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
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.
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
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.
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.
This is my personal blog about prostate health, with an initial emphasis on biopsies. It is a journal of my adventures from learning I had a high PSA level, to having various tests and procedures. Do I really need a prostate biopsy? Are there any options or alternatives to a prostate biopsy? I hope to answer these questions for myself over the upcoming weeks and months. There will also be information on other aspects of prostate health, including cancer, as I go through more testing.
The information on this blog only applies to my personal medical issues. I am neither a doctor or nurse, nor do I have any medical training whatsoever. I do know that physicians are very busy and don’t always have time to keep up on the latest treatments. I also know they can make mistakes or get stuck in a one-size-fits-all routine of treatment. If you think you aren’t getting the best advice, do some research and get a second or third opinion from a specialist or medical professional!