The appointment at the urologist's this morning (10.15) lasted at least a half an hour and included a review of family history (no prostate cancer) as well as previous infirmities, afflictions - from bronchitis to high blood pressure. Also a physical exam, which was passed with flying colors (i.e. no unuusal or abnormal growths, or enlargement of gland in question and no other evidence of anything amiss). These were all good signs, but alas, not enough to convince the urologist to leave out a biopsy.
His primary concern was the unrelenting increase in the PSA (doubling from 2.8 to 5.6 in a year, then increasing again to 6.1 in 3 months, and again to 6.5 in 3 weeks - registered in a most recent blood test that also found a low free PSA percent of 5.1. In combination, he said, all the numbers pointed to biopsy. There was only left the matter of scheduling it.
A range of dates, times was available at the front desk, but since the longer the time the longer the build up of anxiety, I decided to arrange it for next Wednesday morning, at 10.30. This would be the day after my last physical therapy session (for a strained lower back muscle) and also leave ample time to finish necessary chores ....like mowing the already overgrown lawn.
Also at the desk I was advised by a nurse of all the things which had to be done prior to the procedure, including filling prescriptions. The key one is for the antibiotic, Levofloxacin (500 mg), one of which is to be taken 1 hour prior to the procedure and the other the next day.
The issue of antibiotics and their potency is an especially critical one for me, as my wife had to be hospitalized twice for c. diff. infection in late 2006, and early 2007, after taking only four days of Augmentin.(Augmented Amoxycilliin) for a sinus infection. This high potency antibiotic essentially erased nearly all her "good" gut bacteria, leaving her prey to clostridium difficile, which had her running to the toilet 22-25 times a day for over a week, until she had to be hospitalized for treatment....ending with vancomycin - the only thing that would stop it.
On questioning the urologist about the antibiotic prescribed and possible risks of acquiring c. diff. he assured me that its emergence was more an issue of duration of use. And since I am only on it for two days (as opposed to the normal three or four) there was little chance of redux situation, with me now as the 'star'. He didn't rule out, however, adding yogurt and acidophilus to my diet to ramp up the good guys in the gut. Just as an extra precaution and because I also likely have latent c. diff. spores in the gut.
Also emphasized by the RN was the importance of following instructions on administering an "Adult FLEET Enema" 2 hours prior. The accompanying biopsy fact sheet and summary states in loud caps: IF YOU DO NOT USE AN ENEMA YOUR APPOINTMENT WILL BE CANCELLED! Fair enough! It's probably not as bad as the "cleansing" one must undergo before a colonoscopy, drinking all that disgusting pineapple tasting stuff - then having to sit on the can for eight hrs.
Before the actual procedure I have to provide a urine sample to rule out any urinary infections. Immediately before the actual biopsy there will also be an ultrasound examination, in which an ultrasound probe is inserted into where the sun don't shine. Transducers on the end of the probe then will send sound waves into the prostate. When different textures and densities are encountered to those deemed normal, the waves are reflected back to the transducer. A computer then measures the time for the sound waves to travel out and back, dispatching the information to the urologist.
The importance of the ultrasound can't be overemphasized, as it can well reveal conditions (not cancer) that are present and may have incepted high PSA readings. These include: inflammation, cysts, vascularity, and prostate stones. (One must magine they're somewhat like gall stones except maybe a lot smaller!)
Finally, the biopsy is done by insertion of a spring-loaded device (through the ultrasound tube) which injects ten fine needles, five on each side of the prostate. The end of each needle snatches tissue each time, which is recovered as a sample for the histology. Ultimately, that histology will be scored on what's called a "Gleason score" with 5 being the highest....and also indicating the worst, cancer. Two samples bearing cancer cell histology are then added together to yield the total score. What you do not want to see is anything like a '10' which basically means your choice of options for treatment is pretty limited.
