Biopsy?

Hi.

I'm 51 y/o with history of chronic prostatitis. Just had an increase in
PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked
him why not repeat PSA, just in case? He said the labs don't make
mistakes. Should I push him on this or just accept the biopsy?

Larry

"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
> Hi.
>
> I'm 51 y/o with history of chronic prostatitis. Just had an increase in
> PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked him
> why not repeat PSA, just in case? He said the labs don't make mistakes.
> Should I push him on this or just accept the biopsy?
>
> Larry

First off if your doctor thinks labs don't make mistakes he's a fool.

Second, to my knowledge biopsies are not usually considered until PSA is
usually up around 4.

Personally I'd find anohter uro. It sounds more like he just bought a new
BMW and need someone to make payments for him

LOL! Thanks!

I just think he's looking to CYA. BTW, PSA over 4 is not the only
criteria used. The rate at which it increases is also a consideration.

Larry

whoknew wrote:
> "Larry" <larry@nospam.net> wrote in message
> news:4812005d$0$25032$607ed4bc@cv.net...
>
>>Hi.
>>
>>I'm 51 y/o with history of chronic prostatitis. Just had an increase in
>>PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked him
>>why not repeat PSA, just in case? He said the labs don't make mistakes.
>>Should I push him on this or just accept the biopsy?
>>
>>Larry
>
>
> First off if your doctor thinks labs don't make mistakes he's a fool.
>
> Second, to my knowledge biopsies are not usually considered until PSA is
> usually up around 4.
>
> Personally I'd find anohter uro. It sounds more like he just bought a new
> BMW and need someone to make payments for him
>
>

whoknew wrote:
> "Larry" <larry@nospam.net> wrote in message
> news:4812005d$0$25032$607ed4bc@cv.net...
>> Hi.
>>
>> I'm 51 y/o with history of chronic prostatitis. Just had an increase in
>> PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked him
>> why not repeat PSA, just in case? He said the labs don't make mistakes.
>> Should I push him on this or just accept the biopsy?
>>
>> Larry
>
> First off if your doctor thinks labs don't make mistakes he's a fool.
>
> Second, to my knowledge biopsies are not usually considered until PSA is
> usually up around 4.

That is way out of date. For a 51 year old man, a much lower threshold
would be appropriate. But it is the rate of change that is important
rather than the actual value., and if the trend shown in the last test
continued, it would be reasonable to go to biopsy.

It is possible, on the other hand, for PSA to vary for a lot of reasons
other than prostate cancer, even assume the labs anever make mistakes.
Many doctors would wait a few months and take another reading to see if
the trend were continued.

Did your doctor suggest any other reason for concern, such as a
suspicious DRE?


If you are really concerned about the matter, you could seek another
opinion,
>
> Personally I'd find anohter uro. It sounds more like he just bought a new
> BMW and need someone to make payments for him
>
>

Leonard,

The only "abnormality" from the DRE was the "left lobe was slightly
larger than the right lobe". I'm not sure that really constitutes an
abnormal DRE. And I confirmed the PSA numbers. It did not go from 1 to
1.8 in one year. It went from 1 to 1.6 in one year, and then from 1.6 to
1.8 in the subsequent year. In other words, it took 24 months for it to
go from 1 to 1.8, not 12 months.

Larry

Leonard Evens wrote:
> whoknew wrote:
>
>> "Larry" <larry@nospam.net> wrote in message
>> news:4812005d$0$25032$607ed4bc@cv.net...
>>
>>> Hi.
>>>
>>> I'm 51 y/o with history of chronic prostatitis. Just had an increase
>>> in PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I
>>> asked him why not repeat PSA, just in case? He said the labs don't
>>> make mistakes. Should I push him on this or just accept the biopsy?
>>>
>>> Larry
>>
>>
>> First off if your doctor thinks labs don't make mistakes he's a fool.
>>
>> Second, to my knowledge biopsies are not usually considered until PSA
>> is usually up around 4.
>
>
> That is way out of date. For a 51 year old man, a much lower threshold
> would be appropriate. But it is the rate of change that is important
> rather than the actual value., and if the trend shown in the last test
> continued, it would be reasonable to go to biopsy.
>
> It is possible, on the other hand, for PSA to vary for a lot of reasons
> other than prostate cancer, even assume the labs anever make mistakes.
> Many doctors would wait a few months and take another reading to see if
> the trend were continued.
>
> Did your doctor suggest any other reason for concern, such as a
> suspicious DRE?
>
>
> If you are really concerned about the matter, you could seek another
> opinion,
>
>>
>> Personally I'd find anohter uro. It sounds more like he just bought a
>> new BMW and need someone to make payments for him
>>

