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Biopsy last Friday 6/15/07

Hi all-

I recently turned 40, and as a promise to my dad who is a 3 time prostate cancer survivor, I had a PSA test. My result was 4.6, which prompted a referal to a urologist.

The urologist did a urine test, DRE, and recomended I come back for a biopsy. I did, and it was done last Friday ( 3 days ago ) 6/15/07.

To say it was painful and a cluster would be an understatement. The female doctor and staff could not get the ulstrasound equipment working, so the probe and needle were inserted and taken out 3 times before they could see my prostate on the screen. The rest of the procedure was "routine", I guess, except for them bursting what must have been a fairly large hemroid inside me ( which I had NO IDEA I had! )

During and for a good 48 hours after the procedure, I was in a pretty good amount of pain. Why they do not automatically give you a valium before and prescription for vicodin after is beyond me.

Anyway, as they were cleaning up, the doctor said my prostate was a normal size ( 18cc I think? ) and had no noticeably abnormalitys. I said "good, then I'm out of the woods, right?" and she then explained to me that the cancer can come in two forms. One is the more traditional nodule like bumps, and the other is more like tentacles or roots. Do you guys have any experience with this? Is one worse than the other?

I am nervous about my results. They should be available sometime late this week. I'll post whatever they are.

Thanks for letting me vent.

Chris L
Amador County, CA

Re: Biopsy last Friday 6/15/07

Hi Chris,

Sorry to read of your bad experience with the biopsy. I really do not know why doctors are not more considerate. For most men biopsy is not a problem, but for a signficant number it is - so why not as a matter of routine provide pain killers?

There are many variants of prostate cancer, which is why it is very difficult to generalise about the disease. I'm sure we'll all hold thumbs on your PSA being due to something other than a tumour - which is the case for the majority of men.

Re: Biopsy last Friday 6/15/07

Hi Chris, Sorry to hear about your tough time with the biopsy. I was luckily sedated when I had mine. I am not sure about the nodule, root theory, but I had 3 Dre with nothing showing up and ended up having PCa. Keep you hopes up that it is just an inflamation or an infection of some sort, the power of positive thought is very underrated!! Good Luck!!

Mike
psa:4.2 gleason:6 stage:T1C age:36

Re: Biopsy last Friday 6/15/07

Chris:

I'm sure your urologist knows what she is talking about regarding the types of cancer, but it sounds like your biopsy was a horror story. In short, most of us have felt some of your pain.

To tell you not to worry until the pathology report comes in would be stupid. Of course you will worry about the results. At this point in your early journey, I would suggest one thing. Try not to dream up scenarios and problems before they occur. Either you do or do not have prostate cancer. Hoorah if you don't. You will deal with it if you do. When my initial pathology reports came in from the lab, they had me at a Stage T-1C (early) and Gleason 7 (4+3) which would indicate that a more aggressive cancer was dominate in my prostate. After they took my prostate out with robotic surgery, they found the cancer was actually a Gleason 7, but it was a 3+4 which means a less agressive cancer was the predominate cancer. I still needed treatment, but it goes to show that the results of the biopsies need to be checked and re-checked. I also had a prostacint test using redioactive isotopes merged with a cat-scan. The results of that test were dead wrong when reviewed against the final prostate, vesicles and tissue matter that were taken on May 16.

You may not need any advice right now, but get a urologist that knows what he is going and doesn't hurt you. Don't be afraid to take charge of your care and decisions. It's your body and you need to make the best decisions for you. Think of doctors as consultants and mechanics. The surgeon will push surgery, the radiologist will push seeds or some other radioactive treatment. They all have their agendas.

Try to relax this week and think about positive things. One day at a time. If the results come back showing you have cancer, get ready to ask a zillion questions of your doctor, the doctor that performed the lab test, and other doctors. I saw my urologist twice. Once to perform the biopsy, the other to give me the results. The rest of the time I spent with prospective surgeons and radiologist interviewing them. I kept my general physician and urologist informed by having the other physician's tests sent to them.

Good luck. I hope your test is negative (which is positive) and that you don't have cancer.

Mike
San Antonio, TX

Re: Biopsy last Friday 6/15/07

Chris:
Satistically your chances of having an infection are much higher than having cancer. With that said also consider trhat your promise to your Dad may save your life. My son is now 43 and had his first PSA test at 41 summer 2005 the date of my diagnosis. Fortunately his so far is negative. Knowing that there may be a concern is the first step toward stopping the progress and most likely stopping the spread beyond the gland.

One of the most important steps for you is to take command of your treatment. We have been trained to "leaving the driving to the Docs." If you are not entirely confortable with the diagnosis and/or the process get another opionion. Demand written information of everything - biopsy result etc so that you can share the findings with another physcian for interpretation. The reading of biopsy test does not always come out the same. Gather all the information you can and then and only then make your own decisions. Best of luck

John

Re: Biopsy last Friday 6/15/07

Chris,

The urologist should have offered a local anesthetic. When I was biopsied in 1997 this was uncommon, but it is very common now.

Your urologist was correct as far as PCa cancer. Dr. Oppenheimer, a leading pathologist who specializes in PCa describes the cancer as often being "diffuse" and spread throuhgout the tissues rather than in a nodule or tumor.

Although a positive biopsy means you have cancer, a negative biopsy does not rule it out. Biopsies often miss cancer since very small samples are taken. Arnold Palmer had (I believe) 15 biopsies before his was found.

Due to the importance of the Gleason score in the decision process AND the fact that prostate cancer is frequently understaged by “general purpose” pathologists who look at a lot of different tissue, If your biopsy shows cancer, I suggest that you obtain a second opinion on your biopsy slides from a pathologist that specializes in PCa. Here is my list of some of the better pathologists:

Johnathan Epstein
Johns Hopkins University, Meyer 7-181
600 N Wolfe Street, Rm173, Baltimore, MD 21205
(410)955-2162

David Bostwick
Bostwick Laboratories
9351 W. Broad Street
Richmond, VA 23294
Website: http://www.bostwicklaboratories.com/
Electronic mail: bostwick@bostwicklaboratories.com
Telephone 800-214-6628
fax 804-288-6568

John McNeal
Stanford University Medical Center, Dept. of Urology
Room S-287, Stanford CA 94305
(415)725-5534

Jonathan Oppenheimer
Oppenheimer Urologic Reference Lab (OURLAB)
1854 Air Lane Drive; Suite 17A; Nashville TN 37210
Telephone: 615-847-0410 or 1-888-8OURLAB
FAX: 615-232-8009
Website: http://www.ourlab.net/
Electronic mail: Dr Oppenheimer: dro@ourlab.net
General Information: info@prostatelab.com

If cancer is not found from this biopsy, continue to monitor your PSA, and if it keeps increasing, have another. Some doctors are better at finding cancer than others, Dr. Fred Lee being among the best.

Jack

Re: Re: Biopsy last Friday 6/15/07

How do we approach a second opinion from the paths? I need to know the routine. How to go about this. Thanks!
Christina

Re: Re: Biopsy last Friday 6/15/07

How do we approach a second opinion from the paths? I need to know the routine. How to go about this. Also, why could we not ask the uro for a xanax or valuim for the night before and perhaps before the biopsy? Why not ask for pain medication afterwards?Thanks!
Christina

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