bph and biopsy questions

bph and biopsy questions

I have just spent the last hour searching for some answers and although
there are lots of hits, my questions weren't answered. I'm hoping this group
can help.
I just had an appointmant from my urologist and didn't think to ask some
questions at the time. (Doh!)

I have BPH and have been taking XTRAL.for about 3 years now. Previous meds
were not as effective and caused dry ejaculation. This one works well.
My PSA has risen from 3.4 to 6.8 over the last 3 years. The rise is during
the time I have been taking XATRAL.
I am scheduled for a biopsy. Prior to 3 years ago, my PSA went up to about
5 and then fell over a period of 3 years to 3.4
I have had 2 previous biopsies taken at times when the PSA took a large
jump. Both were negative.

a) Lately I have noticed that certain foods affect my flow. It seems like
anything which has hot peppers tightens things up.
What other foods cause problems?

b) I have booked an expensive one month trip to Australia for mid March. At
the moment I don't know when the biopsy will be scheduled but I want to make
sure I don't have problems while on a month long trip out of Canada where we
have medicare. I can't recall what the recovery time is for the biopsy. I
think it was at least a month . Can anyone provide this info?

c) will the biopsy cause any flow problems?

Thanks
Wayne Jones
Ottawa

Re: bph and biopsy questions

On Mon, 8 Jan 2007 10:15:54 -0500, "Wayne" <wrjones@newsguy . com >
wrote:

>I have just spent the last hour searching for some answers and although
>there are lots of hits, my questions weren't answered. I'm hoping this group
>can help.
>I just had an appointmant from my urologist and didn't think to ask some
>questions at the time. (Doh!)
>
>I have BPH and have been taking XTRAL.for about 3 years now. Previous meds
>were not as effective and caused dry ejaculation. This one works well.
>My PSA has risen from 3.4 to 6.8 over the last 3 years. The rise is during
>the time I have been taking XATRAL.
>I am scheduled for a biopsy. Prior to 3 years ago, my PSA went up to about
>5 and then fell over a period of 3 years to 3.4
>I have had 2 previous biopsies taken at times when the PSA took a large
>jump. Both were negative.
>
>a) Lately I have noticed that certain foods affect my flow. It seems like
>anything which has hot peppers tightens things up.
>What other foods cause problems?

Chocolate, for me, is bad, especially dark chocolate (which is the
BEST). Other foods to avoid are coffee and beer. There are lots of
other foods on the list too, but the info is not very consistent.
* tinyurl . com /yhodp4

>b) I have booked an expensive one month trip to Australia for mid March. At
>the moment I don't know when the biopsy will be scheduled but I want to make
>sure I don't have problems while on a month long trip out of Canada where we
>have medicare. I can't recall what the recovery time is for the biopsy. I
>think it was at least a month . Can anyone provide this info?

If you mean a trans-rectal biopsy, the recovery time is about an hour
if there are no complications. Sometimes there is bleeding that can
last a few minutes or hours, and you will notice red or pink urine...
semen can be red for weeks.

One possible complication is infection, which I guess can occur any
time within 5 days or so of the procedure. This can usually be fixed
up at Emergency, but is potentially very serious if not treated
promptly. Another possible complication is acute urinary retention
which would probably occur immediately afterwards. The fix is
catheterization at Emerg.

>c) will the biopsy cause any flow problems?

Probably not, but everyone is different. The prostate gets stabbed
several times, and that could cause some swelling, I suppose, which
might reduce flow.

Has acute retention been an issue with you? Or very slow flow that
threatens retention? Retention is a medical emergency that needs to be
relieved within a couple of hours. That can be a problem if you are
miles from a hospital (or on a trans-Pacific flight). Consider
learning self-catheterization (from your uro, or search this NG), then
take the necessary supplies with you.

Ed


>Thanks
>Wayne Jones
>Ottawa
>
>
>

Re: bph and biopsy questions

Thanks for your reply Ed.

It looks like if I don't have any problems after a couple of weeks apart
from blood in the semen, I am safe. So, I should be ok with a biopsy 1 month
before my trip.

