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Biopsie: im Spital oder bei einem Arzt?

User
Posted 03 Dec 2024 at 07:39

My husband (PSA 67, extensive PI-RADs lesion in tZ and pZ with long contact to pseudocapsule, relatively fit, in his 50s) should have a fusion biopsy as a next step. 

I already got him an appointment at a nearby hospital (the one mentioned by the referring urologist) but a husband of a colleague said he could do it at this practice (this would be on our social health insurance the same as in hospital, we are not in the UK, so it is not a question of money) and recommends this as it would be less hectic than in hospital and apparently takes less than 10 minutes. That sounds nice to me but not sure how much I should say one thing or another to my husband. 

Both options would be soon, the hospital scheduled a pre-Op consult for this Friday with biopsy one week later. My colleague's husband would be roughly the same time frame, on the other hand he is further away than the hospital but not a major journey. 

Anyone who has been through it have a recommendation? I only want to be supportive of course and not complicate things or stress my husband. 

User
Posted 03 Dec 2024 at 11:11

In my opinion go to the hospital. Imagine if you need a second opinion about something, effectively you are telling your colleague you think her husband is wrong. How is that going to effect with your friendship.

The hospital is more anonymous, and that's better.

Dave

User
Posted 03 Dec 2024 at 16:21

I can well understand that a smaller place makes it appear more comfortable and personal.   If I was confident the place had the same or better equipment, staff and timescales it could be tempting.

Although, as you already have the date of the biopsy at the hospital and Christmas is approaching I'd be wanting to get it done.   There are possible advantages of having all the diagnosis and treatment at the same place.  Dividing treatment makes any blame for delays, for example, less easy to identify. 

The biopsy isn't always accurate, mine was upgraded after the operation, and that's not uncommon.  So the final treatment is a bigger factor.

Thanks for coming on here.  It's noted you're in Austria and it would be interesting to know more about how treatment goes there if you wish to continue asking or writing progress.

I recognise your name is 'questions'.

All the best, Peter

Edited by member 04 Dec 2024 at 14:39  | Reason: Not specified

User
Posted 06 Dec 2024 at 18:18

The biopsy is basically painless. Once the Doctor begins he will hear clicks each time a core is taken. My only preparation was a self administered fleet enema just to clear the rectum prior to my leaving for my appointment. Once I went into the Doctors office I was back out in less than 20 minutes including the time I waited for him. Mine was ultrasound guided based on the MRI. I did take antibiotics before and after. My Urologist said he had never had anyone get an infection for the hundreds he has done and from speaking with other Urologists anyone that has they believed the patient fid not follow the antibiotic regimen. I actually had to take them for a week due to a weakened immune system from chemotherapy from an earlier cancer 20 years ago. No special requirements afterwards. I was told I might have a little blood in my stool (I had none) or in my urine. The only blood in my Urine was immediately after I was done with the biopsy I went into their bathroom to urinate and one tiny clot of blood was in the toilet. That was it. Never any further blood on urination. My Biopsy was at 5:30pm so I just went home, but was told if mine had been in the morning I could have returned to a light office job in the afternoon. No special needs of the bathroom were required, just told to drink plenty of water. Now what was shocking although I was warned was that my semen would be rust colored. Abstaining from sex or ejaculation for a week  I think is what I recall and no heavy lifting for a couple days. When my wife and I decided to play around we decided to hold off on actual intercourse the first time to see my semen. After that it was decided to temporarily use a condom more for her comfortability with the color of the semen as there was nothing wrong with it. The color returned to normal within 3 weeks. Hope that helps.

User
Posted 06 Dec 2024 at 19:50

I found the biopsy quite uncomfortable , but not painful.   I had 30 ‘cores’ ( like having staples is the nearest description ).  I have had no trouble with peeing apart from going quite often , but I was doing that before. I had a small amount of blood ( a bit like diluted tomato juice) for the first inch of a pee for about two weeks , but it was no bother.   Semen does come out brownish red which does spoil the moment a bit !! I did a 4 mile walk a couple of days after the biopsy with no problem. 

