Prostate Biopsy

[Lost in LOS]

I have always had a PSA of less than 1. I did a physical about 3 weeks ago and all was well except my PSA was 8.4, I waited a week and tested it again and it was 7.6. Both of these are way out of the normal range of 1 - 4. I made an appointment with the Urology specialist at Bangkok Pattaya Hospital. I had some symptoms but the doctor said they were not for prostitus, according the the internet searches I did, they were] ie: tingling at the head of my penis when I urinate - my testicles hurt a little bit - frequent urination - my kidneys were hurting for a week about two weeks ago but that went away.

The doctor then did the finger up the butt and was searching around for what seemed like a long time, oh oh. He said that I didnt have symptons for prostatitis but had a node on my prostate. He said we need to do a biopsy, anyone had this done and can advise me?

I searched on the internet and read some awful responses to the procedure, said the pain of the biopsy was unbearable. I read that, with local anesthesia, there was a lot of pain throughout the 30 minute procedure. It was suggested by many blogs to get sedation, they cant put you to sleep but half sleep. I am not a chicken for this stuff but this sounds awful, in an area I don't want anyone messing with . I am paying for this so insurance is not the issue and I am willing to pay more for some comfort.

I would like to hear about experiences with people who had it done and from some of the doctors that are on the site. Sheryl always seem to have some good advice. I would appreciate any help as I have to get it done withing the next week or so

Also, for those that had it done here what was the cost, they wrote down 20k, then the girl in office that gives prices, had a conversation with the boss and changed it to 28k. I then started speaking Thai with the girl and asked why it got more expensive, and she said oh, you speak thai and understood our conversation. I said yes [but only got half of it] but I figured it was about insurance when she said she will check with them . I told her in Thai that insurance wont pay for it and to put the price back to 20k, she looked nervous and said the 28k was the normal price for everyone, including Thais. I would like to verify this with someone

thanks for any help, this one is important and I dont want to mess up, so I am asking questions before I have a problem

[bunnaag]

I had 3 biopsies done each one 12 samples.My PSA the last time was 34.7.Nothing was found.Only when I made an MR of the Prostate they found an area which could be cancer.The first biopsie was done in the Bangkok-Had Yai hospital and the cost was about 10,000 Bath.

It hurt only a little bit more in Thailand than in Germany as they used bigger diameter sample needles and they gave the injection in the bum not into the prostate.If you take ASS than you should stop about taking it 5 days before.

Edited March 2, 2011 by bunnaag

[Lost in LOS]

I had 3 biopsies done each one 12 samples.My PSA the last time was 34.7.Nothing was found.Only when I made an MR of the Prostate they found an area which could be cancer.The first biopsie was done in the Bangkok-Had Yai hospital and the cost was about 10,000 Bath.

It hurt only a little bit more in Thailand than in Germany as they used bigger diameter sample needles and they gave the injection in the bum not into the prostate.If you take ASS than you should stop about taking it 5 days before.

there is an option for sedation, I am thinking about that after reading many blogs on the internet. The all talk like it hurts like hell and why go through that if I don't have to. So they don't give you the local in the prostrate but in the butt, that sounds a bit better but I understand it still really hurts when they biopsy

[Beechboy]

I have had it and it is not a very pleasant experience.

To put your mind at rest, I did not feel a single thing.

I was injected with local anaesthetic in the correct places and was wide awake listening to the clicks that accompany the removal of each sample. There are usually nine taken.

My advice: Go to the best hospital you can to make sure you get premium treatment and ensure you are to be properly anaesthetised.

[WarpSpeed]

Sorry to tell you but the price change is reflective of the opposite. They ALWAYS charge more for uninsured then insured because the weight of the insurance company gets them a discount and payment is viewed as suspect with the patient paying..

Sorry to hear about your prostate troubles, I might be heading down that road myself soon so I'll be looking to your thread for some relative guidance.. Good luck to you...

Personally though you may or may not want to hear about it but I share a widely held belief that biopsies do more harm then good. There is some empirical evidence that suggests a biopsy releases previously encapsulated cancer cells into the body and allows for cancers to metasticize to other locations.

This has not been proven openly as there are also political reasons for that, but it is something to consider. Prostate problems are one of those afflictions that is difficult to make a determination about since the choices are potentially life altering in numerous ways. If it were any other type or location I'd suggest they just remove it in it's entirety and do the pathology of it after the fact to determine follow up treatment.. I do not envy you, your choice...