On Apr 25, 10:02 am, Larry <la...@nospam.net> wrote:
> Hi.
>
> I'm 51 y/o with history of chronic prostatitis. Just had an increase in
> PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked
> him why not repeat PSA, just in case? He said the labs don't make
> mistakes. Should I push him on this or just accept the biopsy?
>
> Larry

Hi Larry...A PSA increase of 0.75 ng/ml, some say 0.50, in a year
suggests further evaluation. A repeat of the PSA test is a good idea,
IMO. Better yet might be a retest after a 2-3 antibiotic regimen to
see if prostatitis might be the real culprit (unfortunately not all
prostatitis responds to antibiotics)...ron

Thanks, Ron. So I wonder why this guy is so anxious to do a biopsy
before trying antibiotics, especially given I have a history of
prostatitis?

Larry

ron wrote:
> On Apr 25, 10:02 am, Larry <la...@nospam.net> wrote:
>
>>Hi.
>>
>>I'm 51 y/o with history of chronic prostatitis. Just had an increase in
>>PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked
>>him why not repeat PSA, just in case? He said the labs don't make
>>mistakes. Should I push him on this or just accept the biopsy?
>>
>>Larry
>
>
> Hi Larry...A PSA increase of 0.75 ng/ml, some say 0.50, in a year
> suggests further evaluation. A repeat of the PSA test is a good idea,
> IMO. Better yet might be a retest after a 2-3 antibiotic regimen to
> see if prostatitis might be the real culprit (unfortunately not all
> prostatitis responds to antibiotics)...ron

"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
> Hi.
>
> I'm 51 y/o with history of chronic prostatitis. Just had an
> increase in PSA from 1 to 1.8 over one year. My uro is ordering
> a biopsy. I asked him why not repeat PSA, just in case? He said
> the labs don't make mistakes. Should I push him on this or just
> accept the biopsy?
>
> Larry

I'm not a doctor but it is my understanding that prostatitis
does elevate PSA levels. Furthermore, I suspect that PSA tracks
flareups. When you're having a bout of prostatitis the PSA may
go up during that period and then come back down if the
inflammation recedes.

Apparently, PSA levels can go up due to a number of different
factors. If you had sex the night before the blood draw, or if
you had a digital rectal exam shortly before the blood draw, that
could elevate PSA levels (again, I'm not a doctor, but those are
the conventionally accepted views.) The theory is that there
should be no stress on the prostate for 48 hours before the blood
draw in order to get an accurate reading.

It is commonly held that people with prostatitis should get a
round of antibiotic treatment to see if it goes down. From my
reading, I think that the majority of prostatitis cases are not
in fact due to bacterial infections and won't respond to
antibiotics. I know that I've suffered from prostatitis and had
no response to antibiotics except a queasy stomach for 28 days.
I personally don't believe in taking antibiotics unless you
really need them, and would ask the uro to do a urine culture to
find out if there are higher than normal levels of bacteria in
the urine - which might indicate that an antibiotic would do some
good and not just wipe out beneficial bacteria in your body and
help breed antibiotic resistant organisms.

As for labs making mistakes, well, I'm sure it's true that
mistakes are pretty rare. But no matter what systems they have
in place to prevent them, there are still human beings running
the labs. I would have liked your doctor's statement better if
he had said that mistakes are rare rather than that they don't
happen. Still, the odds are high that the reading is correct.
The main issue is, is this increase in PSA really due to cancer?

Did the uro feel anything on his digital rectal exam? If he did,
then I think he's right that a biopsy should be done.

If not, then I like your idea of repeating the PSA rather than
getting a biopsy.

I'm a little reluctant to contradict your uro. He's a
credentialed expert and I'm not. However, your PSA is well
within normal limits, you have an alternate explanation for the
recent rise (prostatitis), a biopsy is expensive and invasive, a
PSA test is cheap and non-invasive, and prostate cancer is
normally a very slow growing disease anyway so that waiting a bit
and re-testing is unlikely to put you at much risk. The usual
theory is that anyone with a PSA below 10 and a Gleason score
(which you can't get without a biopsy unfortunately) below 7, has
a very high probability of successful treatment.

