All posts by Darren K

Prostate Biopsy Part II: They’re not just for testing a tumor anymore

Yesterday, I discussed some of the various unpleasantries involving a prostate biopsy.

If that wasn’t unpleasant enough, here’s the kicker.  Unlike other cancers, you don’t get a “Yes or No” (malignant or benign) diagnosis from a prostate biopsy.  You see, with most cancer, a tumor is found by hand, CT scan, MRI or other diagnostic.  Then, a biopsy is done to see if it is malignant or not.  For whatever reasons, they use an invasive biopsy to actually search for cancer of the prostate.  It’s a semi-random core sampling of 12 or more small areas within the much larger prostate gland.  If you are unlucky and have a cancer and they are lucky enough to hit the right spot, then you know it’s “Yes.”  It’s also quite possible they miss the spot.  Then you know nothing at all because of frequent false negatives.  Maybe you got it, maybe you don’t.  Some people have multiple biopsies over a period of years before they finally hit the right spot and find the cause of their worsening symptoms.  Hopefully by then, it’s not too late.

Continue reading Prostate Biopsy Part II: They’re not just for testing a tumor anymore

Biopsies Part I: What they won’t tell unless you ask

I was a bit freaked out the day I heard about the various cancers I might have and the biopsy that may be to come.  Of course, I turned to Google for answers.  It’s has been a great help, but also a big curse.  What I’ve learned is a bit surprising.

To most urologists, a prostate biopsy is routine.  They just do them.  A lot of them.  It’s a relatively quick, outpatient procedure done in their office, usually taking only 20 minutes or so.  Then you’re on your way with no restrictions, but $1000 lighter, plus or minus.  Of course, usually that’s covered by insurance, so many people don’t care.  You may know someone who had a biopsy and, being a man, they probably said it was no big deal.  Heck, around a million prostate biopsy procedures are done each year in the USA alone.  That’s a big business, measured in billions.  Still, I didn’t have any lumps.  My PSA wasn’t at an alarmingly high level and hadn’t increased much in the last year.  I don’t have any other symptoms at all, urinary, sexual or otherwise.  What was a biopsy and do they just do them as a matter of routine procedure on anyone who might have any risk whatsoever? Continue reading Biopsies Part I: What they won’t tell unless you ask

Urologists: You don’t want to be a regular customer!

I already had a urologist.  I had a vasectomy back in 2005.  I had another in early 2008.  Yup, I was very fertile, so I needed two.  I guess they don’t always work.  My first one was a Vasclip procedure.  It was marketed as being less painful, with a quicker recovery, fewer side effects and similar success rate.  In my case, it was all true, except for the often overlooked success rate part.  The second vasectomy was less pleasant overall than the first one, but at least it worked!  Vasclip is no longer in business, but my urologist is.

Anyway, I consulted him again in November of  2008 on my physician’s advice.  He did another urine test, another blood test and another DRE.  The results were essentially the same.  DRE showed a slightly enlarged, but otherwise normal prostate.  Trace of blood in the urine.  PSA level (using their lab) was 2.7.  They also measured something called “Free PSA”.  My level was 19.3%.  Over 25% is usually considered low risk for prostate cancer.  Under 10% is considered a warning flag for prostate cancer.  My level was in between, so it didn’t add much information.  What I did learn was that a PSA level of 2.4, 2.5 or 2.7 is not normal for someone in their 40s.  While a level of 4.0 is a standard level of further action for people in their 50s or 60s, my level should have been under 2.5, and the vast majority of people my age have a PSA level under 1.0 ng/mL.

What I also learned is that the trace of blood in the urine could be related to the prostate, but it could also be related to other problems in the urinary system.  Kidney stones, kidney tumors and bladder cancer were mentioned, among other possibilities.  I’ll go into that in a future blog, but suffice to say these possibilities have mostly been ruled out at this point.  For the time being, I’m still going on a moderately high PSA level and a slightly enlarged prostate.  I also heard the word “biopsy” for the first time.  I’ll be honest, that scared me a bit, though the urologist treated it as an everyday sort of thing.

A Story of PSA Levels

I’m already a couple months into my adventure with prostate health, but it began well over a year ago.  Back in late 2007, I had a routine physical at my wife’s urging.  I wasn’t quite 40 at the time.  I had no health issues or symptoms at all, other than some lab results…  My urine test showed a trace of blood (microscopic hematuria).  My blood test came back with a PSA (Prostate Specific Antigen) level of 2.5.  My physician wasn’t too concerned.  He said to have another urine test in a few months (I did, and it was normal).  As for the PSA, he wasn’t too concerned about that, either.  He said it was at the high end of normal, but is something to watch.  Indeed, the lab report said anything between zero and 4.0 (ng/mL) was a normal result, so I didn’t think anything of it.

Not until fall of 2008, when I had to have another physical in order to do some volunteer work that required some state issued forms to be completed by my physician.  As a matter of procedure at age 40, I was given my first DRE.  Digital Rectal Exam.  Yeah, not very pleasant, but I guess it’s a fact of life from here on out.  I was told my prostate was slightly enlarged, but otherwise normal.  Apparently, prostate cancer can not only cause enlargement, but sometimes makes it feel hard and/or bumpy.  So, at least I didn’t have to deal with that, not yet anyway.

Nonetheless, there was still a concern, as my PSA level was still borderline.  This time it was 2.4.  Combined with the DRE and PSA, I showed a trace of blood in my urine again.  That was enough of a warning sign that I was told to see a urologist for a consultation.  It also set in motion the series of tests and events that let to this blog.  I’ve learned a lot over the last couple months.  As I continue to learn more, I hope I can share some of it with others in a similar situation.