Anxious

My urologist is also a surgeon (maybe they all are?) and works at the medical building attached to my hospital. He performs LRPs and apparently also teaches at the University of Toronto. He's young but seems very sharp.

If, and this is a big if, my biopsy is positive, should I stick with the guy who's provided primary care or ask for a referral to a cancer centre?

I need to have a plan for when he gives me the results. I also need to assure my wife I have a plan.

Again, I might be jumping the gun on both a positive result and surgery as the best solution.

If you have concerns about the biopsy, you can also ask to be sedated, especially since your wife will be going with you. When I had mine done, my urologist, who is also a friend of mine, recommended sedation. They knocked me out using propofol. It's sort of like a twilight sleep that usually is used for performing a colonoscopy. Procedure gets done, they reverse it, 15 minutes in recovery to make sure you are ok and let you get your feet under yourself, and home you got. No pain and you don't even know somebody is poking around back there with evil intent.......lol

My uro's office confirmed I will get a peristaltic nerve block. They also asked my uro about a rectal swab and he felt it unnecessary. I can take Cipro, so that's good news given that's what I've been prescribed.

I don't believe I can get major sedation, but I'm going to ask my psychiatrist (who treats my bipolar disorder) if he can prescribe a couple of Xanax (or whatever) for the morning of the Bx.

I've done some research and it appears our healthcare system only offers PSA and Free PSA testing. No PHI for me, unless I go to the U.S., which isn't really practical at this point.

Nervously awaiting the Bx on August 15th and the results on August 30th.

Thank you all for your input.

So I just found out I can get a PCA3 test in Canada. There's one private lab that does it. They're in Montreal (about 5-6 hour drive from me), but I'd be prepared to make the trip for some peace of mind. They turn around the results within 10-days.

My question to you guys is this: should I just let the biopsy guide me through this, or should I fortify the biopsy with an additional test (PCA3)? I get the impression PCA3 is normally marketed as a precursor to biopsy, not an adjunct.

Thanks for any views you have. Still 7 weeks until I get my biopsy results.

Thanks, hrpufnstuf. That saves me a trip to Montreal

hrpufnstuf said...
If the biopsy is negative and you and your doctor are still concerned, then the PCA3 might be something to consider.

Geekything, as the subject of negative biopsy has been raised, there's something you should know about... just in case your doctor(s) don't mention it (mine didn't)... If the biopsy is "negative" it does not mean that you do not have cancer.

If your PSA continues to rise and your doctor(s) dismiss it, you will definitely have reason to be "anxious".

My PSA rose steadily for several years. All of my DRE's were negative and the first biopsy was negative. My urologist performed no additional tests, but gave me lots of Cipro. When he retired another urologist ordered an MRI which located a large tumor up near the bladder. That was two years ago last week. Post-RP pathology confirmed high risk advanced PCa.

I understand that you are limited by your country's "free" healthcare system, so I cannot make any recommendations, but can only encourage you to never give up if things look bad and you seem to be the only one concerned about it.

My biopsy isn't scheduled for another month and the results in six weeks. This is making me a bit anxious ;)

But in happier news, I found out today that one of the better hospitals in Toronto (Sunnybrook) has a "rapid biopsy program". They'll evaluate you with their nomogram, get you in for biopsy within 72-hours if they feel you need one, and get the results within 72-hours after that. I've left them a message and am hopeful I'll hear back on Monday.

I also found their chief surgeon's publicly available nomogram from the Sunnybrook site. It scored me within 4-points of my urologist's "ballpark" risk estimate. I'm not sure if this is a good or a bad thing, but at least I know my urologist is decent at throwing together a gestalt prediction.

Am I right in thinking I'll have to wait 6-to-12-weeks after the biopsy before a PSA test is useful again?

So I heard back from the hospital that does "rapid" biopsies today. Apparently, they can't fit me in until August, which means I may as well stick with my first scheduled biopsy of August 15th. So much for "rapid".

ejc61: thanks for the feedback on when to retest. I certainly want valid results.

Good that you got that. Likely it will be a non-event for you.

A URO should understand that some need a little help getting through the procedure.

Andrew