concerned about prostrate Cancer. ? PIRADS-4

[Eternity6]

sorry I might have posted in the wrong area, but basically my husband has had urine probs urinating every 30 mins for months, been sent to urologist on the two week pathway this was two weeks ago, he had a mri which states 84cc gland with a PIRADS-4 lesion seen in left lobe that measures 14mm in diameter and says this requires further evaluation, he is 60 in few months, ( Smoker) his recent PSAHas been noted 6.12 which was the latest one last week, but before was 4.57 a few weeks ago, his creatinine is raised at 154

He is a diabetic type 2 but was to.d to stop metformin two weeks ago as has been dong well keeping levels down for several months. His renal function was normal a few months ago, urologist has now arranged for him to have an urgent Uro flow and a ultrasound scan renal tract on Monday, which is in two days time, however he has sent a letter out to him received today stating he’s on waiting list for possible prostrate biopsy transperineal one to be performed local in daycase procedure, what I’m asking for basically if anyone can tell me if this is a painful procedure as he’s really worrying about this, he has just been put on tamsulosin only two days ago, and was told maybe would need a catheter another thing that’s concerning him being told this, but no mention of catheter in this letter he has received today, this is all new to him and I guess like everyone else feels it’s a fear of the unknown

[Tall_Allen]

If they take their time to numb the nerves, it should not be painful. I've had 3 biopsies- the first was very painful because the urologist did not give me anything. The second I had general anesthesia and felt groggy for 2 days afterward. The third, the urologist used a pelvic plexus nerve block, and I didn't feel a thing. I'm impressed that they are doing a transperineal biopsy. He should ask his urologist how he prevents pain.

[Eternity6 in reply to Tall_Allen]

Thanks for replying yes it’s definitely a transperineal biopsy as states that in his letter

[NotDFL]

With a competent urologist and proper local anesthesia, the procedure should be almost painless. It's my understanding that the transperineal method is the preferred one these days because of a lower chance of getting an infection.

[Eternity6 in reply to NotDFL]

I was just this second reading about it and that’s actually what it is saying

[d3is4me]

Hi I had DRE then MRI then Transperineal biopsy under general anesthesia Day Surgery no pain a little discomfort for a few days.

[Eternity6 in reply to d3is4me]

Thank you, glad no pain, I wonder if more people are advised to have a general more than local, hopefully he finds out soon, so grateful that things are being done in quick succession now he has a consultant on the case, it’s very difficult trying to work while you are having to empty your bladder every 30 mins, day and night this has been going on for months, very little sleep to be honest I don’t know how he’s coping I know I wouldn’t,

[tad4]

I have had a transperineal biopsy and you won't feel a thing because you either have a GA or nerve block, I had a GA. The result after, severe bruising and peeing blood for a while and don't even think about riding a bicycle. I tried Tamsulosen but didn't work, so I am on Duodart (tamsulosin + dutasteride) which does work for me. Essential you have a biopsy and best through perineum. The results will determine the best course of treatment.

[Eternity6 in reply to tad4]

Thank you, my husband has been told via letter from consultant he will be having a local when he has his transperineal biopsy, I don’t know whether that will change nearer the time, he goes to hosp tomorrow for a kidney scan ultrasound and has a flow test, he has on,y been on the tamulosin med for three days so very early days, no he doesn’t ride a bike,

[tad4 in reply to Eternity6]

I shall tell you the procedure for my situation. Admitted to hospital for Day Surgery (Prostate Biopsies). Given a needle in the back, then General Anaesthetic. You are positioned on your back, legs up and scrotum tethered out of the way to enable multiple biopsies to be taken through the perineum into the cancer sites in the prostate. That is why you are severely bruised like someone has taken a baseball bat to your nether regions. My Gleason Scale was 9 and so I was put on ADT (Zolodex) followed by Brachtherapy and EBRT. After Brachy, I could not pee so tried Tamsulosin (Flomax) - didn't work, hence on Duodart. So far so good, PSA .008, but need bone scan soon to determine if I have other mets due to soreness in the rib cage. Your husband should ask for a GA, then you are assured he won't feel a thing, until he wakes, soreness goes after a few days. I stopped peeing blood also after a few days. Stay positive.

