So your primary care doctor told you that your PSA was elevated. Your wife convinced you that you needed to see the urologist. The appointment wasn’t that bad and he didn’t have fingers the size of Andre the Giant. But you just got the wonderful news that you need a prostate biopsy. What!!!!!!  Are you sure????? 

Actually with modern ultrasound and advances in the use of local anesthesia, a prostate biopsy should not be as horrific as you would expect. Lets talk a little about the indications and the procedure.

If your PSA is elevated for your age and/or if you have an abnormal digital rectal examination of the prostate, you need a prostate biopsy. That is assuming that there are no other reasons for the abnormality such as an active urinary infection or recent ejaculation within 48 hours of the blood test.

You will likely be given a couple of doses of antibiotics to take before and after the procedure. Some urologists will have you use a Fleet enema a few hours prior to the procedure. You will be told to stop any blood thinners such as aspirin for one week prior to the procedure.

Prostate biopsy is performed in the large majority of cases under local anesthesia. Ask you urologist if he does a needle block with lidocaine. If not, he is using “OK anesthesia”. That’s where he continually says, “ Don’t worry, your gonna be OK…” If that is the case, find another urologist. This procedure is much better tolerated with local anesthesia or sedation. The majority of patients are perfectly fine with a local anesthetic.

An ultrasound probe is placed into the rectum. It is bigger than an examining finger and slightly smaller than an elephant tusk. (Just kidding…..)  For most men the most difficult part is the placement of the probe. Once placed, the procedure is quick and with a lidocaine block, painless.

The urologist will measure the size of the prostate with the ultrasound. He will look for abnormal areas to specifically biopsy. Next, he will administer the lidocaine block and within a minute or so the prostate will be fully numbed. Typically, anywhere between six and twelve biopsies will be taken from the prostate.

After the procedure, it is common to see blood in the urine and some blood in your bowels. This will typically last for a day or two, but can extend out to a week or so. It is also very common to see blood in your semen. This can last from a couple of weeks to a couple of months depending upon your frequency of ejaculation.

The pathology typically takes about one week to return. Many urologists will call a patient with there results, but I think it is more typical to plan to come in and discuss the results with your urologist. I never like to give “bad” news over the phone. I find it very impersonal.

Next week we’ll discuss biopsy results and their meaning. For now, this has been the next step in the pathway to learning about the organ known as the prostate. Feel free to comment or ask questions. Talk to you next week.

What is PSA and why do you even care?

PSA stands for Prostate Specific Antigen. It is a protein that is responsible for the liquefaction of semen. More importantly, it has become one of the most sensitive markers for cancer we have in medicine.

PSA is made in both health and disease states. There is a range of normal values and depending upon the lab and your age, your PSA may be anywhere from almost zero to upwards of 6.5 ng/ml.

PSA can be elevated because of prostate infection or enlargement. It can be elevated by ejaculation within 24 - 48 hours of having your blood drawn. It can be elevated by chronic inflammation. It can also be elevated because you may be outside of the range of normal yet still be totally normal. But we are most concerned about an elevated PSA because it is often an indicator of prostate cancer. And while infection and inflammation can be a problem, prostate cancer can be a terminal problem.

Most urologists recommend getting your PSA checked on a yearly basis once you are above age 50. If you have a family history of prostate cancer or are of African-American descent, we recommend that you be screened starting at age 40. The good news is that it only requires a blood draw. The bad news it, you need a rectal exam at the same time. And while it may be uncomfortable, it should be fast and like taxes it should only be once a year.

If your primary care doctor tells you that your PSA is elevated, he or she will most likely recommend that you see a urologist. As I said before in my opening remarks, urologist are doctors who specialize in disease of the urinary tract and are often considered the “Mens Health Doctor.” 

When you go to the urologist, make sure that you know your PSA number. Better yet, ask your primary care doctor for a copy of your labs and bring it to the urologist along with a list of your medications and any other pertinent medical facts about you.

Having an elevated PSA does not mean that you have prostate cancer. But having an elevated PSA means you need to make sure you don’t have prostate cancer. On the whole most urologists are good guys with off-beat senses of humor. In other words, the kind of person that would be fun at a dinner party. Do the right thing and get your elevated PSA checked out. It may be the best step you make in preserving your health.