Edited March 2, 2011 by WarpSpeed

[Chris Lawrence]

I had this last year in OZ.

Didn't feel a thing until I woke up after opperation. A bit uncomfortable but they will give pain management meds for this.

Blood remains in your seamen for about 8+ weeks; just need to put a hat on when having sex in this period.

Resolved the issue, no cancer and treatment of meds to improve urine flow. Part of the biopsy procedure was to also a "re-bore" for the wee to flow better.

You might like to see if the could also increase the girth or add to the top as a complementary procedure

Jokes aside, if your Doctor is recommending the procedure don't mess around with waiting; get it done. Good luck with the procedure, it should work out fine.

[Sheryl]

Most people do not report it to be all that bad. I think those who had an unusually painful time are most apt to post on a blog about it! Also skill of the doctor is a factor.

Should the biopsy show a malignancy, you would be much better off getting -- and would have a wider range of options for -- treatment in Bangkok.

For which reasons you might want to consider consulting one of the Bangkok urologists listed in the pinned notice here. You can call the hospitals ahead to see about price of biopsy.

[Lost in LOS]

I am going to get checked by a new guy, here in pattaya, tomorrow. http://www.pih-inter...s/DR_JESADA.php Credentials look good, so I will see if he has the same conclusions. Depending on how I like him and the results of the test, I will either go to him or try Sheryl's recommendations in Bangkok

the original guy worried me a little bit. Checking on the internet I have many symptoms of prostatitis, and after he did the finger up the butt test, i assumed he would do a urine test, to double check. He didn't and went right for the biopsy option, which makes me wonder if he just wants me on the operating table.

Does anyone know the general price I should be looking for, for a biopsy for someone living here, no insurance? I guess I will try it with the local anesthesia. I want to know what price to shoot for since they always inflate it at the beginning.

thanks for all the help and I will keep you all posted

Edited March 3, 2011 by Lost in LOS

[Sheryl]

I would expect a private hospital to cost something in the range of 20,000 - 25,000 inclusive of the pathology report.

As the pathologist's fee is likely to be around 5,000 or so, be sure when you get quotes to clarify if it is the cost just of the procedure or of the procedure plus path report.

The above are just rough guesses, as prices have gone up a lot lately.

While I agree the doctor should have done a urinalysis , prostatitis would not cause a nodule on the prostate. If there really is a discrete firm nodule present, it's going to have to be biopsied. but good idea to let another doc do a manual exam to see if he also concurs that a nodule is present. While you are at it, insist the second doc do a urinalysis.

[tim armstrong]

Hi LiL,

I think I will need another one soon, and I'll go to Dr. Thanoo Choovichian at Samitivej. He understands farlangs well and is open to questions. Don't know the cost, but as there are so many of us reading this post in a similar position, maybe we could get a bulk discount!!? Anyway I'm talking to Dr.Thanoo in the next couple of days, so I'll let everyone know the quote. By the way the first one I had in Oz 5 years ago was not very painful at all, more like a series of insect stings. Regards.

[Gik]

I am going to get checked by a new guy, here in pattaya, tomorrow. http://www.pih-inter...s/DR_JESADA.php Credentials look good, so I will see if he has the same conclusions. Depending on how I like him and the results of the test, I will either go to him or try Sheryl's recommendations in Bangkok

the original guy worried me a little bit. Checking on the internet I have many symptoms of prostatitis, and after he did the finger up the butt test, i assumed he would do a urine test, to double check. He didn't and went right for the biopsy option, which makes me wonder if he just wants me on the operating table.

Does anyone know the general price I should be looking for, for a biopsy for someone living here, no insurance? I guess I will try it with the local anesthesia. I want to know what price to shoot for since they always inflate it at the beginning.

thanks for all the help and I will keep you all posted

Was there waste of time. Doctor when i squeeze my penis a little i feel strong pain - dont squeeze it, 600 baht, Next!

[Lost in LOS]

went to the other guy, at pattaya international hospital, I liked him better right away. I told him the same symptoms as I told the first guy, he said sounds like infection, the other guy said it didn't [according to the internet searches I did it these are symptoms of prostitus]. he said if cancer the psa never goes up that fast, it is usually more gradual. He said we will take a urine test [the other guy didnt, which immediately made me suspicious since it was an obvious simple test just to be sure] and then the finger test. finger test was good, said there was a small bump, like the other guy said, the prostrate wasn't enlarged and felt good, but he thought it might be past infection leaving a calcium deposit. Urine sample came back with infection. he gave me pills to take for 3 weeks, and said then i should come back and take PSA and urine test again.