So, I'd schedule another PSA test. I'd be sure there is no sex,
no digital rectal exam, maybe even no bike riding, for 48 hours
before, and see what it says. I think there is a good chance it
will be lower than your last reading. If it's higher, then maybe
you should get a biopsy.

Good luck.

Alan

Thanks, Alan. The only thing he noted upon DRE is the left lobe bigger
than the right. He said sometimes that means something and sometimes
not. And in fact, I am having a bit of dull pain on the left side, so
I'm thinking it could be the prostatitis.

Larry

Alan Meyer wrote:

> "Larry" <larry@nospam.net> wrote in message
> news:4812005d$0$25032$607ed4bc@cv.net...
>
>>Hi.
>>
>>I'm 51 y/o with history of chronic prostatitis. Just had an
>>increase in PSA from 1 to 1.8 over one year. My uro is ordering
>>a biopsy. I asked him why not repeat PSA, just in case? He said
>>the labs don't make mistakes. Should I push him on this or just
>>accept the biopsy?
>>
>>Larry
>
>
> I'm not a doctor but it is my understanding that prostatitis
> does elevate PSA levels. Furthermore, I suspect that PSA tracks
> flareups. When you're having a bout of prostatitis the PSA may
> go up during that period and then come back down if the
> inflammation recedes.
>
> Apparently, PSA levels can go up due to a number of different
> factors. If you had sex the night before the blood draw, or if
> you had a digital rectal exam shortly before the blood draw, that
> could elevate PSA levels (again, I'm not a doctor, but those are
> the conventionally accepted views.) The theory is that there
> should be no stress on the prostate for 48 hours before the blood
> draw in order to get an accurate reading.
>
> It is commonly held that people with prostatitis should get a
> round of antibiotic treatment to see if it goes down. From my
> reading, I think that the majority of prostatitis cases are not
> in fact due to bacterial infections and won't respond to
> antibiotics. I know that I've suffered from prostatitis and had
> no response to antibiotics except a queasy stomach for 28 days.
> I personally don't believe in taking antibiotics unless you
> really need them, and would ask the uro to do a urine culture to
> find out if there are higher than normal levels of bacteria in
> the urine - which might indicate that an antibiotic would do some
> good and not just wipe out beneficial bacteria in your body and
> help breed antibiotic resistant organisms.
>
> As for labs making mistakes, well, I'm sure it's true that
> mistakes are pretty rare. But no matter what systems they have
> in place to prevent them, there are still human beings running
> the labs. I would have liked your doctor's statement better if
> he had said that mistakes are rare rather than that they don't
> happen. Still, the odds are high that the reading is correct.
> The main issue is, is this increase in PSA really due to cancer?
>
> Did the uro feel anything on his digital rectal exam? If he did,
> then I think he's right that a biopsy should be done.
>
> If not, then I like your idea of repeating the PSA rather than
> getting a biopsy.
>
> I'm a little reluctant to contradict your uro. He's a
> credentialed expert and I'm not. However, your PSA is well
> within normal limits, you have an alternate explanation for the
> recent rise (prostatitis), a biopsy is expensive and invasive, a
> PSA test is cheap and non-invasive, and prostate cancer is
> normally a very slow growing disease anyway so that waiting a bit
> and re-testing is unlikely to put you at much risk. The usual
> theory is that anyone with a PSA below 10 and a Gleason score
> (which you can't get without a biopsy unfortunately) below 7, has
> a very high probability of successful treatment.
>
> So, I'd schedule another PSA test. I'd be sure there is no sex,
> no digital rectal exam, maybe even no bike riding, for 48 hours
> before, and see what it says. I think there is a good chance it
> will be lower than your last reading. If it's higher, then maybe
> you should get a biopsy.
>
> Good luck.
>
> Alan
>
>

Don't forget to examine your family history. I found out after my
diagnosis that my grandfather had pCa. If I and my doc knew that before
I probably would have had a biopsy many months earlier when my PSA was
under 4. And I possibly may have had negative margins instead of
positive margins to go along with my aggressive Gleason which can
influence a lower PSA.