I am hoping for a 1, 2 or better, 0! Anything to avoid a next round requiring treatment that can leave you in a hospital and with surgical risks, not to mention having to deal with urinary catheters, associated infections!
As for the pain aspect, the urologist was most sympathetic since not all males experience pain, but many do (leading 1 in 3 to never have a biopsy again!) The difference is attributed to whether the injecting needle hits a nerve or not. Contary to some myths, the prostate is not unenervated! It's got nerves all right, it just depends whether the biopsy needle hits 'em or not! If not, the guy brags he felt no pain. If they do, the guy goes into a ball and lets out a primal scream vowing no more tests....ever.
Anyway, I will be allowed to have a light sedative (versed) during the procedure....and yes, my wife can be there too! Perhaps the ideal nerve-calmer of all!
Showing posts with label % fpsa test. Show all posts
Showing posts with label % fpsa test. Show all posts
Wednesday, July 11, 2012
Tuesday, July 3, 2012
NOT the News I wanted to hear!
Four days before my 66th birthday, the news I received this morning was nowhere near what I wanted to hear. At 8.45 a.m. it was my doctor's voice, mellow but firm: "I'm afraid I have bad news for you: the free psa test you took last week came back with a 5.1% reading......" Of course, after two high total psa test results I'd been pinning my hopes on the free psa % (or % fpsa) to be my deliverance. (If the value came back 25% or more I could justifiaby and rationally forego a biopsy given that 92% of men in that category had BPH or benign prostate hypertrophy - not cancer. To me it was great odds to avoid the possible complications of a biopsy - see below).
It became possible about five years ago to measure the different forms in which PSA is found in the blood, either free (fPSA) or bound to serum proteinase inhibitors (complexed PSA; cPSA). It was observed that these molecular forms occur in different proportions in benign prostatic hypertrophy and prostate cancer. Patients with prostate cancer show a lower proportion of fPSA, while those with BPH have a higher percentage. Assays were developed to measure fPSA, and researchers set up prospective clinical trials. Even before results were in, many predicted that determination of percent fPSA (%fPSA) would add value to PSA screening.
Summing up results of the clinical studies with %f PSA, Milenko Tanasijevic, MD, associate director of Clinical Laboratories, Brigham and Women’s Hospital, Boston, averred, "We believe that there is sufficient evidence showing the clinical usefulness of percent free PSA in clinical practice, especially for patients in whom total PSA is between 4 and 10 and who have a negative DRE."
The relative risks of prostate cancer given by the % fpsa results are well known, and my meager 5.1% (total psa reading of 6.1 at last testing 2 weeks ago) fell into the category of men with more than a 60% probability of having cancer, as opposed to benign prostate hypertrophy.
Anyway as she rambled on, informing what the research showed on cancer probability for my % f psa my mind had by then blanked out. In any case I already knew it and the odds.
By the end of her message she flatly told me there could be no more excuses or other tests, and she was referring me to a urologist for a prostate biopsy. Of course, given the choice between that and two root canals I would likely take the latter any day. A prostate biopsy meanwhile is no sport with more than 12- 80mm long needles inserted one by one at a time into one of the most sensitive regions of the body to snatch (in turns) 1/2" sections from differing positions and then do it again. Some have colorfuly referred to it as "being sodomized by knitting needles".
One Brit who faced it wrote on his blog some years ago:
"All men everywhere should demand sedation during a Prostate Biopsy. Accept no less. Demand sedation -- unless you like knitting needles being inserted where the sun don’t shine -- and 15 samples (or more!) being extracted by a circle of eleven needles, from a place that does not usually have needles pricking it & poking it.
I think what makes me most furious is that in this day & age of instantaneous information available on the internet, the “sedation” option for a Prostrate biopsy is almost not there.