I liked this guy alot. I will post back when next test done. Doctors exam, prostrate exam, urine test, antibiotics for 3 weeks 1,360 baht. good experience all around

thanks for everybodys help and I will keep it posted

[Robby nz]

I have not had anything done to the prostate but have had in recent times 2 biopsys with cystascope done to remove tumours from the bladder and 2 weeks ago from the urethera.

Both were done using spinal blocks and I was able to watch on a TV screen what they did and removed.

Cost was under 13,000b for the first and under 9,000b for the second.

This included 2 nights in hospital in a general ward and lab work.

I was quoted 20,000 in both cases but it turned out much less.

Dont know how this would compare with a prostate biopsy however I would think that would be a relativly simple procedure.

[Sheryl]

went to the other guy, at pattaya international hospital, I liked him better right away. I told him the same symptoms as I told the first guy, he said sounds like infection, the other guy said it didn't [according to the internet searches I did it these are symptoms of prostitus]. he said if cancer the psa never goes up that fast, it is usually more gradual. He said we will take a urine test [the other guy didnt, which immediately made me suspicious since it was an obvious simple test just to be sure] and then the finger test. finger test was good, said there was a small bump, like the other guy said, the prostrate wasn't enlarged and felt good, but he thought it might be past infection leaving a calcium deposit. Urine sample came back with infection. he gave me pills to take for 3 weeks, and said then i should come back and take PSA and urine test again.

I liked this guy alot. I will post back when next test done. Doctors exam, prostrate exam, urine test, antibiotics for 3 weeks 1,360 baht. good experience all around

thanks for everybodys help and I will keep it posted

Great! Goes to show the value of a second opinion.

Standard practice in a case such as this would be to fully treat the infection and then recheck the PSA.

[WarpSpeed]

prostrate exam,

He made you prostrate for him ?? and required payment to boot ? That's kind of demeaning of him, how'd you do in that test ? Hope all works out for ya...

Just curious though everything I've ever read or been told tells me that prostatitis is not curable due to the internal makeup of the prostate and the minute chambers similar to the tonsils that make it up and the depth of the infection as there are recesses that are inaccessible.

In fact even tonsillitis runs the risk of not being cured even by surgery as a bit of tonsil remains post operation that can't be removed as it would require the removal of too much throat muscle and may effect speech afterwards..

I also always wondered why prostate milking is not recommended for additional therapy and treatment while on antibiotics as it seems to me that this would drive out the infection so that it could be infiltrated by antibiotics.

I understand the concern for possibly going septic for someone who is not being treated (by the way this is also the case for anyone who has been previously diagnosed with prostatitis or even suspects being infected) but for someone who is, it would seem to be a good way of increasing effectiveness of any course of antibiotics...

Edited March 4, 2011 by WarpSpeed

[Sheryl]

Acute prostatitis is fully curable with appropriate and timely treatment.

Chronic prostatitis is more difficult, but if it is of the bacterial type can usually be cured, although antibiotic resistance can pose a problem. Nonbacterial chronic prostatiits is a challenge but in recent years advances have been made making it possible to relieve the condition in many cases, although severel therapies much usually be employed.

In any event per post #12, the OP has bacterial prostatitis. So treatment is a long course of antibiotics.

Hopefully a culture and sensitivity was obtained but I would not be surprised, this being Thailand, if it was not. it is essential that the bacteria responsible be fully eradicated with a sufficiently long course of an antibiotic to which it is sensitive.

[Lost in LOS]

Acute prostatitis is fully curable with appropriate and timely treatment.

Chronic prostatitis is more difficult, but if it is of the bacterial type can usually be cured, although antibiotic resistance can pose a problem. Nonbacterial chronic prostatiits is a challenge but in recent years advances have been made making it possible to relieve the condition in many cases, although severel therapies much usually be employed.

In any event per post #12, the OP has bacterial prostatitis. So treatment is a long course of antibiotics.

