Just had my annual physical at 59. PSA went to 3.9 - double the previous year. Prostate enlargement was detected, so off to urologist I was sent. They said "we can offer you a biopsy." I've read quite a bit, and have scheduled the biopsy, but have some concerns about possible infection. Today they said they would administer an injection for pain control. Nothing said about numbing gel of any kind. Procedure to be done at Lahey Clinic, Burlington, MA. Input? Feedback? Opinions? All views are welcome. Also, I contemplated having PSA retested and foregoing the biopsy for two months. Thanks all! T Hart
Infection is usually not a problem if you take your antibiotics before and after. My favorite anti-pain technique is an injection or two of prilocaine/lidocaine to numb the area, followed by a nerve block into the prostate. Zero pain. Zero residual drowsiness.
That said, I am not a big fan of rushing into biopsies because it's often the start of a slippery slope. If it were me, I'd take two weeks of Cipro to rule out bacterial prostatitis, then take another PSA. If it's still high, I'd go on Proscar or Avodart for 6 months to rule out the effect of BPH. If your PSA doesn't drop or continues to rise after that, a biopsy might be a good idea.
I've seen too many guys have a biopsy, find an insignificant amount of what probably would be an indolent cancer, and suffer the consequences of a prostatectomy.
There will be a new blood test called PHI sometime soon. You can also get a PCA3 test, if you want, although insurance may not pay for it unless after a negative biopsy.
I agree with the antibiotic although 95% of any case of prostatitus is non bacteriological. Taking additional tests such a PCA3 is another good idea. I too was thinking of taking Avodart to lower my rising PSA, but I didn't want to confuse the natural path and start a new base line which would probably confuse the urologists on where my PSA was really going. It certainly would be a good idea to take another PSA test within a few months with free PSA to rule out lab error. I agree that every stone should be overturned before going for a biopsy.
Last edited by Administrator; 09-15-2012 at 02:27 PM.
A short term followup repeat PSA is a good idea, although most urologists do not give antibiotics for the repeat unless they suspect bacterial prostatitis.
We are assuming your DRE did not show anything suspicious.
Sorry you have entered the elevated PSA conundrum.
Last edited by hb-mod; 08-27-2012 at 03:53 PM.
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I had my 12 needle biopsy a few months back under the NHS in the UK. It went ok, no infections and despite what people say, not a lot of pain. I made sure I voided before I went to the hospital. They gave me IV Gentamicin 160mg, Ciproxin 500mg for 5 days ( I took the first dose in the hospital ) and PR Metronidazole 1gm. A numbing injection was administered through the rectum into the prostrate and I hardly felt a thing. I was talking away to the nurse whilst it all happened and counted the clicks so I knew when it was over.
I made sure I took the Cipro as instructed. I also drank lots of water each day and I have been fine. Blood in semen but to be expected and fades away after time.
Personally, one of my worries about the biopsy is my allergy to most antibiotics., I still have fasciculations as a side effect from taking Levaquin for 30 days to rule out bacterialogical prostatitus. Some antibiotics can by themselves have some nasty side effects. I believe Cipro and Levaquin are from the same family of antibiotics (fluoroquinolone). Of course, I'm probably one of the very few with side effects and antibiotics are a must for a Trus biopsy.
Last edited by Infinity29; 08-28-2012 at 03:39 PM.
In reply to T Hart initial post I feel that, prior to offer the biopsy, they should have tested, with total PSA, also the free PSA. While there is an ample marge of indeterminacy the free PSA percentage is helpful in distinguishing BPH and PCa.
Have you done it?
From my readings and trying to educate myself I also agree today with Tad Allen post.
As I am near your age and have similar PSA I also posted elsewhere on my status, concerns and doctors recommendations. You might wish to check that thread too.
I did a 28 day course of Cipro also, and my PSA stayed at 25. At that point, along with some lower back pain, I was pretty convinced the biopsy was in order. Your PSA is relatively low although high enough to warrant decisive action...the longer you wait the less options you will have for treatment. I would definately try a short course of antibiotics and have a second test to rule out infection or inflammation, and make sure you have no sexual activity several days prior to the PSA test as this can elevate the readings. However, the biopsy is the only way to know for sure if cancer is present, and I can't see how it could be "the start of a slippery slope." Either it is cancer or it isn't, and the biopsy will show this generally. the only way it wouldn't is if the tumor is so small that they miss it in the 12 cores they sample...which, if that is the case, I would keep getting PSA tests every 6 months, and if it keeps rising, I'd have another biopsy down the road. Once it is detected, it can be treated...and if its not, then watchful waiting is sufficient. Cancer is not something to play a guessing game with, and a needle biopsy isn't that big a deal. It was quick, I was under light sedation and came out of it easily, and the after effects were minimal . Some blood in ejaculate after a week or two but it cleared up. I had none in my urine but some men do briefly. No pain.And the pathology report was back in a week and then you will know conclusively and can plan from there.