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Search results for “Urologist”
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Who will do my biopsy?

This is almost always the job of a urologist. In unusual circumstances, experienced specialist nurses may also perform them.

Are there any risks involved with having a biopsy?

The main risk is infection, which is why you will usually be given antibiotics to take in the days before and afterwards. The risk is, however, far lower with the transperineal biopsy (under 1 per cent) than with other forms of biopsy.

The majority of infections begin within a week of the biopsy. Signs that you have a possible infection include having cloudy or smelly urine, pain in your abdomen or a fever – if you have any of these symptoms in the days following your biopsy, immediately contact your urologist or seek other urgent medical help. Some infections may require treatment in hospital with intravenous antibiotics.

The swelling caused by the procedure may cause some problems urinating in the days afterwards – this is most common after a template biopsy, as more samples are taken than during other biopsies. You will normally be asked to urinate before you go home after your biopsy. If you are later unable to pass urine at home, contact your doctor – you may need a temporary catheter.

You may also notice some blood in your urine (or stools) for a few days afterwards. This is normal – but if it persists beyond a few days or becomes heavier, consult your doctor.

It is also common to have blood in your semen for up to 12 weeks afterwards – which may appear red or rust-coloured. This is not a cause for concern, nor is it dangerous for your partner.

Some men experience temporary erection problems after a biopsy, due to swelling around the prostate affecting the nerves involved in having an erection. However, this only happens in a minority of cases and the issue will normally resolve itself within weeks as the swelling calms down.

There are two nerves that control erections, with one nerve running down each side of the prostate in the groove between the prostate and the rectum.
What is a PSMA PET CT scan?

This is the most sensitive type of scan for detecting prostate cancer cells, wherever they are in the body. At the moment it is mainly used for those whose cancer has returned after TREATMENT, but the potential for its use is developing all the time.

To have the scan you first have a dye injected which contains radioactive makers which attach to PSMA, a protein found on the surface of prostate cancer cells and then show up on the scan.

PSMA PET CT scans are increasingly used in the UK, but have only recently been approved by the FDA in the USA and so there is limited availability.

We suggest you speak to your urologist about whether you are eligible, and where the scan is available.

The scan takes 20-40 minutes to complete.

Who can I discuss my scan results with?

Your urologist or GP will explain and help you to understand the results of your scans.

Do I really need to have my cancer genetically tested?

Tests that determine the genetic profile of the cancer can help doctors understand how your cancer is likely to behave and how quickly it might grow or spread.

These tests are used at different stages of the process. Exosome Dx or Select MDx can pick up genetic material from prostate cancer cells in a urine sample before a prostate biopsy. Oncotype MDx tests tissue taken during the biopsy. Another genomic test, Decipher, can be done on either prostate biopsy tissue or prostate tissue removed after surgery.

Genomic tests have limited availability in the UK (where they are available privately) and the US (where they can be expensive). They can, however, give additional useful information to help determine the best form of treatment for you. The best option is to discuss with your urologist whether genomic tests are necessary and which of them is most suitable to your situation.

What are the Gleason grade and score?

The Gleason grade measures the potential aggression of the cancer, which is determined after a pathologist has looked at samples of your prostate cancer under the microscope.

The grade goes from 1-5, with 1 indicating cancer that is going to grow very slowly, if at all, and 5 being the highest, meaning the cancer is likely to grow quickly.

To give the most accurate picture, two scores are given – the first representing the most common type of cells found in the biopsy, and the second number being the highest grade of the remaining cells. The two are added together to give a total score. So, if most of the cells were a Gleason grade 3 and the rest were mainly a 4, this would give 3 + 4 (and a total score of 7).

Generally, a total score of 6 or less means the cancer is likely to grow slowly if at all, 7 indicates an intermediate risk cancer with a moderate risk of growth, and above 7 means it is a high risk cancer likely to grow quickly.

Your Urologist may also refer to another grading system known as the ‘Gleason Grade Groups’ (GGG), which also runs on a range from 1 to 5. GGG1 is the equivalent of total Gleason score of 6; GGG2 equates to Gleason 3 +4; GGG3 to Gleason 4+3; GGG4 to Gleason 4+4; and GGG5 to a total Gleason score of 9 or 10.

How quickly do I need to start treatment?

If you have been diagnosed with low-risk cancer that is confined to the prostate, it is likely that your urologist will recommend you just stay under surveillance, with regular PSA checks and MRIs.

For those with the next level, intermediate or high-risk localized prostate cancer, you aim to make your decision about starting treatment within three or six months.

Finally, for patients with advanced disease the situation is a bit different. The recommendation is to start treatment, which is likely to be hormone therapy to begin with, as soon as possible.

How do I choose the best surgeon (USA)?

If you are in the US state healthcare systems, you may be referred to a surgeon based on geography. Prostate cancer surgery tends to be conducted in major cancer centres, and as long as your surgeon is doing a high volume of cases, they will be proficient.

In the private sector, you can shop around to find a surgeon you’re comfortable with. Take advice from your urologist and ask around for recommendations. You may choose to meet different surgeons before making a final decision.

How do I choose the best surgeon (UK)?

NHS patients will normally be referred to a surgeon operating locally, but you can ask to see another if you are unhappy. Take advice from your GP or urologist and ask around for recommendations.

All Urologists practising in the UK are legally required to be on the Urology Specialist GMC Register: https://www.gmc-uk.org/registration-and-licensing/the-medical-register

How do I find out about available trials?

Ask your urologist and oncologist whether there are any trials for which you may be eligible to join.  

NowWhat will soon be launching a trial search service.

Should I be worried by slight fluctuations in my ultrasensitive PSA test?

Not necessarily. While the ability of the ultrasensitive test to detect tiny levels of PSA is why it is sometimes used after surgery, as levels of PSA are so low once the prostate gland is removed (because this is where PSA is made) as to be barely detectable (usually 0.1 mg/ml or less), this sensitivity also means it can detect tiny changes in PSA levels, which may not in fact be significant. This is why the use of ultrasensitive PSA tests remains controversial.

If your PSA level does start to climb, your urologist will usually review your original reports and take a view based on these as well – not just the ultrasensitive PSA results – as to whether there is any need for further (adjuvant) treatment.

Are nomograms useful?

They can be – but remember the information they give may not always be the news you were hoping for. So, do talk to your urologist and family before deciding if you want to use one. 

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