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Should he have a biopsy

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User
Posted 25 Nov 2014 at 11:57

Hi

First time on here and looking for some advice.

By way of background my 56 year old husband had a CT scan to check for reoccurence of kidney stones in September. Three weeks later he had an urgent call from his urologist asking him to go in immediately.  It transpired that swollen lymph glands had been detected and prostate cancer was suspected.  A DRE and PSA check followed and the next day he was told his PSA level was 476 and that he had prostate cancer.  His urologist started him on a variety of casodex immediately and two weeks later he was given an injection of Zoladex.

All that was 4 weeks ago and since then he has had an MRI scan, a bone scan and a further PSA test.

Last night he was told his PSA level had fallen to 14 and the cancer had spread outside his prostate.  His urologist had predicted this but was very pleased with the fall in the PSA.

The question now is does he need a biopsy ?

My husband is not the best at dealing with all this and he has heard that a biopsy is a particularly unpleasant procedure.  He asked the urologist if it could be avoided and we were told it was only necessary for statistical purposes although he probably would have to have it done if an oncologist became involved.

He's worried now that by not having it done it could make his situation worse.  Does anyone have any advice on this ? 

Its a difficult situation at the moment.  He's not the most positive of people and I would welcome any upbeat stories I could pass on to him

Thanks

 

User
Posted 25 Nov 2014 at 15:26

Hi

Most of the men on this forum including myself have had a biopsy. I would not describe it as "particularly unpleasant". A local anaesthetic is injected into the prostate to reduce discomfort. I found it a little uncomfortable and not so different from the DRE except there is a bit of noise as the needles take the tissue samples. I did not experience any pain although some men do. About a dozen samples are taken.

It only takes a short time about 30 minutes and you can leave the hospital soon after the procedure is over. The down side is that there is a possibility of contracting infection although you take antibiotics before and after the procedure as a preventative measure. There can also be some bleeding for a couple of weeks afterwards.

You are allowed to eat and drink normally before and after the biopsy so it can't be that bad.

As far as I understand it the biopsy is necessary firstly to confirm the cancer and secondly to allocate a Gleason grade to it. That may be the "statistical purposes" that were mentioned to you. The Gleason grade is a number running from 2 to 10 depending on how aggressive the cancer is. Grades are usually between 6 and 10 with grades 8 to 10 being the most aggressive.

The Gleason grade and the results of the MRI and bone scan determine which are the most suitable treatments.

I found that the thought of the procedure was much worse than the actual experience. I seem to remember discussing the weekend's football results with the medical team as I lay there having the samples taken.

Tom

Edited by member 25 Nov 2014 at 15:27  | Reason: Not specified

User
Posted 25 Nov 2014 at 16:19

Hello & welcome aboard. Even though we'd all rather not have to be here.

That's an excellent drop so far in the psa & shows the P.Ca. is responding favourably to treatment.

Strictly speaking a biopsy is not required at this time as the Urologist is happy to start treatments based on the other evidence. This sometimes is the case & there are men who never have a biopsy.

The question may rise again if other treatments such as radiotherapy ( R/T ) are deemed appropriate to help. Until all the scan results are discussed then that is an unknown. But if an Oncologist requests one then maybe insist anaesthetic is used. It wasn't for me & it was not pleasant , but quite manageable & I drove home straight after.

Treatments will not be withheld I'm sure ! So I'd suggest wait & see if deemed really necessary for additional treatments. Then he may feel it's worth a little bit of temporary discomfort for a few minutes.

 

My results were a high grade ( 4+5 ) and high; I'm still here over ten years on.   

User
Posted 25 Nov 2014 at 17:31

Not pleasant, but not difficult to deal with. If the advice is to have the biopsy, then get it done. The results will help determine the treatment path for the better. To leave it for a bit of discomfort would be folly, maybe not disastrous, but would help give the best chance in the future.

Paul

Stay Calm And Carry On.
User
Posted 25 Nov 2014 at 18:22
Hi

One thing to bear in mind is that hormone treatment does have an effect on the structure of the Cancer cell, which makes it difficult to grade and may give a false reading depending on how long ago hormone treatment started.

Roy

User
Posted 25 Nov 2014 at 19:33

Hi welcome I found the biopsy was not unpleasant and apart from a twinge felt no pain , my lymph nodes where swollen and I had a biopsy under local anisthetic (they did remove one) this came back clear good news and apart from bruising it was ok,in both instances I found that everyone involved treated me well and talked to me explaining what they where doing .all the best Andy

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User
Posted 25 Nov 2014 at 15:26

Hi

Most of the men on this forum including myself have had a biopsy. I would not describe it as "particularly unpleasant". A local anaesthetic is injected into the prostate to reduce discomfort. I found it a little uncomfortable and not so different from the DRE except there is a bit of noise as the needles take the tissue samples. I did not experience any pain although some men do. About a dozen samples are taken.

It only takes a short time about 30 minutes and you can leave the hospital soon after the procedure is over. The down side is that there is a possibility of contracting infection although you take antibiotics before and after the procedure as a preventative measure. There can also be some bleeding for a couple of weeks afterwards.

