and it's obviously best to go with current best practices.

Glad to read that your husband's urology appointment has been rescheduled. It's also good that you will be part of the process. It can be hard for one person to remember all that is being said in a medical office.

Rob.Ski

First, let me say I'm proponent of MRI before biopsy. Be aware that it's not a given that you'll see a lesion if you have cancer. My first MRI was clean. Followed up with blind biopsy that found cancer. So, if MRI is not feasible for some reason, still get biopsy. Not seeing a lesion and not finding cancer in biopsy doesn't mean you do Not have cancer. MRI is an indication and biopsy confirms you do have PCa if positive. If mri and biopsy are negative, continue monitoring PSA. If it continues increasing recheck for PCa. It's increasing PSA that warrants concern.

Wifesupport1

So thankful for all the feedback from you guys. I’ve taken all of your suggestions into consideration. I’ll report back with the new appointment date and results once we receive them.

Marlon

Wifesupport1, so the DRE did not find any lumps, bumps or areas of concern. That's good. The problems you describe can all be from BPH and not necessarily linked to cancer. PSA is not a measure of cancer, it's a measure of the amount of prostate tissue in your body. BPH can elevate PSA as well as infection, inflammation, or even riding a bicycle. It's a rapid increase in PSA that is an indicator of possible cancer. So I wouldn't assume the worst until you are further down the road.