User
Posted 07 Dec 2024 at 10:24

My experience was similar to those above.  I found it a bit uncomfortable, a dull pain, and decided to clench my buttocks but the doctor told me to stop doing it.  When I got the results 3 samples were missing and I wondered if they were the one's I clenched.   They only found cancer on 1 sample and it was only 5% of the tiny sample.  That was surprising as it was 13mm I was told.

I recall they gave me a large pad to put in my underwear and some extra ones.  It had blood on it.  If it is a rectum biopsy he should eat food that makes his stools softer.

Looking forward it could be Christmas before you get the result.  In the UK I had 2 appointments in the Christmas week as my operation was 16th Dec.  One was to remove the staples from my operation and the other was to remove the catheter.  So you might get the result at that time.  I was called at home and asked to go to the hospital that afternoon where a nurse gave me the result.   I then had an MRI and a bone scan a few days later.  Nowadays they do the MRI first.

Good luck  Peter

User
Posted 07 Dec 2024 at 15:05

I sometimes wish I'd asked for such reports. Many people say you should. I find it worrying.

I don't have any qualifications on this but after doing a search those terms are like many things that can be either way so it advises a biopsy.

He might need something to reduce inflammation as well as whatever other treatment they offer.

His prostate is very large, 112cc, and there is a calculation that says what your psa should be for size of prostate.  Also how much psa a lesion of gleason 3, 4 and 5 produces. A 3 isn't far off normal but a 4 gives quite a lot more.

You could worry yourself by thinking too much.  I was told to take each step as it comes.  Calculations can mean little as I found when mine re-occurred much slower than I calculated.

Today we have winds with 100kph gusts so I'm staying in.  See if anyone else has more information and feel free to reply.

All the best Peter

User
Posted 07 Dec 2024 at 17:31

The ellipsoid sounds a better formula than the square.  I didn't think the difference would be so great.  Although we don't know the shape.

Walnut is often used as a size comparison.

User
Posted 15 Dec 2024 at 15:19

Hi,   Yes, I think it would be better to tell them.  I was giving an alternative which was fine for me.  Males should be told in case it runs in the family and they want psa monitoring earlier than normal.

Is it a PSMA PET scan.

Good luck with the results.  Peter

 

 

 

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User
Posted 03 Dec 2024 at 11:11

In my opinion go to the hospital. Imagine if you need a second opinion about something, effectively you are telling your colleague you think her husband is wrong. How is that going to effect with your friendship.

The hospital is more anonymous, and that's better.

Dave

User
Posted 03 Dec 2024 at 16:21

I can well understand that a smaller place makes it appear more comfortable and personal.   If I was confident the place had the same or better equipment, staff and timescales it could be tempting.

Although, as you already have the date of the biopsy at the hospital and Christmas is approaching I'd be wanting to get it done.   There are possible advantages of having all the diagnosis and treatment at the same place.  Dividing treatment makes any blame for delays, for example, less easy to identify. 

The biopsy isn't always accurate, mine was upgraded after the operation, and that's not uncommon.  So the final treatment is a bigger factor.

Thanks for coming on here.  It's noted you're in Austria and it would be interesting to know more about how treatment goes there if you wish to continue asking or writing progress.

I recognise your name is 'questions'.

All the best, Peter

Edited by member 04 Dec 2024 at 14:39  | Reason: Not specified

User
Posted 03 Dec 2024 at 16:58

The biopsy is quick and without pain. I would still have it done at the hospital as having a close colleague connected to it as just being given a referral by a colleague and you then check the person out. Your records are at the hospital along with the tissue and your colleague’s husband does not need to add a step getting it to pathology which is probably at or near the hospital. A good excuse is you are just going to the hospital for convenience because of the holiday’s.