You are allowed to eat and drink normally before and after the biopsy so it can't be that bad.

As far as I understand it the biopsy is necessary firstly to confirm the cancer and secondly to allocate a Gleason grade to it. That may be the "statistical purposes" that were mentioned to you. The Gleason grade is a number running from 2 to 10 depending on how aggressive the cancer is. Grades are usually between 6 and 10 with grades 8 to 10 being the most aggressive.

The Gleason grade and the results of the MRI and bone scan determine which are the most suitable treatments.

I found that the thought of the procedure was much worse than the actual experience. I seem to remember discussing the weekend's football results with the medical team as I lay there having the samples taken.

Tom

Edited by member 25 Nov 2014 at 15:27  | Reason: Not specified

User
Posted 25 Nov 2014 at 16:19

Hello & welcome aboard. Even though we'd all rather not have to be here.

That's an excellent drop so far in the psa & shows the P.Ca. is responding favourably to treatment.

Strictly speaking a biopsy is not required at this time as the Urologist is happy to start treatments based on the other evidence. This sometimes is the case & there are men who never have a biopsy.

The question may rise again if other treatments such as radiotherapy ( R/T ) are deemed appropriate to help. Until all the scan results are discussed then that is an unknown. But if an Oncologist requests one then maybe insist anaesthetic is used. It wasn't for me & it was not pleasant , but quite manageable & I drove home straight after.

Treatments will not be withheld I'm sure ! So I'd suggest wait & see if deemed really necessary for additional treatments. Then he may feel it's worth a little bit of temporary discomfort for a few minutes.

 

My results were a high grade ( 4+5 ) and high; I'm still here over ten years on.   

User
Posted 25 Nov 2014 at 17:31

Not pleasant, but not difficult to deal with. If the advice is to have the biopsy, then get it done. The results will help determine the treatment path for the better. To leave it for a bit of discomfort would be folly, maybe not disastrous, but would help give the best chance in the future.

Paul

Stay Calm And Carry On.
User
Posted 25 Nov 2014 at 18:22
Hi

One thing to bear in mind is that hormone treatment does have an effect on the structure of the Cancer cell, which makes it difficult to grade and may give a false reading depending on how long ago hormone treatment started.

Roy

User
Posted 25 Nov 2014 at 19:33

Hi welcome I found the biopsy was not unpleasant and apart from a twinge felt no pain , my lymph nodes where swollen and I had a biopsy under local anisthetic (they did remove one) this came back clear good news and apart from bruising it was ok,in both instances I found that everyone involved treated me well and talked to me explaining what they where doing .all the best Andy

User
Posted 26 Nov 2014 at 08:57

Thank you all for your advice.  It's cetainly something we need to discuss again with his urologist.  He left the decision up to my husband but I'd hate to think it could affect a later treatment plan if his cancer wasn't given an initial gleason score.

I hope you're all keeping positive.  It's something my husband is finding it difficult to be but I'm hoping that comes later since we're still in the early days of initial diagnosis.

User
Posted 26 Nov 2014 at 09:19

Hi N56,

Most men do have a biopsy in the initial diagnosing stage. Trevor was however one of the few men who didn't have one his initial starting psa was 13000 and his scans revealed significant spread in his bones and lymph nodes so coupled with this and other medical issues his Oncologist at the time decided not to do a biopsy. (We have since changed hospitals ) but not for this reason.

Well done for the drop in your OH psa it is always heartening to see this. Every man copes differently with this dx and there is no right or wrong way , some as your OH react in not wanting to know very much (head under the quilt response) this is Trevor by the way and others research like mad .

Anyway welcome to our gang although I am sure like the rest of us you would rather not be here. I have found the forum to be my life line in the past 18mths so if you find it helpful keep posting we are a friendly bunch .

BFN

Julie X

ps very interesting Roy that the HT changes the structure of the cancer cells. X

NEVER LAUGH AT A LIVE DRAGON
User
Posted 30 Mar 2015 at 10:39

hi

if this helps just back from hospital after having my biopsy, as others have said the thought is much worse than the procedure,  the doctor who did mine made me feel relaxed from the start, it was all over much quicker than expected didnt feel any pain, just heard the loud clicks which sound like a stapler being used, took 10 samples in total, so now we sit and wait.

run long and prosper

'pooh how do you spell love'

'piglet you dont spell love -you just feel it'

User
Posted 30 Mar 2015 at 19:10

Hi

 

My husband was given the option of general anaesthetic as he is not great with needles. He was in for the day.

Glen

User
Posted 01 Apr 2015 at 22:45

My experience of 12 core biopsy was that it was just like being flicked gently with an elastic band and having a minute amount of blood in my urine for 2 to 3 days afterwards. Another advantage of biopsy which I can't see that has been mentioned so far is that the samples taken help identify which type of cancer is present - there are at least 27 types and it may help and oncologist help form what he feels is the most appropriate treatment along the line for a particular type of cancer.

Barry
 
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