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FISH Test results: Wondering What's Next
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FISH Test results: Wondering What's Next

I am writing to see if anyone can help with the interpretation of my test results and case history so far. About 6 weeks ago, I saw the Urologist regarding a slight, persistent swelling in the right testicle. He said it was probably caused by inflammation and advised me to cut down on exercise (which I was doing about 5 days a week). However, during the routine strip testing of the urine, he said there were traces of blood in the urine (though it was not visible at all) and ordered an ultrasound which revealed a 4 mm stone. He immediately scheduled a shockwave treatment to get rid of the stone---the underlying logic being that if the traces of blood persist even after the pulverization of the stone, there would be cause for concern for bladder cancer. However, in the meantime, I purchased Hemastix on my own, stopped my exercise for about 14 days and tested the urine for traces of blood on my own. The tests at home were negative for three consecutive days, and I did not know if it was due to stopping of the exercise or whether it was just random. My primary care doctor initially felt that a 4mm stone is not a big deal and would probably pass on its own. In any case, because of this and the negative test at home, I asked the Urologist whether it might be a better idea to wait for a few more weeks to see if the stone grows larger than 4 mm since I had absolutely no symptoms---no pain, no frequent urge to urinate (or any more than what I was used to) except the traces of blood detected some weeks ago by his office. Then the Urologist's office called and scheduled a urinalysis. In the meantime, I resumed my exercise, and the Hemastix strip started to show slightly positive results.

I am 59 and have been using Caverject/Edex for ED for a couple of years. It seemed that whenever the injection is used, the hemastix strip would show slightly positive result. However, when I asked the Urologist during my second visit, he said there is no connection between the two at all.

The Urologist's office called last week to schedule a visit and gave me the choice of seeing him either in the office or the hospital. I asked what the purpose of the visit was and the secretary simply said that the test showed some abnormality in cells, and so the doctor wants to take a look at it. She would not say what exactly he would be looking at, or what the abnormalities were. I requested a copy of the FISH results directly from the lab, and finally received it just two days ago. Now I am indeed fightened because the report says: "POSITIVE fluorescence in situ hybridization (FISH) result using the Vysis UroVysion TM assay... INTERPRETATION AND COMMENTS: An ABNORMAL hybridization pattern was observed with 5 cells exhibiting numerical abnormalities for chromosomes 3,7,9, and 17. This result is indicative of bladder cancer according to the UroVysion Directional Insert."

I guess that pretty much leaves little room for doubt. I am surprised that I would get this bladder cancer without any major symptoms and am worried about how long it might have been present in the bladder. I have Rheumatoid Arthritis for about 8 years for which I take Enbrel injection and Salagen for dry mouth.

My appointment with the Urologist is coming up in 2 days and from past experience, I know that he does not like to talk much, but pretty much tends to summarize things in two or three minutes. I am concerned about having to make a decision about something on the spot. What do you think I can expect during this visit? From what I have read so far, it appears that I can look forward to his inserting a flexible or rigid tube through the penis. Following are my questions:

a) Is there a risk in this procedure? Should I insist on a second opinion now before any futher exploration is done?

b) Are there alternatives that I should ask him to explore first? Or is the FISH result so overwhelmingly definitive that I should not waste any more time and ask him to go ahead and even take a biopsy if necessarry?

c) Further, could there be a link between the use of Caverject (and possibly injecting it wrongly a couple of times over the years) and bladder cancer?

Thank you for any guidance you can provide.   [I know that I am probably going through a denial phase in spite of the test results stating the obvious about the indications of bladder cancer.]
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Hello. I am not a doctor but have had bladder tumors removed. As far as I know, the only way to confirm a bladder cancer diagnosis is for the doctor to use that flexible tube(cystoscope) to look inside the bladder for the presence of a tumor. If he sees one, they'll schedule you for surgery to remove and biopsy the tumor. I don't know about the relationship of your medications to bladder cancer; I was told it is mainly a result of smoking or working with certain chemicals.

Most importantly though, is that you are in charge of your treatment. Write down the questions you wish to ask; bring along your wife or a friend yo help in case you are overwhelmed. Don't leave the office till you are satisfied.

Good luck.
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