Prostate biopsy, how painful? PSA 6; smooth prostate
Age 65, digital rectal exam by internalist and also by unrologist determined that prostate is enlarged slightly, but is smooth with no lumps or rough spots. One, and only PSA check came up 6. Regarding a biopsy:
Am afraid to death of having prostate biopsy done. Should I be? How painful is the procedure? What are after effects from their taking tissue from prostate during biopsy? How concerned should I be, with a 6 at my age, should I rush to the biopsy, or wait a bit while checking psa over time? If you are a professional, do you think I should wait, watching PSA over next 6 moths, each test at 3 months, say, or not? Anyone familar with AMAS anti malignin antibody screen that, I understand, is much more accurate than PSA at determining ANY cancer in body, IF in early stages, but not in later stages? My urologist knows nothing about this test, yet I know an internalist/oncologist who uses it all the time, and it is sometimes done with people suspected of possibly having prostate cancer. Seems to me, if I understand the test and its accuracy correctly that it would be much more desireable than biopsy that is standard routine for unologists these days? Should I ask for a free PSA test---urologist didn't suggest or offer it to me, before thinking about biopsy? Any input would be appreciated, thank you in advance.
Hi. I'm not a professional.
Let me address your very understandable concern about a biopsy. These days it is common for doctors to administer a local injection of Lidocaine to the prostate area. This is in addition to putting Lidocaine gel on the biopsy probe. By all accounts, this makes the biopsy completely tolerable. Ask your doc about this.
I had two biopsies BEFORE this was common practice. They hurt, to be sure, but only lasted a few minutes. I wouldn't worry too much about pain if the doctor is going to give you a little shot of lidocaine first.
If you want it to be totally comfortable, you can have it done under general anesthesia. I had my third biopsy done like that. Piece of cake.
Your suggestion about waiting for another PSA to see the trend over time sounds reasonable. If you really want that, ask for it. On the other hand, don't do it solely to avoid discomfort.
According to Dr. Walsh, only about 9% of men in their 60's have PSAs in your range. 75% have PSAs of 2.5 or lower. 89% have PSAs of 4.0 or lower. So your PSA is high, but PSA is prostate-specific, not cancer-specific. It's possible that the elevation is caused by something else like prostatitis or benign enlargement (BPH).
AMAS is not yet a standard test like PSA. The manufacturer, Oncolab, does not recommend it for screening of the population in general, although it has been used on high risk people like chemical workers.
See the Oncolab website ( http://oncolabinc.com )under "limitations" and also these sites for more on AMAS:
Hope that helps.
Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
My experience with biopsies was very similar with no real problems. Complications are rare.
Yes, an elevated PSA can be caused by various things including BPH. The prostate naturally produces PSA, and the larger the prostate is, the more PSA is produced.
The trend is more relevant than one individual reading, and a "free PSA" test will indicate the % of PSA from benign causes, and the probability of PC.
I've had two bipsies.
The first one was almost a breeze. No problems at all.
For the second one, I was overdosed with Pethidene and passed out. They were going to cancel, but I wanted to go ahead - wasn't going through that again! Anyway I found the second biopsy only slightly uncomfortable, probably as a result of mental tension - after all I was dosed up with Pethidene.
So....painful? No. Possibly uncomfortable, but no more than that. IMHO, you should have no worries about having a biopsy, certainly you have nothing to fear from it.
It's not something you'd look forward to, but if your urologist recommends a biopsy, rest easy. You'll have more information about your condition afterwards.
I, too, was anxious about a biopsy. My PSA going in was 6. I would say that it was not painful - no more than an injection. The instrument they use must be some kind of a "gun" - there was a loud click every time they hit me, followed by the prick with no more pain than an injection - if that much. They hit me about 10 times and made me flinch every time!
In my experience, I am glad I had the biopsy right away. It turned out that it reported a Gleason of 7 and by the time I wound my way through the medical system 5 months later for a radical prostatectomy, my PSA was 13.1 and Gleason of 9.
Surgical pathology reports showed:
Focal established extra-capsular invasion
Four lymph nodes positive for metastatic cancer
Certainly if I was going to do it over, I would have the biopsy ASAP, but I know that each of us has a unique situation. I think it is ok to be anxious and even depressed - it has certainly been a part of my life for the past year!
Glad somebody else is nervous about the biopsy. I was, and both times.
First doctor didn't even give me a perscription for any pain medication afterwords. I guess I was to bite on a bullit that night.
Second time I was a pro and it was still no fun.
I'm just glad medical science has invented that little gun they use, as I wouldn't want some doctor with a scaple doing the same thing.
I counted backwards as the little spring loaded gun thingie takes its samples. That helped.
Second doctor had a smaller device which was more "comfortable" than the first doctors chrome plated telephone pole, he used.
After a day your fine and you forget about it. (sort of like labor I guess)
Good news is that it saved my life, as I had just a 4 PSA but a good sized tumor that would have gotten alot worse as I watched my PSA every 3 months.
My PSA dropped to 3.2 just to fake me out too. My prostate was smooth and felt perfect to all doctors.
Guys I feel sorry for are the ones who have the rising PSA, but take repeated biopsies, which are all negative.
The other good thing is the biopsy makes the RP surgery seem easy, as they use alot better drugs on the RP.
The most important thing is to get the biopsy done soon, not next year.
I would repeat the PSA test. 2 days prior to test, do not ride a bike, no strenuous exercise or have sex/ejaculate as this can cause a slight rise in PSA. Also, do not have digital exam prior to PSA test. You should also have your urine tested for infection prior to PSA test. If there is infection, antibiotics should be given and then retest PSA. Also, BPH can cause rise in PSA. Inflamation of prostate gland can cause a rise in PSA. Be sure to rule out all infection possibilities, then follow guidelines above prior to retest.
I would do the above to ensure the most accurate reading possible.
I had my PSA jump from 4.0 to 5.4 in 12 months. My doctor suggested an immediate biopsy and he did it 3 hours later. While I felt all 12 stings, it wasn´t that bad and worth in the end. I had 2 with a Gleason 6 (3+3) each. Since this was my second biopsy I had an idea what to expect. For me the sting was worth the peace of mind.. Schedule for removal 1 May.
I just had one a month ago. It was my second, the first was moderatedly painful (7 years ago). The one I just had they shot something in there that numbed me up, it was painless. Don't fret.
don't worry too much about the biopsy, I have had 2 and they are fairly easy. My PSA climbed from 4 to 8 over a couple of years and it turned out to be BPH.