FelmerDingle

Larry wrote:
> Thanks, Alan. The only thing he noted upon DRE is the left lobe bigger
> than the right. He said sometimes that means something and sometimes
> not. And in fact, I am having a bit of dull pain on the left side, so
> I'm thinking it could be the prostatitis.
>
> Larry
>
> Alan Meyer wrote:
>
>> "Larry" <larry@nospam.net> wrote in message
>> news:4812005d$0$25032$607ed4bc@cv.net...
>>
>>> Hi.
>>>
>>> I'm 51 y/o with history of chronic prostatitis. Just had an
>>> increase in PSA from 1 to 1.8 over one year. My uro is ordering
>>> a biopsy. I asked him why not repeat PSA, just in case? He said
>>> the labs don't make mistakes. Should I push him on this or just
>>> accept the biopsy?
>>>
>>> Larry
>>
>>
>> I'm not a doctor but it is my understanding that prostatitis
>> does elevate PSA levels. Furthermore, I suspect that PSA tracks
>> flareups. When you're having a bout of prostatitis the PSA may
>> go up during that period and then come back down if the
>> inflammation recedes.
>>
>> Apparently, PSA levels can go up due to a number of different
>> factors. If you had sex the night before the blood draw, or if
>> you had a digital rectal exam shortly before the blood draw, that
>> could elevate PSA levels (again, I'm not a doctor, but those are
>> the conventionally accepted views.) The theory is that there
>> should be no stress on the prostate for 48 hours before the blood
>> draw in order to get an accurate reading.
>>
>> It is commonly held that people with prostatitis should get a
>> round of antibiotic treatment to see if it goes down. From my
>> reading, I think that the majority of prostatitis cases are not
>> in fact due to bacterial infections and won't respond to
>> antibiotics. I know that I've suffered from prostatitis and had
>> no response to antibiotics except a queasy stomach for 28 days.
>> I personally don't believe in taking antibiotics unless you
>> really need them, and would ask the uro to do a urine culture to
>> find out if there are higher than normal levels of bacteria in
>> the urine - which might indicate that an antibiotic would do some
>> good and not just wipe out beneficial bacteria in your body and
>> help breed antibiotic resistant organisms.
>>
>> As for labs making mistakes, well, I'm sure it's true that
>> mistakes are pretty rare. But no matter what systems they have
>> in place to prevent them, there are still human beings running
>> the labs. I would have liked your doctor's statement better if
>> he had said that mistakes are rare rather than that they don't
>> happen. Still, the odds are high that the reading is correct.
>> The main issue is, is this increase in PSA really due to cancer?
>>
>> Did the uro feel anything on his digital rectal exam? If he did,
>> then I think he's right that a biopsy should be done.
>>
>> If not, then I like your idea of repeating the PSA rather than
>> getting a biopsy.
>>
>> I'm a little reluctant to contradict your uro. He's a
>> credentialed expert and I'm not. However, your PSA is well
>> within normal limits, you have an alternate explanation for the
>> recent rise (prostatitis), a biopsy is expensive and invasive, a
>> PSA test is cheap and non-invasive, and prostate cancer is
>> normally a very slow growing disease anyway so that waiting a bit
>> and re-testing is unlikely to put you at much risk. The usual
>> theory is that anyone with a PSA below 10 and a Gleason score
>> (which you can't get without a biopsy unfortunately) below 7, has
>> a very high probability of successful treatment.
>>
>> So, I'd schedule another PSA test. I'd be sure there is no sex,
>> no digital rectal exam, maybe even no bike riding, for 48 hours
>> before, and see what it says. I think there is a good chance it
>> will be lower than your last reading. If it's higher, then maybe
>> you should get a biopsy.
>>
>> Good luck.
>>
>> Alan
>>
>>

"Larry" <larry@nospam.net> wrote in message
news:4812005d$0$25032$607ed4bc@cv.net...
> Hi.
>
> I'm 51 y/o with history of chronic prostatitis. Just had an increase in
> PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I asked him
> why not repeat PSA, just in case? He said the labs don't make mistakes.
> Should I push him on this or just accept the biopsy?
>
> Larry


Hi Larry. Get the biopsy. I'm 45 years old, had a normal PSA, but a lump was
found during my annual physical. I was sent off for a consultation with a
urologist and they repeated the DRE. As a result, I had a biopsy done right
on the spot. My test results came back positive for prostate cancer. My
surgery was on March 20th and I'm recovering slowly.