[SteveTheJ]

My prostate biopsy was horrible because the urologist used lidocaine and not nearly enough. Prostate biopsy is the only way to tell if there is cancer though so take the advice of any man who says he felt nothing during or afterward.

Urination problems don't predict prostate cancer. I had both (starting in 2014 I had issues urinating not nearly as bad as your husband's and cancer diagnosed in 2020). This is correlation, not causation; IOW, the fact my prostate was enlarged didn't mean I was gonna get cancer.

Urologist told me after the worst manual prostate exam in the history of the world that my prostate was hard and that's a bad sign. That's what led to the biopsy and the cancer diagnosis. Despite causing me all that pain I'm grateful to this guy and would recommend him to anyone with the significant caveat that he use significantly better pain management for the biopsy.

[Hidden]

I had a conventional biopsy. Yeah a few 'bee stings' but pain doesn't last. The important thing was to avoid NSAIDS (aspirin, aleve, etc) or anything that could act as a blood thinner for a week prior. No big deal.

[Eternity6 in reply to Hidden]

Thank you

[groundhogy]

I took a resveratrol some days after biopsy thinking it would help. It did not. Urine got pink and peeing became difficult. I guess resveratrol is s good blood thinner?

[Hidden]

I can only speak for what my husband (also a type 2 diabetic) said all FOUR times he has had biopsies done in same manner for the past several years. He said it was not a painful experience as he was given medication first. He never complained afterwards either. A friend has been through the biopsy procedure, and he didn't complain either. I know this is a very scary time for both of you. It sounds like you and the doctor are on the right track. There is a reason for every test and step they are taking. They need to check and rule out other possible causes. The whole picture of your husband's situation needs to be evaluated. I understand the confusion of so much information doctors throw at you! Also, the frustration of waiting for everything and getting the final diagnoses and plan for any treatment. Hang in there, you are not alone.

[Eternity6 in reply to Hidden]

Thank you very much, like I said earlier it is very early days yet, it’s good to hear of others experiences of biopsies, will know a bit more tomorrow hopefully as seeing the consultant in the morning

[Hidden in reply to Eternity6]

I will be watching for your posting on everything.

[Eternity6 in reply to Hidden]

Thank you I will let you know tomorrow after we see the consultant

[FRTHBST]

It sounds like the doctor will be doing the tests necessary to determine cause of urination problems. Basically what my doctor told me was that my difficulty in urination was caused by both benign prostate enlargement that occurs in many men as they age and is distinct from cancer as well as the cancer itself. ADT and/or radiation treatment will shrink the prostate and take pressure off the urethra which travels through the center of the prostate. Removal through prostatectomy would have the same result. In the meantime either a foley catheter, which is left in place, or intermittent self catheterization can be a good solution. having experienced both- I preferred the self administered.

The above is jumping ahead a bit. The biopsy results should provide a lot of information about appropriate treatment options. If possible, pathology specimens from the biopsy should be sent to a center of excellence for a second opinion. Many here recommend Dr. Epstein at Johns Hopkins. It's important to take your time and find doctors and treatment(s) that you're comfortable with and using a catheter for a period may be part of this process.

[Eternity6 in reply to FRTHBST]

Hi he’s home from hospital and was given the self catheterisation, the nurse did it when they did the scan she told him that he was retaining one litre of urine so it had to be a catheter he wasn’t to go home like that, she did it and showed us both how it works, and said this has to be done twice daily next being tonight so will be trying in 7 hours time, and she would ring him on Friday to see how he’s managing if any problems then he’s to have the fitted catheter,

[Fightinghard]

I had the old fashioned biopsy. Like WSO said, felt like a dozen quick bee stings but pain only lasted a couple seconds for each one. Dr gave me preventitive antibiotic pill and that was about it. Trace of blood in urine for couple days and no catheter. Not too bad of experience. .