Almost not there? Far into one article the writer says, in a very vague way, “general anesthesia helps….but your insurance company might refuse to pay.’ Saying “general anesthesia helps’ sounds like saying that an aspirin might help a headache. No, no, no. General anesthesia obliterates all pain at time of contact (later you will feel some soreness). General anesthesia doesn’t just help, it annihilates all memory of the pain.
In Modern Times there should be an addition to the Doctor’s Motto: “If at all possible, inflict no pain,” should be added to “Above all do no harm.’
I really am furious at the state of affairs. Everyone needs to know that in the case of a Prostate biopsy (a very-very common procedure for older men), “There is no reason for pain in a modern, well equipped room.’"
I definitely will be taking this guy up on his advice and insisting on sedation, and whoever the urologist is may regard me as "wimp", "wuss" or whatever, but hell - if you're going to have sedation for a colonoscopy why not for something 100 times more invasive!
The pain, of course, is not the worst aspect - another is the possibility of complications which I covered in an earlier blog. SO imagine my freak out when I also pulled up a comprehensive report out of Johns Hopkins Hospital, published in The Journal of Urology in 2011, noting all the hospitalizations for infections (an increase of ~ 7%) reported within 1 month for Medicare patients undergoing biopsy since 2000. (This compares with a hospitalization rate of 0.5% during the same 1 month post -biopsy period in the 90s). You can read much more on their findings here:
http://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_study_reveals_significant_rise_in_prostate_biopsy_complications_and_high_post_procedure_hospitalization_rate
Excerpt:
"Hopkins researchers have found a significant rise in serious complications requiring hospitalization. The researchers found that this common outpatient procedure, used to diagnose prostate cancer, was associated with a 6.9 percent rate of hospitalization within 30 days of biopsy compared to a 2.9 percent hospitalization rate among a control group of men who did not have a prostate biopsy. The study, which will be published in the November 2011 issue of The Journal of Urology, was posted early online.
The researchers emphasize that this new data should serve as a reminder to physicians to carefully weigh the risks and benefits of biopsy for individual patients and take all precautions to prevent infections and other complications.
The Johns Hopkins team’s findings are the result of the largest analysis ever performed of Medicare records of American men age 65 and older who underwent prostate biopsies in the last two decades. They found that having a prostate biopsy makes patients more than twice as likely to need hospitalization in the immediate post-procedure period. Those hospitalized had a range of complications, such as bleeding and infection, as well as flare-ups of underlying medical conditions, such as heart failure or breathing disorders."
Where will this lead and where will it go? I can't say for now, but will keep blogging as long as I can and keep readers appraised. My first visit with the specialist is unlikely to be before next Wednesday and the biopsy will not likely be before the following week - Wednesday or Thursday. I keep hoping for the best including that no cancer will be found.
Meanwhile, I am weighing treatment options!
Get set for the possibility of another atheist on a cancer ward!
It became possible about five years ago to measure the different forms in which PSA is found in the blood, either free (fPSA) or bound to serum proteinase inhibitors (complexed PSA; cPSA). It was observed that these molecular forms occur in different proportions in benign prostatic hypertrophy and prostate cancer. Patients with prostate cancer show a lower proportion of fPSA, while those with BPH have a higher percentage. Assays were developed to measure fPSA, and researchers set up prospective clinical trials. Even before results were in, many predicted that determination of percent fPSA (%fPSA) would add value to PSA screening.
Summing up results of the clinical studies with %f PSA, Milenko Tanasijevic, MD, associate director of Clinical Laboratories, Brigham and Women’s Hospital, Boston, averred, "We believe that there is sufficient evidence showing the clinical usefulness of percent free PSA in clinical practice, especially for patients in whom total PSA is between 4 and 10 and who have a negative DRE."
The relative risks of prostate cancer given by the % fpsa results are well known, and my meager 5.1% (total psa reading of 6.1 at last testing 2 weeks ago) fell into the category of men with more than a 60% probability of having cancer, as opposed to benign prostate hypertrophy.
