Connect
Questions about the diagnostic process
Hello,
I'm a 63 year old male. My dad had prostate cancer at 58 years old in 1990. He had radical prostatectomy (the procedure was pretty rough back then) but he's been cancer free since. About three years ago I noticed common urinary issues that got progressively worse (reduced stream, trouble emptying, etc.). My PSA tests started rising over the past couple of years and finally got referred to urologist when it was over 4. I got put on Flomax. They ran a PHI test which was 47.9 so got sent for 3D MRI with contrast on a 3T machine. Here's the radiologist's impression: Lesion 1: At the level of the mid gland extending into the prostatic apex in the right lateral transition zone, there is a mildly T2 hypointense lesion with associated diffusion restriction measuring up to 1.7 cm with a volume of 1.28 mL (PI-RADS 4). I got scheduled for a transrectal fusion biopsy with a well known urology oncologist. My doctor/hospital is Duke University Medical Center, a national cancer center of excellence. I have several questions...
1. Is it normal to wait over two months to get scheduled for a biopsy after MRI? They said they were unusually backed up because of increased patient volume.
2. I've been immunocompromised in the past due to an autoimmune disease/medications and had numerous serious infections including bacterial meningitis. I'm not currently on immunosuppressing meds. I asked about risk of infections from transrectal procedures because I read they are fairly common. They said almost all the doctors at Duke do transrectal fusion biopsies and that prophylactic antibiotics should keep me safe. But the Nurse practitioner said she'd ask as one doc does transperineal biopsies but I never heard back . Should I press this issue more or just go along with the transrectal procedure?
3. Is a 1.7 cm/1.28 ml lesion large enough to cause the urinary symptoms? Or maybe there's also BPH?
4. I know that biopsy if the only way to officially diagnose malignancy. But with what is known so far, how prepared should I be for the biopsy to be malignant?
Thanks!
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
I had a 30 core transperineal MRI fusion guided biopsy because of my large 120 gram prostate at Mayo Phoenix and it was painless and much less worrying than a transrectal although I told the urologist that if I had a choice between him or going to the dentist the dentist would win every time.
-
Like -
Helpful -
Hug
3 ReactionsI would absolutely go with transperineal - totally avoids fecal contamination and possible infection - some of which can be life threatening even without immune issues.
I pressed for one, had it done with local anesthetic; no pain, blood in urine or aftereffects. Besides, many feel there is greater access to more surfaces of the prostate using the TP method. Best!
-
Like -
Helpful -
Hug
2 ReactionsI was fearful of that procedure also.I spent 50yrs in the animal industry and watched 99.9percent of animals tha somehow got fecal material inside their body cavity die inspite of whatever antibiotic used. I was flabbergasted by the proposed procedure . Not enhanced by the death of my friend from septis from his biopsy, Urologist assured me the likelihood was only 1 in 764 that I would die from it. Changed urologists at that point and went to a nci facility took the protective antibiotic and lived to tell this tale.
-
Like -
Helpful -
Hug
1 Reaction1. My father also had prostate cancer, and I followed PSA until it got over 4. I waited 2 months from decision for biopsy until appointment was available. I assumed I had cancer until proven otherwise (which of course was the case.) Use this time to learn about possible treatments and ways to manage side effects.
2. Since you are immuno compromised and have had infections as a result before, I would be very assertive with your desire for minimal risk, and don't rest until you can get a transperineal biopsy. I had a transrectal with no pain or complication, but in your case, caution is the best approach.
-
Like -
Helpful -
Hug
2 ReactionsI switched to an NCI Designation Cancer Center. It really helped. I created a simple "Notes" treatment tracking timeline on my phone to use before, during, and after my oncology sessions, helps me and oncology/cancer team with communication treatment planing/process.
-
Like -
Helpful -
Hug
1 Reaction