User
Posted 06 Dec 2024 at 16:37

Yes, we are in Austria. :)

My husband went to the pre-Op consultation today and they said it would take 2-3 weeks to get the results. 

Any tips for the post-biopsy days? How long does it take to recover?

He thinks it is via the rectum. He will take antibiotics the day before the biopsy and the day of the biopsy as far as he understood. They said he would/might urinate blood etc. 

I hope no one minds me asking if it was very painful?
Should I arrange anything special about the bedding for afterwards?

Do people need to go to the loo more often after the biopsy? Just wondering in case I should warn the kids to try and give priority. 

 

User
Posted 06 Dec 2024 at 18:18

The biopsy is basically painless. Once the Doctor begins he will hear clicks each time a core is taken. My only preparation was a self administered fleet enema just to clear the rectum prior to my leaving for my appointment. Once I went into the Doctors office I was back out in less than 20 minutes including the time I waited for him. Mine was ultrasound guided based on the MRI. I did take antibiotics before and after. My Urologist said he had never had anyone get an infection for the hundreds he has done and from speaking with other Urologists anyone that has they believed the patient fid not follow the antibiotic regimen. I actually had to take them for a week due to a weakened immune system from chemotherapy from an earlier cancer 20 years ago. No special requirements afterwards. I was told I might have a little blood in my stool (I had none) or in my urine. The only blood in my Urine was immediately after I was done with the biopsy I went into their bathroom to urinate and one tiny clot of blood was in the toilet. That was it. Never any further blood on urination. My Biopsy was at 5:30pm so I just went home, but was told if mine had been in the morning I could have returned to a light office job in the afternoon. No special needs of the bathroom were required, just told to drink plenty of water. Now what was shocking although I was warned was that my semen would be rust colored. Abstaining from sex or ejaculation for a week  I think is what I recall and no heavy lifting for a couple days. When my wife and I decided to play around we decided to hold off on actual intercourse the first time to see my semen. After that it was decided to temporarily use a condom more for her comfortability with the color of the semen as there was nothing wrong with it. The color returned to normal within 3 weeks. Hope that helps.

User
Posted 06 Dec 2024 at 19:05
That helps a lot, thanks!
User
Posted 06 Dec 2024 at 19:50

I found the biopsy quite uncomfortable , but not painful.   I had 30 ‘cores’ ( like having staples is the nearest description ).  I have had no trouble with peeing apart from going quite often , but I was doing that before. I had a small amount of blood ( a bit like diluted tomato juice) for the first inch of a pee for about two weeks , but it was no bother.   Semen does come out brownish red which does spoil the moment a bit !! I did a 4 mile walk a couple of days after the biopsy with no problem. 

User
Posted 07 Dec 2024 at 10:24

My experience was similar to those above.  I found it a bit uncomfortable, a dull pain, and decided to clench my buttocks but the doctor told me to stop doing it.  When I got the results 3 samples were missing and I wondered if they were the one's I clenched.   They only found cancer on 1 sample and it was only 5% of the tiny sample.  That was surprising as it was 13mm I was told.

I recall they gave me a large pad to put in my underwear and some extra ones.  It had blood on it.  If it is a rectum biopsy he should eat food that makes his stools softer.

Looking forward it could be Christmas before you get the result.  In the UK I had 2 appointments in the Christmas week as my operation was 16th Dec.  One was to remove the staples from my operation and the other was to remove the catheter.  So you might get the result at that time.  I was called at home and asked to go to the hospital that afternoon where a nurse gave me the result.   I then had an MRI and a bone scan a few days later.  Nowadays they do the MRI first.

Good luck  Peter

User
Posted 07 Dec 2024 at 11:51
Yes, he had the MRI first and it seems to say there is a 39mm lesion and a 14mm lesion. Is that considered big?

They said 2-3 weeks to get the results.

User
Posted 07 Dec 2024 at 12:57

Did they give you that result verbally as 39mm is about the size of a prostate and is often given as say 39cc.  30cc would be more normal.  I should look that up.   