I did get a lot of dark chocolate for xmas. It's also my favourite.
The article was useful.
A lot of he foods to avoid all seem to be those which would cause
urination --salt, alcohol,caffeine, large amounts of fluids at once--
Actually, when I consume alcohol it makes me pee but the flow is great.
Maybe that's the cure ;-)

Avoiding delaying urination is most interesting.
The few scary times when I have noticed a really slow flow and a hesitation
to even get started is due to that. If I am lying in bed and, as usual, I
feel like I should get up and go, I hold off and fall back to sleep. Then I
eventually wake up (after dreaming of searching for a washroom- a recurring
dream ;-) and then when I try and urinate, it feels especially tight. Those
are the times when I really worry but now I know why. I may have been
blaming it on the food which has never bothered me before.
Also, likely, the condition is gradually getting worse and it takes less to
slow the flow. That could also be the cause of the PSA rises. After 2
negative biopsies, I wish they had something better than literally '10 pokes
in the dark'.
Wayne

Re: bph and biopsy questions

On Tue, 9 Jan 2007 14:00:06 -0500, "Wayne" <wrjones@newsguy . com >
wrote:

>Thanks for your reply Ed.
>
> It looks like if I don't have any problems after a couple of weeks apart
>from blood in the semen, I am safe. So, I should be ok with a biopsy 1 month
>before my trip.
>
>I did get a lot of dark chocolate for xmas. It's also my favourite.
> The article was useful.
>A lot of he foods to avoid all seem to be those which would cause
>urination --salt, alcohol,caffeine, large amounts of fluids at once--
>Actually, when I consume alcohol it makes me pee but the flow is great.
>Maybe that's the cure ;-)

Salt retains fluid and I don't think it makes you pee more. Probably
it does the opposite.

Diuretics like alcohol and caffeine make you pee (especially alcohol,
and most especially beer), but after you have peed a few times, then
the body is left dehydrated, and you are much less likely to pee after
that.

>Avoiding delaying urination is most interesting.
>The few scary times when I have noticed a really slow flow and a hesitation
>to even get started is due to that. If I am lying in bed and, as usual, I
>feel like I should get up and go, I hold off and fall back to sleep. Then I
>eventually wake up (after dreaming of searching for a washroom- a recurring
>dream ;-) and then when I try and urinate, it feels especially tight. Those
>are the times when I really worry but now I know why. I may have been
>blaming it on the food which has never bothered me before.
>Also, likely, the condition is gradually getting worse and it takes less to
>slow the flow. That could also be the cause of the PSA rises. After 2
>negative biopsies, I wish they had something better than literally '10 pokes
>in the dark'.

It is well known that it is harder to pee at night. That's my
experience too. When I get up, it sometimes takes a few minutes for
the prostate to "wake up", especially when my bladder is real full.
Only then will it let urine pass. And when my bladder is full, it
perversely won't void completely... I need to wait 5-10 min and then
pee again.

In a situation like this, when I just wake up in the middle of the
night and manage to pee after a few minutes, it feels like I'm peeing
gallons but it often is only a very small amount.

As you suggest, there is a danger there that you will go back to your
warm bed after discharging only this very small amount. You will wake
up again before too long, fuller than ever, and that makes it harder
to pee. If your condiiton is advanced enough, you could go into acute
retention that way.

So figure out the shortest route to Emerg for relief, or learn
self-catheterization in case you go into retention sometime in the
future. Emerg can be very slow. If the bladder becomes too overful,
this can damage the bladder. This damage can be permanent. I suggest
you inform yourself about this.

At night, pee into a bottle so you can see how much you are making.
Don't give up until you are sure you have emptied your bladder.

I don't think peeing difficulty causes a rise in PSA. Instead your
prostate is probably growing, and a bigger prostate makes more PSA.
Probably that's what you meant.

Are you taking anything for your condition? If not, talk to your uro
about Proscar... it is intended to stop or greatly slow growth of the
prostate. It won't help symptoms much, but should prevent your
condition from getting worse. The sooner you start the better.

I'm not a doc... the above is not advice.

