Biopsy or not?

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So I have been to my Urologist now twice with prostate issues. I have pain in my groin. I am having a clear discharge after urination and I go a lot. Some times my orgasm is painful and I have noticed a lack of sex drive. She wants me to try Alfuzosin to help with urination. I had just finished three weeks of Cipro and had some improvement of my symptoms. I noticed last night that when I have an errection that I can feel a lump in my Rectum. My meeting with my uro went a bit strange if you ask me as she asked do you think you still have prostatitis? I said I am not sure because I still have symptoms, so she didn't want to do a PSA test yet. She said try the medicine to see if you get a bit of releif and come back in four weeks we will test your PSA then and if it is high she said she will want to do a biopsy. I feel like she knows something that I don't. My dad had similar issues at my age and it was BPH and they never did a biopsy on him so why me? I did find it painful when she milked my prostate as I screamed. Frankly I didn't think that would happen, but years ago when I was 18 I had to see a Urologist for a similar problem and I remember that it hurt so bad I passed out. This seems to be normal for me. Call it a hunch, but I don't beleive that I have prostate cancer, but I doubt that I will have a low PSA with all that is going on. Honestly what will change in 4 weeks that she wants to do a PSA then? I doubt things are going to change. I will not have a biopsy though. If I have to explore this more I think a 3T MRI would show what is wrong with my prostate and it will tell if I need a biopsy or not. Why on earth would my Uro assume my PSA is going to be high and need a biopsy. Why wouldn't we do some less invasive tests first. Anyone else have these issues? I am scared now to go back in.

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  • Posted

    If you have a prostate infection, your PSA is usually high and can take some months to settle back. Blind biopsy is crazy without an MRI as you just get 12 or so needles into your prostate at random, all looking for cancer.

    I just had a mpMRI with a 3T machine. Get my report in a day or so. I have had prostatitus for the last 4 months (PSA 12)and doctor said no blind biopsy, but a MRI guided biopsy to the suspect sites if the report warrants it.

    Geoff

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    • Posted

      That makes sense to me as I think that we should try to find out if a biopsy is even needed. I really think it is BPH or still a stuborn case of prostatitis. I think one reason she may be jumping to a biopsy is I am on testosterone replacement so some believe this can fuel cancer. My other doctor thought that it can cause PC and said no. There is no study that links PC to TRT. I told her I would have never started TRT if I thought it could cause PC. Frankly, I don't think anyone would.

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  • Posted

    Craig.........Geo  Is right.  You have a prostate infection.  Sometimes it takes a while to heal.  Last year I had a prostate infection in Dec.  Was on Cipro 1000mg for a month.  Give it time. My PSA last year was 4.0 and a few weeks ago my PSA was 0.7  Which my Uro is happy with.  If you have prostatitis try to watch what you eat.  I have a friend that I worked with that is 32.  He has had prostatitis from the time he was 17.  He follows what he eats and take his pills and he is doing great.  Don't be pushed into anything  Ken    

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  • Posted

    geoff90305 and you are correct.  An mpMRI is the only way to go now to determine if your prostate has any areas suspicious for PCa.  Random biopsies are obsolete.   Presumably, your urologist thinks that an infection will be gone in 4 weeks.  And I also agree that mentioning biopsy is premature without an mpMRI.

    If an mpMRI turns up suspicious areas, then a biopsy would be next.  Best is an in-bore biopsy on the same MRI machine that the mpMRI is being performed, so the biopsy needle can be directed precisely at the suspicious area.  Next best is the overlay method using software to overlay the MR image on the Ultrasound image. Third, is the so-called cognitive registration without actually overlaying the two images on the US machine.

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    • Posted

      My urologist said "If" he needs to do a biopsy, he always has a mpMRI done first  and gets the report. If report suggests some suspicious areas,  then an in-bore biopsy on the same MRI machine is carried out within a week or so.

      Geoff 

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    • Posted

      Then if a tumor is found.  You can have a Focal Laser Ablation done.  It is also done  with a MRI machine. It targets just the tumor and leaves the healthy tissue alone.  A urlolgist the first thing they what to do is a turp to get ride of it.  They say this so they can check the tissue.  One thing get me if it good there is no way to put it back.  Take care guys  Ken    
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    • Posted

      The Focal Laser Ablation looks like the same as a lumpectomy for a breast. Also, it appears to offer the least invasive procedure. 

      I seem to see many non complimentary comments about TURP

      Geoff

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    • Posted

      I think it old and I am glad that there are new procedure out there.  I had a Uro-lift done in April of 2015 I'm great No side effect.  To many problems with any of the procedures that cut or burn away at the prostate.  I think unstead of making it better they make it worse.  You take care of 1 problem and you end up with many more..Take care  Ken

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  • Posted

    Trans-Rectal Ultra Sound.  Ask you urologist about this test instead.  It is more accurate and not invasive as the biopsy they use that uses needles and samples taken by pricking sections of you prostate.
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    • Posted

      I had always thought the TRUS was quite a bit behind the mpMRI, as the TRUS shows shapes and shadows. And compared to MRI guided biopsy, not as good identifying the area to be biopsied. The mpMRI shows in detail the prostate border outline, multiple slices some 3mm thick and any dodgy areas usually clearly shown, as well as a good guess at the severity of the pca, if found.

      In Australia, our Government will not allow an MRI for prostate to be rebated in our health scheme, and we have to pay for it 100%. The TRUS and TRUS Biopsy has a Government rebate. Maybe we need a few Government 'members' to go through a prostate evaluation to realise how beneficial a MRI is. 

      Geoff 

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  • Posted

    Same old story. It sounds like you need a different urologist. You are correct about the 3T. The 3 T can detect cancerous tumors, and non cancerous ones. That should be step 1 after you get a new urologist. Then, if they do decide to do a biopsy, at least they will know where to poke, and not be shooting blind. Shooting blind is dangerous because they can miss a cancer all together, or miss a dangerous cancer, and hit one that only justifies "watchful waiting", so you will wait while the dangerous cancer grows. She doesn't seem to know what she is doing; get someone else.

    A biopsy is dangerous by itself, so it shouldn't be done lightly. Doesn't stabbing a large needle several times through your NON-STERILE colon into your prostate sound like a wonderful way to get one hell of a prostititus??? They may ply you with antibiotics before the biopsy, but if that worked, prostititus from any source would be easy to cure, and it isn't.

    In any case, you could have a UTI, or already have a prostititus. Start with a new urologist, then a UTI test, then if that's negative, get the 3T.

    If you had a cancer for so many years, you would be dead now. Most likely you have a UTI or prostititus.

    Let us know what's going on.

    Neal

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    • Posted

      That is what I was thinking. I figued I have had these symptoms for over a year now and if it were an agressive cancer I wouldn't be here now. It could also be BPH. I just not buying the whole cance thing. So I will have to ask her why she is so quick to biopsy in my case. I would get a 3T if possible first, but insurance has to pay and not sure they will. Here is the deal, I have not had the PSA yet and both my Uro and I think it will be high, but it might be just fine. So I will stress if it is high, until then I think I need to relax a bit. Thanks for the reply.

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