Hopefully a culture and sensitivity was obtained but I would not be surprised, this being Thailand, if it was not. it is essential that the bacteria responsible be fully eradicated with a sufficiently long course of an antibiotic to which it is sensitive.

doctor gave me ciroflex 500, twice a day for 3 weeks. My pharmacy friend in Maui said they give, 750mg twice a day for 3 weeks. Think I should do the 750 to be safe than sorry, cant imagine it would hurt. As far as the culture, I am in your court, probably none.

[hansunger]

Acute prostatitis is fully curable with appropriate and timely treatment.

Chronic prostatitis is more difficult, but if it is of the bacterial type can usually be cured, although antibiotic resistance can pose a problem. Nonbacterial chronic prostatiits is a challenge but in recent years advances have been made making it possible to relieve the condition in many cases, although severel therapies much usually be employed.

In any event per post #12, the OP has bacterial prostatitis. So treatment is a long course of antibiotics.

Hopefully a culture and sensitivity was obtained but I would not be surprised, this being Thailand, if it was not. it is essential that the bacteria responsible be fully eradicated with a sufficiently long course of an antibiotic to which it is sensitive.

doctor gave me ciroflex 500, twice a day for 3 weeks. My pharmacy friend in Maui said they give, 750mg twice a day for 3 weeks. Think I should do the 750 to be safe than sorry, cant imagine it would hurt. As far as the culture, I am in your court, probably none.

---------------

i guess you mean: CIPROFLEX?

here is also an interesting article: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=15947609&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

[fredge45]

Good that you had the second opinion and are on the way to recovery. I've had prostatitis in the past and immediately recognized it from your symptoms. Ciprofloxacin seems to be the best drug of choice. The most sound advice I have received regarding urologists is to find a treater, not a cutter. Seems that many would like nothing more than to push the biopsies and rush to surgery.

[kurnell]

I've been reading that the PSA test is pointless as a high reading can have a number of causes (some entirely unrelated to the prostate) and the vast majority are not cancer related.

[bunnaag]

I've been reading that the PSA test is pointless as a high reading can have a number of causes (some entirely unrelated to the prostate) and the vast majority are not cancer related.

the PSA is always related to the prostate.The name says it PROSTATE SPECIFIC ANTIGEN.But it must not always be cancer it can also be infection or BPH.And it is not pointless.

[fred110]

I've been reading that the PSA test is pointless as a high reading can have a number of causes (some entirely unrelated to the prostate) and the vast majority are not cancer related.

the PSA is always related to the prostate.The name says it PROSTATE SPECIFIC ANTIGEN.But it must not always be cancer it can also be infection or BPH.And it is not pointless.

When checking PSA, the blood must be drawn before the digital exam. Also sex should be avoided 24 hours before.

There is now a Trans-rectal Mapping, a much more thorough type of biopsy that samples the entire gland in a 3D mode.

[maloyd1]

While in the UK I had 10 biopsies taken on one session with only local.  I felt every tug as the flesh was ripped out.  Can't say it was painful but waiting for that machine to snatch another piece was unberable.  Went in about 4 weeks later for a session of 20.  This time they gave me an injection that does not actually put you out but once it was administered the next thing I remember was the nurse asking if I was OK and it was all over.  So do ask for the semi-knockout shot if they do it.  By the way this was a regular NHS Hospital so the cost of the special jab cannot be too expensive!!!  Maybe.<br>

[kurnell]

I've been reading that the PSA test is pointless as a high reading can have a number of causes (some entirely unrelated to the prostate) and the vast majority are not cancer related.

the PSA is always related to the prostate.The name says it PROSTATE SPECIFIC ANTIGEN.But it must not always be cancer it can also be infection or BPH.And it is not pointless.

I think you need to read up on what the discoverer of this test, Richard Ablin has to say about the procedure and how inaccurate it is.

[SurfRider]

.

A recent article that you might find worthy of reading:

http://www.newsvine....ancer-predictor

Study: PSA rise not good prostate cancer predictor

WASHINGTON — A rising PSA level isn't such a good predictor of prostate cancer after all and can lead to many unnecessary biopsies, says a large new study.

.

[bobbysan124]

I had a biopsy of the prostate last year in U.S. There is a "block" that's been developed in the last few years. Most insurance doesn't pay for it (and I have very good insurance) so I was out-of-pocket 200 USD. But I didn't feel a thing at any point in the procedure, including the application of the "block." Only heard the clicking sound as my urologist took the samples, and he took more than usual to be safe rather than sorry. And absolutely no pain afterward either. You'll just see little flecks of blood in urine for a bit. Good luck.

