Prostate Biopsy

[pagenie__0]

     My 50 year old husband has been having prostate problems since
  about age 42.  He has been taking Hytrin since then and had been
  going to the urologist yearly.  His PSA results have been elevated
  for the past year and a half.  He had a scope of the prostate which
  showed nothing out of the ordinary for his condition about 2 years
  ago.  During the last year he has had PSA run at six month intervals.
  Even though the last exam was OK, the PSA level raised 3 pts. since
  6 months ago.  It is now in the range of 6+.  He is scheduled for a
  biopsy on May 6.  
    
     Please give me your impressions of this sitation.  We live in a
  mid-size town but are in an area near Columbus, Cleveland and Pitts-
  burgh.  The doctor seems very through but we would like to have
  the best at the earliest point.  Should we consider a second opinion
  and when?
     Just out of my own curiosity, would this situation have a bearing
  on fertility and sexual desire?  We never conceived and his sperm
  tests showed "grossly abnormal" sperm at age 32.  His libido has always
  been low.  
     We have two adopted children, age 14 and 7.  I love my husband
  very much and he is a very good husband and father.  We are very
  scared.  Any honest help or advice would be appreciated.
  Thank you.
----------------------------------------------------------------------------
Dear Pagenie,
By now you may well have a diagnosis. Remember, however, that the biopsy report only reflects what the needle entered. If the biopsy is not that  of a prostate cancer but his PSA stays elevated, a repeat biopsy should be performed in the next few months. Certainly not every elevated PSA indicates a cancer. Physically large prostates, true prostate infections, quite recent orgasm, prostate massage, death of prostate tissue due to sudden blood vessel blockage  (infarction) can also cause such elevations. However, in the absence of these, I would continue to be concerned about a rising or elevated PSA and search for a cancer with random and multiple biopsies.
A second opinion about management of a prostate cancer is often worth pursuing if only to make you feel that you are being given reasonable options and by way of self education. You do not want to look back and say that had you had different information you would have proceeded differently. As far a where to go, consider  any academic center. They will have a urologist who is particularly concerned with prostate cancer. Talk withyour urologist and see whom he would recommend.
There is not a known relationship between prostate cancer or dysfunction and libido. Nor, do I think, can you draw a relationship between fertility and his urinating problems.
Best of luck to the two of you. If we can be of further help please contact us as below.
This information is provided for general medical information purposes only. Please consult  your physician for diagnostic and treatment options pertaining to your specific medical condition. We of the Department of Urology at the Henry Ford Hospital have experience with difficult and involved urological problems such as you describe. If you would like to make an appointment  [for a second opinion], please call us at  (1-800-653-6568). We can also arrange local accommodations through this number if this is  your need. Please bring any x-rays [and pathology slides] (not just the reports) as well as any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly
HFHS M.D.-SAL
*Keyword: prostate cancer, PSA