A PSA test is not the definitive answer as to whether there is a problem or
not. Get a DRE and get a biopsy just to make sure. The biopsy is unpleasant
but releatively painless and it will take about 10 to 15 minutes depending
on how many samples need to be taken. Waiting for the results is actually
worse.

If you have any questions, feel free to ask.

Thanks, I can appreciate your story and why you would recommend it.
Actually, I just verified that my PSA went from 1 to 1.6 to 1.8 over 2
years (not 1 year). I am still going to question him about it again.

Regarding the biopsy, can you provide any sense for what "unpleasant"
means to you re the biopsy? I mean, a biopsy needle goes through the
intestinal wall and about an inch into the prostate. That is only
"unpleasant"? What exactly do you feel? Pressure? Pain? Very quick? How
would you describe it?

Thanks!

Larry

NB wrote:
> "Larry" <larry@nospam.net> wrote in message
> news:4812005d$0$25032$607ed4bc@cv.net...
>
>> Hi.
>>
>> I'm 51 y/o with history of chronic prostatitis. Just had an increase
>> in PSA from 1 to 1.8 over one year. My uro is ordering a biopsy. I
>> asked him why not repeat PSA, just in case? He said the labs don't
>> make mistakes. Should I push him on this or just accept the biopsy?
>>
>> Larry
>
>
>
> Hi Larry. Get the biopsy. I'm 45 years old, had a normal PSA, but a lump
> was found during my annual physical. I was sent off for a consultation
> with a urologist and they repeated the DRE. As a result, I had a biopsy
> done right on the spot. My test results came back positive for prostate
> cancer. My surgery was on March 20th and I'm recovering slowly.
>
> A PSA test is not the definitive answer as to whether there is a problem
> or not. Get a DRE and get a biopsy just to make sure. The biopsy is
> unpleasant but releatively painless and it will take about 10 to 15
> minutes depending on how many samples need to be taken. Waiting for the
> results is actually worse.
>
> If you have any questions, feel free to ask.
>
>

On April 25, Larry wrote:

(snip)

> Regarding the biopsy, can you provide any sense for what "unpleasant"
> means to you re the biopsy? I mean, a biopsy needle goes through the
> intestinal wall and about an inch into the prostate. That is only
> "unpleasant"? What exactly do you feel? Pressure? Pain? Very quick? How
> would you describe it?

Well, my anecdote is this: I felt almost nothing. Why? Because I
required that I be administered anti-pain drugs.

Some here will claim that it's not so bad; others will claim that it was
horrible without drugs.

I claim that no one knows what will happen and that only a self-styled
macho fool would decline pain prevention.

One thing I have wondered about and has not been answered by anyone is
this: if the patient does not experience pain and tense up, the uro
should have a more convenient task. Hello?

Regards,

Steve J

Larry wrote:

> Regarding the biopsy, can you provide any sense for what "unpleasant"
> means to you re the biopsy? I mean, a biopsy needle goes through the
> intestinal wall and about an inch into the prostate. That is only
> "unpleasant"? What exactly do you feel? Pressure? Pain? Very quick? How
> would you describe it?

If my doctor hadn't said, "here goes another one" before each needle
jab, I'm not sure I would have realized he was doing anything beyond
jamming hardware where it doesn't belong. Since he did, I noticed a
twinge of "unpleasantry" each time. He said that's about how
the vast majority of his patients perceived it. I'm sure some gay men
have had far rougher experiences which, overall, they enjoyed.

Our intestine wall nerves perceive only stretching, not cutting (I've
watched them snip bumps from my intestine walls during colonoscopies,
and it was as though it was just a video of someone else's intestine.)
All I actually felt during colonoscopies was the introduction of enough
gas to inflate the intestine significantly, and we've all felt that many
times; they're called gas pains.

A few men say their biopsies were very painful. I have no idea whether
that's physiological or psychological.

I.P.

The first biopsy was without pain medication and unbearable to the point
that I passed out after the Uro announced the eleventh probe.
Due to this newsgroups existence and advise from contributors, I told my Uro
at the second biopsy that I wanted to be sedated or whatever. He performed
the procedure whilst I was under a short spell of anastatic.
In response to I.P.'s comment...I am a masochist and know what pain is, but
can assure you that the acute pain I felt at my first biopsy was NOT
psychological!

John