Ed

Re: bph and biopsy questions

Concerning high PSA and biopsy, you may want to read this interview with Dr
Stamey:

* w w w .medscape . com /viewarticle/489474

------------------------------------------------

And this one with Dr Lee:

The PSA prostatic cancer test: avoid an unnecessary biopsy - prostate-
specific antigen
Healthfacts, May, 1992

"PSA [level alone] doesn't diagnose cancer," said Fred Lee, M.D., in a
telephone interview. "PSA is a glycoprotein secreted by the normal prostate
gland. As men age the gland gets larger in a good percentage of cases, and
this is called benign prostatic hyperplasia."

The enlarge prostate usually makes more PSA, explained Dr. Lee, who is a
clinical professor in radiology and urology at Wayne State University in
Detroit.

However, PSA levels are also elevated by the presence of cancer. Thus to rule
out cancer, most doctors recommend further testing with transrectal
ultrasound, which in turn usually leads to a needle biopsy of one or more
sections of the prostate.

Dr. Lee expressed alarm about the increase in the number of biopsies caused
by the use of PSA as a screening test. He had no trouble with a biopsy
recommendation to men with blood levels higher than 10 nanograms per
milliliter, or 10 ng/ml, because this indicates a high likelihood of cancer.
But Dr. Lee took issue with the common practice of ordering ultrasound and an
immediate biopsy on men who fall within the grey area, between 4 ng/ml and 10
ng/ml. A large portion of the older male population with benign prostatic
hyperplasia are within this range.

Dr. Lee attributes the rush to biopsy to a lack of expertise in interpreting
the ultrasound results. "What you've got is all these urologists out there
who have ultrasound equipment, and they've got this [elevated] PSA, and they
don't know what the hell to do with it, so they're bringing all these poor
souls in and biopsying them." His alarm has its personal aspect. Dr. Lee
developed the field of transrectal ultrasound, the use of high-frequency
sound waves to image the prostate.

While urologists making up their capital investment are a major factor in the
overuse of ultrasound, consumer demand also plays a role. Over the last few
years, screening with transrectal ultrasound has been marketed directly to
the public as a lifesaving procedure.

A needle biopsy of the prostate is often presented as an innocuous procedure,
but it has risks. "The biopsy is done through the rectum, which is full of
bacteria, so you can't help but place bacteria into the prostate," said Dr.
Lee, outlining the typical scenario following high PSA results. "Prophylactic
antibiotics are given, but antibiotics don't reach high levels in the
prostate."

"It's a gland that doesn't concentrate antibiotics very well. Once a man gets
a low-grade infection in the prostate, it tends to stay for a long time. Then
the PSA goes higher, the patient gets more worried, and the urologist get
more worried. And what does the doctor do? He biopsies a second time. So
they're in a cycle." One-third of his practice consists of men referred to
him after this scenario, said Dr. Lee.

Dr. Lee advocates a more cautious approach to elevated PSA that will reduce
the number of unnecessary biopsies. He co-authored a new study (Cancer, March
1) that correlates the size of the prostate with PSA levels. This is done
with a skilled use of ultrasound. "We determine how large the gland is, and
we predict how much PSA the man is entitled to."

Unfortunately, most urologists do not follow this approach. They tend to use
ultrasound as the means of locating biopsy sites, whereas Dr. Lee employs the
technology to determine who really needs a biopsy. The technology is also the
center of a turf struggle between radiologists and urologists. The majority
of urologists who now own their own ultrasound equipment have had it for less
than a year or two, according to Dr. Lee, who is a radiologist.

"And they have had no training in how to read imaging--that's the realm of
the radiologist. Transrectal ultrasound has a lot of built-in error,
depending upon the expertise of the person doing it," said Dr. Lee. "It's
very subjective."

Some researchers argue against screening because prostatic cancer is often so
slow-growing that it never becomes lethal or even symptomatic within a normal
lifespan. Autopsy studies of older men who died of other causes show that
nearly half have cancer in the prostate.

--------------------------------------

This concerning the needle biopsy is also enlightening:
* chetday . com /needlebiopsy.htm

Re: bph and biopsy questions

You may get relief by using Saw Palmetto:
* w w w .drweil . com /drw/u/id/QAA365604