14mm isn't that big, mine was 13mm. Over 20mm would be getting large.

User
Posted 07 Dec 2024 at 13:31

TBH I am not sure how to understand the results, though they are in writing.

According to the MRI, his prostate is 50x47x48mm, so much bigger than the norm.


In the MRI results it mentions an extensive hypointense architectual distortion with something that sounds like early arterial hyperenhancement (I am translating and I don't have any medical background) and that measures a maximum of 39mm.

Plus a 14mm diffusion restriction with an extended contact to the psdeuocapsule.

We have it all in writing but my husband has not really discussed the findings in detail with anyone. Just what the next step is, which I guess is all that is really important since we don't really know anything until after biopsy.

They summed it up as extensive PI-RADS V lesion plus of course prostate hyperplasia.

Edited by member 07 Dec 2024 at 13:33  | Reason: puncutation

User
Posted 07 Dec 2024 at 15:05

I sometimes wish I'd asked for such reports. Many people say you should. I find it worrying.

I don't have any qualifications on this but after doing a search those terms are like many things that can be either way so it advises a biopsy.

He might need something to reduce inflammation as well as whatever other treatment they offer.

His prostate is very large, 112cc, and there is a calculation that says what your psa should be for size of prostate.  Also how much psa a lesion of gleason 3, 4 and 5 produces. A 3 isn't far off normal but a 4 gives quite a lot more.

You could worry yourself by thinking too much.  I was told to take each step as it comes.  Calculations can mean little as I found when mine re-occurred much slower than I calculated.

Today we have winds with 100kph gusts so I'm staying in.  See if anyone else has more information and feel free to reply.

All the best Peter

User
Posted 07 Dec 2024 at 16:03
In the internet the volume calculators say mostly Prostate volume (cc) = Length x Width x H x π/6 or a different formula for bullet volume but that would give him apparently 69-74cc?

Anyway none of that is really that relevant till we know more I guess.

User
Posted 07 Dec 2024 at 17:31

The ellipsoid sounds a better formula than the square.  I didn't think the difference would be so great.  Although we don't know the shape.

Walnut is often used as a size comparison.

User
Posted 08 Dec 2024 at 15:14

We have not told the children anything yet but from the sound of it the biopsy is not something they will notice as in seeing something is "different". He can of course if necessary say he does not feel that well.  

 

User
Posted 08 Dec 2024 at 18:46

It's unlikely anyone will notice. I haven't told anyone in 8yrs although I've only my wife. I visited the neighbours with a catheter and bag on my leg and no-one knew. Although if he has surgery you can be a bit delicate for a few weeks.

Many say, most people on this forum, it should be made more public and you should tell people to make the case for awareness and psa screening.

We have an Olympic hero, Chris Hoye with 6 golds, who's announced and written a book about his recent terminal prostate cancer diagnosis at 48.

User
Posted 08 Dec 2024 at 19:09
Well tbh I do want to tell them once we know anything for certain - though obviously it is ultimately his decision.

If he does have surgery I guess he will have time off work, which they would certainly notice. We also sleep in the living room of the flat so they would see him resting. I think he wants to tell them anyway (in an age appropriate manner) if it turns out he does have csPCa.

User
Posted 13 Dec 2024 at 21:16

He had his biopsy today and he understood they will call him in to do a PET scan. He should then get the results of both on 10 January. 

User
Posted 15 Dec 2024 at 15:19

Hi,   Yes, I think it would be better to tell them.  I was giving an alternative which was fine for me.  Males should be told in case it runs in the family and they want psa monitoring earlier than normal.

Is it a PSMA PET scan.

Good luck with the results.  Peter

 

 

 

User
Posted 15 Dec 2024 at 15:28
Oh we would tell them eventually anyway, just not until it is certain and i think maybe about it running in the family only when they are adults. It does seem to run in his family.

Yes, it is a PSMA PET scan.

 
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