Anyway as she rambled on, informing what the research showed on cancer probability for my % f psa my mind had by then blanked out. In any case I already knew it and the odds.
By the end of her message she flatly told me there could be no more excuses or other tests, and she was referring me to a urologist for a prostate biopsy. Of course, given the choice between that and two root canals I would likely take the latter any day. A prostate biopsy meanwhile is no sport with more than 12- 80mm long needles inserted one by one at a time into one of the most sensitive regions of the body to snatch (in turns) 1/2" sections from differing positions and then do it again. Some have colorfuly referred to it as "being sodomized by knitting needles".
One Brit who faced it wrote on his blog some years ago:
"All men everywhere should demand sedation during a Prostate Biopsy. Accept no less. Demand sedation -- unless you like knitting needles being inserted where the sun don’t shine -- and 15 samples (or more!) being extracted by a circle of eleven needles, from a place that does not usually have needles pricking it & poking it.
I think what makes me most furious is that in this day & age of instantaneous information available on the internet, the “sedation” option for a Prostrate biopsy is almost not there.
Almost not there? Far into one article the writer says, in a very vague way, “general anesthesia helps….but your insurance company might refuse to pay.’ Saying “general anesthesia helps’ sounds like saying that an aspirin might help a headache. No, no, no. General anesthesia obliterates all pain at time of contact (later you will feel some soreness). General anesthesia doesn’t just help, it annihilates all memory of the pain.
In Modern Times there should be an addition to the Doctor’s Motto: “If at all possible, inflict no pain,” should be added to “Above all do no harm.’
I really am furious at the state of affairs. Everyone needs to know that in the case of a Prostate biopsy (a very-very common procedure for older men), “There is no reason for pain in a modern, well equipped room.’"
I definitely will be taking this guy up on his advice and insisting on sedation, and whoever the urologist is may regard me as "wimp", "wuss" or whatever, but hell - if you're going to have sedation for a colonoscopy why not for something 100 times more invasive!
The pain, of course, is not the worst aspect - another is the possibility of complications which I covered in an earlier blog. SO imagine my freak out when I also pulled up a comprehensive report out of Johns Hopkins Hospital, published in The Journal of Urology in 2011, noting all the hospitalizations for infections (an increase of ~ 7%) reported within 1 month for Medicare patients undergoing biopsy since 2000. (This compares with a hospitalization rate of 0.5% during the same 1 month post -biopsy period in the 90s). You can read much more on their findings here:
http://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_study_reveals_significant_rise_in_prostate_biopsy_complications_and_high_post_procedure_hospitalization_rate
Excerpt:
"Hopkins researchers have found a significant rise in serious complications requiring hospitalization. The researchers found that this common outpatient procedure, used to diagnose prostate cancer, was associated with a 6.9 percent rate of hospitalization within 30 days of biopsy compared to a 2.9 percent hospitalization rate among a control group of men who did not have a prostate biopsy. The study, which will be published in the November 2011 issue of The Journal of Urology, was posted early online.
The researchers emphasize that this new data should serve as a reminder to physicians to carefully weigh the risks and benefits of biopsy for individual patients and take all precautions to prevent infections and other complications.
The Johns Hopkins team’s findings are the result of the largest analysis ever performed of Medicare records of American men age 65 and older who underwent prostate biopsies in the last two decades. They found that having a prostate biopsy makes patients more than twice as likely to need hospitalization in the immediate post-procedure period. Those hospitalized had a range of complications, such as bleeding and infection, as well as flare-ups of underlying medical conditions, such as heart failure or breathing disorders."
Where will this lead and where will it go? I can't say for now, but will keep blogging as long as I can and keep readers appraised. My first visit with the specialist is unlikely to be before next Wednesday and the biopsy will not likely be before the following week - Wednesday or Thursday. I keep hoping for the best including that no cancer will be found.
Meanwhile, I am weighing treatment options!
Get set for the possibility of another atheist on a cancer ward!
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