[Bagwan]

Having developed an ache situated behind the wife's best friend I consulted a junior doctor at one of the Pattaya hospitals who said it was down to having too much sex. Even though I had told him that a weight loss was down to regular exercise and giving alcohol a miss, he said that my blood sugar was a little high and this was down to beer. I suggested that he was in the wrong job and he would do well as a light comedy actor. I went down to the local laboratory and has a PSA test run. Sure enough it measured 14, same as it had done for the last ten years.

I took myself off to see a Urologist at Bumrungrad, underwent the finger treatment and sure enough no lumps or bumps. I then went for ultra sound tests, one before and one after I had pointed Percy at the porcelain and emptied out. All was well. The Urologist said that just to make absolutely sure he wanted to take a biopsy. I asked about price and he started talking telephone numbers. I refused, not only on account of the cost but he said that would be admitted for three days. I told him that after my experience of being being an inpatient at Bumrungrad I would never ever repeat it.

He explained that I would be admitted in the afternoon to make sure that I was rested, He would perform the biopsy under general anaesthetic the next morning, the following day would be for recovery and then if all was well I could go home the following day. He seemed to go into shock when I said that the procedure had been carried out in the UK before. I had walked into the hospital and half an hour later walked out knowing what the results were. I had felt just a slight jolt as the samples were taken but that was all. I was given an antibiotic pill to take that evening. Two days after the visit to Bumrungrad the ache disappeared and has never returned. That was about three years ago.

Last week just out of curiosity I took the PSA test again. Guess what? 14 again. My understanding is that the NHS guidelines counsel doctors not to use this test unless there are special circumstances. I won't be bothering again.

[Sheryl]

My understanding is that the NHS guidelines counsel doctors not to use this test unless there are special circumstances. I won't be bothering again.

That is not quite correct. The UK NHS guidelines are that PSA should be done on all men who are symptomatic or in a high risk group for prostate cancer and it is still very much used as a diagnostic tool in conjunction with manual exam (DRE) and, if indicated, biopsy. Regarding use of PSA for mass screening of asymoptomatic men who are not in a high risk category, the current UK NHS recommendation -- which very much takes into account that the government has to pay for any screening tests it recommends -- is that PSA should not be automatically done on asymptomatic men not in a high risk category unless they request it, in which case they should be provided with sufficient information "to make an informed choice" which, if it is in favor of PSA test, NHS will then pay for. http://www.cancerscreening.nhs.uk/prostate/prostate-booklet-text.pdf

If that sounds like waffling, it is. The NHS is concerned about the cost implications of screening all men for PSA -- not just the costs of the PSA but the associated costs for the additional biopsies that would doubtless result -- and feels there is insufficient evidence available to present to determne the cost-benefit ratio. A 10 year controlled study that will yield that information is in progress, started in 2w008. So in 2018, a more defintive stance can be expected.

Now in your personal situation, I assume you have benign prostatic disease which accounts for your high PSA and indeed, if you have already had a negative biopsy at and the PSA has since remained stable, albeit at a high level, with no discrete masses felt on DRE, no further biopsy would be indicated. But as the symptoms of your benign prostatic condition could mask the onset of a malignancy you would be well advised to continue to periodically monitor the PSA. With a doctor previously informed, in full, of your history so that he doesn't go off making inappropriate recommendations.

[Chopperboy]

The reason for prostate enlargement as men get older is that their testosterone gets converted increasingly into both DHT(dihydrotestosterone)and Estrogen. By the time a man gets to 54 years he has more estrogen in his body than a woman - hence the "man boobs". The herb Saw Palmetto blocks the T-DHT conversion and chrysin blocks the T-E conversion. Saw Plametto is usually available mixed with other natural ingredients to help support prostate and urinary function. Chrysin is not very absorbable and needs to be taken in the 3g+ per day range. It has the side benefit of having some anti-viral properties. Prevention is much better than cure!

[tim armstrong]

LOS : FYI. Interesting about The costs of a biopsy. Had a little resistance from Samitivej about speaking to Dr. Thanoo over the phone.Maybe they thought they were losing money? Decided to investigate locally, as Nakhon Sawan has 4 private hospitals.

Found a foreign trained and experienced urologist/ prostate specialist. Biopsy cost: 15-20,000 baht.

Eventually got a costing from Samitivej - 50,000 baht. Even though I like Dr.Thanoo, I'm going to see the local guy next week. Regards