My philosophy is that you should always seek a second opinion if it involves major surgery, maybe a third one if the first two opinions disagree or if it’s something life threatening, like cancer.  I did this for a reconstructive knee surgery back in 1994.  I ended up seeing one of the premier orthopedic surgeons in the country.  In retrospect, it may or may not have been worth it.  My knee is fine and my recovery was quicker than the other patients doing physical therapy for the same surgery, at the same time.  On the other hand, the trips to and from the University of Chicago hospital were a bit of a hassle for me and my family.  Plus, it was an arthroscopic surgery that was pretty standard.  I may well have gotten the same result with a local surgeon at a nearby hospital.  We have done the same for my wife for a surgery on a pituitary tumor and a on herniated disc, mostly because we were not reassured at all by the first opinion.  In the case of the tumor (which was benign), our trip to Northwestern University’s hospital was one of the best decisions we ever made.  Going to all this work to find out if a biopsy is necessary is probably a bit extreme, but I also have in mind what the next step might be.

You can’t really get a second opinion on the internet.  I suspect the legal ramifications are too great for physicians to give specific advice without a personal consultation.  You can, however, get more general advice and possibly learn whether or not another professional opinion is needed.  I did just this.  One such resource is AllExperts.com.  You can ask questions anonymously and then determine if you need to see a specialist or get another opinion.  Dr. Leslie gave me some very sound advice that was very helpful to me.  Medhelp is another similar resource.  I’m sure there are a number of other “Ask a Urologist” or “Ask an Oncologist” type of websites on the internet that may be also helpful to men with prostate issues.  You can also search for studies, research and articles by physicians.  If you find an expert who has knowledge specific to your situation, you can always call their office or email them (or their assistant) to see if you can schedule a consultation or get additional information.

There’s also the old fashioned method. Continue reading Second Opinions: Trusting Your Prostate to One Physician →

Last night, I had a telephone consultation with a physician I mentioned previously.  He was very skeptical of my ultrasound results, having concerns with both the physician and the claimed sensitivity of the test.  He believes that based on a current consensus of experts, this ultrasound technology alone is only around 20% likely to detect prostate cancer, rather than the >90% claimed by the radiologist that did the ultrasound.  From what I understand, his preferred method of detecting prostate cancer is a “3 Tesla” high resolution MRI, followed (if necessary) by a biopsy guided by the MRI and ultrasound results.

He also suggests that in patients who do not exhibit cancer, he is able to diagnose prostatitis with his procedure.  He has a diet and dietary supplements that can help treat prostatitis and possibly lower PSA levels if they are the result of prostatitis.

I don’t have the expertise to determine who is right or who is wrong.  In all liklihood, both philosophies may have merit to some degree.  It may not be unlike how there are a number of different treatments for prostate cancer, and various well-regarded urologists, oncologists and surgeons will have their own preference as to which of them is the best option.  All of them have pros and cons which should be considered by the patient as carefully as possible.  Ultimately, it may even come down to which opinion you trust and respect the most.

As for now, I still have some options to consider.  I’m still awaiting the “partial set” of ultrasound images.  I received one small, greyscale 2D image via email this morning.  For $950, I sure hope there are more showing the areas of interest for future use.  Any benefit of having “3D”, “4D” or “Doppler” enhancement with color are completely lost with the images I received so far.

I had my ultrasound yesterday.  I flew to New York City to get it.  The only physican that I could find who was closer and used similar technology for my situation was near Detroit, but they wanted to do a biopsy at the same time.  There are a number of other places doing these sonograms across the country.  New York had the advantage that I would get to visit a few good friends on my overnight visit.

I didn’t know much about the physician, Dr. Robert L. Bard, beyond a few brief email exchanges, some Google searches, and a quick check at the New York state health department to make sure he was a currently licensed physician (he was indeed a licensed radiologist with no complaints listed).  Probably a little extreme to check this, but if I’m flying out-of-state to see someone for a medical procedure, I want to at least make sure I know they are legitimate and not just a website scam or something! Continue reading My Super(?) Ultrasound →

Tests like the PCA3, Power Doppler Ultrasound and 3T MRI are all very promising and based on a lot of research.  There are a few other tests I’ve found that might be of interest.  I haven’t found much research on them, and they are probably not yet available in the USA outside of trials or studies.

http://proactivegenomics.com/

http://www.diapat.com/diapatpcms/cmsengl/front_content.php?idcat=274

http://www.johnshopkinshealthalerts.com/alerts/prostate_disorders/JohnsHopkinsProstateDisordersHealthAlert_1023-1.html

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1475992

http://www.clarientinc.com/Default.aspx?tabid=403 (post biopsy test)

I’m off to New York City for a power doppler ultrasound.  More next week.

Last week I mentioned my PCA test results.  Here is a copy of the report from Bostwick Laboratories.

