Note: This blog is directed mainly to people who actually care about their health.
Recently I came across a 55 year old patient, a retired executive, who was having yearly regular check-ups. This time, he came for a MRI of spine, because he was experiencing some back pain. As I looked at the initial images of his MRI, I could see multiple metastases in vertebrae. There was no obvious mass (tumour) in his abdominal scan I did in morning. Prostate was measuring some 30 grams , okay for his age. I looked at his old papers, and only thing that struck me, was his last year PSA was 15 ng/ml (elevated not yet alarming as he was told). Just out of suspicion, I asked the clinician to get repeat PSA...It was whopping 110 now! Next day, I biopsied randomly from all sextants of prostate (TRUS guided), as I could not see any lesion yet. It proved to be prostate cancer.
Dictum is "you should always get TRUS guided biopsy if PSA is above 10 ng/ml, and if digital rectal examination is suspicious, even if PSA is above 4 ng/ml." And above all, whats the harm? whats the contraindication? and whats the radiologist dilemma? Almost all urologists agree with this dictum, but either patients get anxious, or radiologist is not confident enough. This arcane, grand terminology and explanation of procedure - TRUS guided biopsy...whoosh....putting a bulky rod into the rectum, and then a sharp needle over it, and firing many times.....not gonna do it.....is there a way out? Actually, the way out is much worse some times, as seen in the case I mentioned. And the procedure itself is not that traumatic,painful or risky as it seems.
I personally have done many biopsies (no accurate counts but may be close to hundred if not more), and have never ever experience any complications. Never did I witness any serious complications, done by any damn and first-timer radiologist. And almost hundred percent times, it has cleared the air between cancer or no cancer. Even if malignancy (cancer), it did pick at early stages and was well managed afterwards.
In my words, procedure is
"We do a simple ultrasound of prostate, yes, by putting a probe inside rectum, but it is so well lubricated, it doesn't feel anything. Point is, it will only enter into the rectum, only if patient allows and relaxes, which means, in a painless situation. Else, radiologist would not able to push the probe itself. Its not like older days endoscopies, with a large tube pushed forcefully. Its a two-way thing, and needs some patient co-operation. Almost never did any patient refused to get this done while I was doing the procedure, which means its simple to accept.
Then, we use an accurately single-shot firing biopsy gun. Its not like, we are poking the needle again and again and shearing the hell out of you. Its one shot, like a bee-sting, and that too at a point, where you will never experience pain! Yes, biopsy is always taken when probe is above the dentate line. We can only feel pain if we are shot below this line. Above this line, there can never be any pain by nature of our body. So, its proven painless procedure. Bleeding, yes, when we are actually poking a needle, and that too a few times to get correct number of samples, it would bleed a bit. But, our body is so conditioned, that rectal bleeds of this nature in healthy men (procedure is always done when there is normal clotting time, PT) would be almost immediately healed. I have never seen a person with continuous bleeding after procedure. In fact, I do it on out-patient basis many-a-times, and patient just walks out and never calls me back that he is having this or that. Though, I always call them back, and just trying to know if the procedure does cause any complications. Even if blood in urine or stool keeps coming, it can be handled with much ease."
There is simply no other way to prove that you definitely have a prostate cancer, or you have not. Biopsy is the only way to go. And last but not the least
PROSTATE CANCER IS THE MOST COMMON CANCER IN MOST COUNTRIES NOW.
Recently I came across a 55 year old patient, a retired executive, who was having yearly regular check-ups. This time, he came for a MRI of spine, because he was experiencing some back pain. As I looked at the initial images of his MRI, I could see multiple metastases in vertebrae. There was no obvious mass (tumour) in his abdominal scan I did in morning. Prostate was measuring some 30 grams , okay for his age. I looked at his old papers, and only thing that struck me, was his last year PSA was 15 ng/ml (elevated not yet alarming as he was told). Just out of suspicion, I asked the clinician to get repeat PSA...It was whopping 110 now! Next day, I biopsied randomly from all sextants of prostate (TRUS guided), as I could not see any lesion yet. It proved to be prostate cancer.
Dictum is "you should always get TRUS guided biopsy if PSA is above 10 ng/ml, and if digital rectal examination is suspicious, even if PSA is above 4 ng/ml." And above all, whats the harm? whats the contraindication? and whats the radiologist dilemma? Almost all urologists agree with this dictum, but either patients get anxious, or radiologist is not confident enough. This arcane, grand terminology and explanation of procedure - TRUS guided biopsy...whoosh....putting a bulky rod into the rectum, and then a sharp needle over it, and firing many times.....not gonna do it.....is there a way out? Actually, the way out is much worse some times, as seen in the case I mentioned. And the procedure itself is not that traumatic,painful or risky as it seems.
I personally have done many biopsies (no accurate counts but may be close to hundred if not more), and have never ever experience any complications. Never did I witness any serious complications, done by any damn and first-timer radiologist. And almost hundred percent times, it has cleared the air between cancer or no cancer. Even if malignancy (cancer), it did pick at early stages and was well managed afterwards.
In my words, procedure is
"We do a simple ultrasound of prostate, yes, by putting a probe inside rectum, but it is so well lubricated, it doesn't feel anything. Point is, it will only enter into the rectum, only if patient allows and relaxes, which means, in a painless situation. Else, radiologist would not able to push the probe itself. Its not like older days endoscopies, with a large tube pushed forcefully. Its a two-way thing, and needs some patient co-operation. Almost never did any patient refused to get this done while I was doing the procedure, which means its simple to accept.
Then, we use an accurately single-shot firing biopsy gun. Its not like, we are poking the needle again and again and shearing the hell out of you. Its one shot, like a bee-sting, and that too at a point, where you will never experience pain! Yes, biopsy is always taken when probe is above the dentate line. We can only feel pain if we are shot below this line. Above this line, there can never be any pain by nature of our body. So, its proven painless procedure. Bleeding, yes, when we are actually poking a needle, and that too a few times to get correct number of samples, it would bleed a bit. But, our body is so conditioned, that rectal bleeds of this nature in healthy men (procedure is always done when there is normal clotting time, PT) would be almost immediately healed. I have never seen a person with continuous bleeding after procedure. In fact, I do it on out-patient basis many-a-times, and patient just walks out and never calls me back that he is having this or that. Though, I always call them back, and just trying to know if the procedure does cause any complications. Even if blood in urine or stool keeps coming, it can be handled with much ease."
There is simply no other way to prove that you definitely have a prostate cancer, or you have not. Biopsy is the only way to go. And last but not the least
PROSTATE CANCER IS THE MOST COMMON CANCER IN MOST COUNTRIES NOW.
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