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Old 11-10-2012, 10:51 AM   #8
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Join Date: Oct 2012
Location: NYC
Posts: 38
Pratoman HB UserPratoman HB User
Re: Rising PSA, need guidance on next move

Update - i called the urologist back, and asked him some questions (below with his responses) . I got the questions from readin this and another forum, and he said they were great questions, all the right one's, so thank you to everyone...... i asked
1. should we do free psa, psa3, before doing a biopsy. His response was he generally does those tests when the PSA is above 4. Since my PSA is 2.2, he thinks the results wouldn't be useful
2. What about CIPRO? - His response was that he uses CIPRO alot, but its more likely to be an infection, when there is a sudden spike, as opposed to my situation which has been trending up over a few years, slowly
3. Would doing a biopsy with what might be such an apparently very early stage situation increase the chances of false negative? He said it wouldn't
4. does he use ultrasound to guide the biopsy - he said yes
5. what does he do about pain management - he said it wasn't really necessary, he just uses a little lydocaine around the prostate. I followed up with a question about gel to numb the area before the lydocaine injection, he said he doesnt use it , there is not that much pain frmo the lydocaine injection.

He said regarding the cipro, even though my situation was not typical of an infection it was worth a try (why didnt he try it before i brought it up?) So he gave me a prescription and said to retake in a month.
I said ok. Last thing i told him was that he shouldn't be surprised if i request the records because i would go for a second opinion before i do anything invasive (like a biopsy). He was totally cool with that (as he should be, it wouldn't matter to me if he wasnt)

So that leads me to my next move. I contacted a Doc who was recommended to me at Columbia Presbyterian, Dr DeCastro, for a second opinion, i am going to see him next Friday. Maybe I am wrong, but it bothers me that the doc i am seeing is a one doc practice in a small local office. He was recommended to me by my Primary Care Doc,but you know how that goes, they are all buddies. So i have no way of knowing who is good, but i figure at Columbia, they are well known in Urology, i think on a par with Hopkins, and why not consult with the best.

So we'll see. I will be pretty nervous until this is resolved one way or the other, even though i know that if it turns out to be a problem, it is in all likelyhood very early and curable. I can't even imagine having an "i have cancer" conversation with my 29 - 30 year old kids, no matter how good the prognosis. I think thats what scares me most.