I have not yet been able to find a “calculator” that gives you a risk based on your PCA3 score, as there are for PSA levels.  I have found some interesting webpages and studies about results that may be of help to anyone considering a PCA3 test, because of concerns about a biopsy or repeat biopsy– Continue reading More on PCA3 Prostate Cancer Urine Test →

Here are a few websites that have helped me.  I’ve added them to my blogroll links and hope they might help you, too:

http://www.prostate-cancer.org/

http://www.cancer.gov/cancertopics/types/prostate

http://www.ustoo.com

http://www.prostatecancerfoundation.org

There are also a number of smaller blogs (like mine) and personal webpages about prostate health issues that you can find on Google.  One in particular is about a man who learned he had Prostate Cancer at 41 Years Old.  A story I read with great interest, being the same age.  As for many of the others, it’s hard to recommend them individually, because it’s difficult to contact them to see who is behind the blog.  Is it a person?  Is it a company?  Is it a medical institution?  Is it just one of those fake advertising portals?  Is it legitimate? Continue reading Other Resources on Prostate Cancer and Health →

I have become more concerned about having a biopsy, given the alternatives I have found, like PCA3 and ultrasound.  I continue my search for information and options.  I found a couple websites where I was able to contact other urologists, who basically shared the same view. One suggested I might consider an extended course of antibiotics to see if I had a chronic prostate infection (Prostatitis) before doing a biopsy.  When asked about the PCA3 test or other possible diagnostics, he thought they would be interesting, but not conclusive, and would not be as reliable as a biopsy.   My question still remained.  Could a combination of other non-invasive methods be used before an invasive biopsy to reduce the number of unnecessary biopsy procedures done on men like me, with no compelling indicator for cancer? Continue reading Another Consultation: Finding a Like Mind On Biopsies With Google →

The results of my PCA3 Plus test have at least given me some confidence that I have a little time to fully research my options before I undergo an invasive procedure like a biopsy.

Newer ultrasound technology is another step that can be done before a prostate biopsy.  Like the PCA3 test, it’s not yet widely accepted as a substitute for a biopsy.  Even so, you can find a number of research studies on ultrasounds for this purpose.  Many show them to be quite promising, especially in combination with other diagnostics.  They go by a number of different names and acronyms.  “Color Flow Doppler” (CD or CFD) and “Power Doppler” (PD or PDI or PDUS or PD-TRUS) are typical names.  It might be called a sonogram, sonography or ultrasound.  Many are “3D” or “4D”.  They all apparently give a lot more information than the generic ultrasound most urologists use.  This is apparently because these newer techniques not only see basic tissue features, but also the flow of blood at some level.  Blood flow is apparently altered in tumors or cancerous regions, so this type of ultrasound may be able to detect that.

In fact, according to my friend, Google, this technology is widely accepted and used in other areas of radiology and diagnostic medicine.  Those range from locating brain and breast tumors to getting 3D images of an unborn child.  There are a lot of studies on using them to detect prostate cancer, to help stage surgery for biopsy proven prostate cancer and even as an aid during a prostate surgery or biopsy.  The results seem to vary as to things like sensitivity, specificity and other measures, but most seem to agree that these newer ultrasounds have legitimate use on the prostate, even if not yet a replacement for a biopsy. Continue reading Another Biopsy Alternative? Super Duper Ultrasound →

I played phone tag with my urologist’s office for a while, after I discovered the PCA3 test though a Google search.  I had already verified that a number of labs did this newer test in the USA.   It shocked me a little bit that my urologist hadn’t even mentioned it when I asked about alternative testing before a biopsy.  The sales rep at one of the labs who I contacted for a referral (in case my urologist wouldn’t do it) said they even worked with my health clinic and my urologist in the past for this test.  That shocked me a bit more.  The urologist’s office is busy, though, maybe they just overlooked it or felt it wasn’t useful.  Fair enough, but I decided it was still worth a call to them.  It’s impossible to get a phone call to the doctor.  You can leave a message for a nurse, that is usually returned the next day.  The nurses seemed a little resistant to letting me have this urine test.  They made sure I realized that I must still have a biopsy.  I had already scheduled the biopsy, so I didn’t see any reason not to have more information. Continue reading PCA3Plus™ Test Results Are In →

I mentioned that my urologist also wanted to make sure that the traces of blood in my urine weren’t due to some other urinary problem.  So, I had an ultrasound of the kidneys to check for tumors and stones and possibly other issues.  My results were negative.  The only unusual item was a small cyst on one kidney.  Apparently, these cysts are fairly common and require nothing but a check every few years.  That was a relief.

The next procedure wasn’t quite so easy.  Another concern was a urinary infection or bladder cancer.  The way they check for this isn’t real pleasant and, to be honest, caused me a fair amount of anxiety.  I’m now thankful that in 40 years, I’ve never had to have a catheter.  Apparently, the scope used for a cystoscopy is a glorified catheter that takes video and has some other gizmos.  First, you get some local anesthetic put up your urethra.  Even though no needle was involved, it was not real fun.  The scope wasn’t much fun either.  Plus, they fill you full of fluid to expand the bladder so they can take a good look.  Still, overall, not so invasive and it wasn’t as bad as I had anticipated.  It took maybe 10 minutes, not including the anesthesia and waiting time until the procedure.  Side effects include having the constant urge to urinate and a burning sensation, which lased a couple hours for me.  On the plus side, all was normal on this exam, too.  No indications of anything unusual from inside. Continue reading Enter the PCA3 Prostate Cancer Test →