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Choosing Active Surveillance over any further treatment at this time
Prostate Cancer | Last Active: 1 day ago | Replies (52)Comment receiving replies
Hi and thanks for the input and comments . Yes , when I had my first PSA test and it came back at 11 my regular doctor at Kaiser told me to make an appointment with a urologist . My first call to them I was told to schedule a biopsy , initially I thought it would be okay until I checked on what a prostate biopsy entailed and saw that it was a very invasive procedure - which normally I would agree to but I have had two close relatives ( my little sister and my grandmother ) the only 2 people in my immediate family that has had even minor clinical procedures - died of blood infections . This is the main reason that I hesitate to get a biopsy until all other avenues of testing are exhausted .
My first Urologist , who since retired , made a " deal " with me and said she would agree to postpone recommending a biopsy if my PSE tests didn't increase materially and in the meantime I would be on AS with regular monitoring . When I had my next urologist appointment I was assigned a new urologist - first thing he said was that I probably have cancer and he was going to schedule a biopsy - when I told him about my AS he got pissed off at me ! He said that's a bad idea - that was before he gave me a dre , which he said was fine ..... and I hadn't received my next PSE test ( I just today gave my blood sample and am waiting for the results ) . Obviously not all urologists think along the same lines - I asked him since he thinks I have cancer what does he think my gleason score would be - do you think it would be a 3+4 or worse ... again he got testy and said there is no way to know without the test but " maybe in that range " so I made a deal with him , if my next PSA test comes back and its increased by a couple points or more over my first one I will risk the biopsy .
When I asked him about a PSE test or some of the genomic testing he said they have no real track record and he would not approve anything besides a biopsy .
Anyway for now I'm just waiting for the lastest PSA test results- hoping for the best .
Replies to "Hi and thanks for the input and comments . Yes , when I had my first..."
@ovstampco
I can see others responding to your concern over infections.
First a biosy is not over invasive. There are two methods. Transrectal and Transperinial.
Transrectal comes with a 1-2% (some will give different % but this came from my Mayo urologist). And yes that infection can be very serious. However with this procedure that do have anti biotics given. It is usually done without anesthesia and a lot of us don't like that. The urologist goes in our rectum and then up into prostated to do biopsies.
Transperinial is usually done with anesthesia. The risk of infection is very very low. The scrotum is used to access the prostate. You are asleep an thus don't feel anything before, during, after. I had my biopsies done transperinial and it was very easy. I had no pain afterward. If they had not told me it was over I would not have thought it was done.
Remember PSA are only something to watch. A PSA at or below normal levels does not mean you do not have cancer. I was 3.75 (Below 4 is considered normal) and I had prostate cancer. I higher than normal PSA does not mean you have cancer. It could be BPH or infections, or irritations. Whay my urologiest and R/Os stated is the steady rise of PSA levels that are most concerning and the cause of it needs to be diagnosed.
I and many others can give you our experiences with biopsies. They are a very common surgery and if you have transperineal it comes with very very low infection and very little discomfor or any at all like I had.
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That is a legitimate concern over infections with a traditional trans-rectal biopsy. Fortunately, there is a newer procedure, the trans-perineal biopsy, that eliminates almost all risk of infection.
Not every practitioner does it yet (or even knows how to do it), but with your family history, I think you could make a strong case even if your insurer baulks at any extra cost.