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Having Ankle Pain And Radiates Into The Calf Area. Is It Rheumatism? Could I Go For Prostate Biopsy?
Question: Dear Dr,
I have had an intermittent right ankle pain since late 2008 when I had it investigated and nothing was found. I now comes and goes only when I lie down. On the rare occasions when I get it during the day, standing up, it tends to radiate more into the calf area.
In addition, in the last few months, I have had a radiating pain also in the lower part of my left femur. Could all this be rheumatism or could it be more sinister (like some form of bone cancer). I am particularly concerned as I am about to have a prostate biopsy because I am almost certain of having PCa.
Looking forward to your answer.
XXXX
Still no answer! I am NOT worried about cancer but it is NOT acceptable, that is NOT what I pay for!
I have had an intermittent right ankle pain since late 2008 when I had it investigated and nothing was found. I now comes and goes only when I lie down. On the rare occasions when I get it during the day, standing up, it tends to radiate more into the calf area.
In addition, in the last few months, I have had a radiating pain also in the lower part of my left femur. Could all this be rheumatism or could it be more sinister (like some form of bone cancer). I am particularly concerned as I am about to have a prostate biopsy because I am almost certain of having PCa.
Looking forward to your answer.
XXXX
Still no answer! I am NOT worried about cancer but it is NOT acceptable, that is NOT what I pay for!
Brief Answer:
Dont wory it is not cancer.
Detailed Answer:
Dear XXXX,
Please dont wory as long as you are thinking of cancer. You have this pain since Yr. 2008. If it was cancer it could not have been of this much duration.
There are many other causes of this type of pain you are describing. You should have basic physical examination and basic blood investigation like complete blood count, smear examination, serum biochemistry with lipid profile done in consultation with your primary physician. This will give some clue as regards this type of pain you are having. Some times there is problem with your foot or the shoes you are wearing which can give rise to this type of pain. Your physician will rule it out all.
Regarding prostate biopsy there is no hurry in doing it at the moment unless it has been advised by a competent urologist or by your doctor for if you have prostatic enlargement or have prostatic symptoms. Before thinking of prostatic biopsy you should get your PSA done which is a blood test to find out the abnormality in the prostate.
I hope your concerns are adressed. Feel free to ask more questions if you have any.
Truly,
Dr. J. Ticku
Dont wory it is not cancer.
Detailed Answer:
Dear XXXX,
Please dont wory as long as you are thinking of cancer. You have this pain since Yr. 2008. If it was cancer it could not have been of this much duration.
There are many other causes of this type of pain you are describing. You should have basic physical examination and basic blood investigation like complete blood count, smear examination, serum biochemistry with lipid profile done in consultation with your primary physician. This will give some clue as regards this type of pain you are having. Some times there is problem with your foot or the shoes you are wearing which can give rise to this type of pain. Your physician will rule it out all.
Regarding prostate biopsy there is no hurry in doing it at the moment unless it has been advised by a competent urologist or by your doctor for if you have prostatic enlargement or have prostatic symptoms. Before thinking of prostatic biopsy you should get your PSA done which is a blood test to find out the abnormality in the prostate.
I hope your concerns are adressed. Feel free to ask more questions if you have any.
Truly,
Dr. J. Ticku
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Dr Ticku,
I am glad you have ruled out cancer with respect to my ankle.
I am having extensive tests done by my GP to establish whether it could be due to either osteoarthritis, the most probable cause or the onset of gout, so I am no longer worried and will be glad to know for sure what the cause is since I have neglected this mildish pain which occurs only when lying down for too long!
With respect to my risk of PCa, it is now very high indeed. My PSADT has more than doubled in less than 12 months! from 5.4 (July 2012) to 9.9 (June 2013), total PSA with a current free PSA of 1.57 (16% of total). My prostate size is 68 cc, so my PSAD is 14.4%, I have significant urinary symptoms including frequency, urgency and nocturia (once per night). Every doctor I have seen is advising me to have my first biopsy, my GP in the UK, my GP, Surgeon and Urologist in Oman and I am seeing a second urologist in Muscat, Oman at 7 pm today as he will be the one to carry the imminent biopsy, I cannot wait any longer, I need to know because I could suffer from a PCa with XXXXXXX Score equal or higher than 7 which is potentially fatal in my normal lifespan, so I do need to rule it out. I hope you agree, please have a look at the PSA figures above!
I will wait for your answer on the last point and then close the discussion. Thank you very much for your valuable advice.
Kind regards,
XXXX
I am glad you have ruled out cancer with respect to my ankle.
I am having extensive tests done by my GP to establish whether it could be due to either osteoarthritis, the most probable cause or the onset of gout, so I am no longer worried and will be glad to know for sure what the cause is since I have neglected this mildish pain which occurs only when lying down for too long!
With respect to my risk of PCa, it is now very high indeed. My PSADT has more than doubled in less than 12 months! from 5.4 (July 2012) to 9.9 (June 2013), total PSA with a current free PSA of 1.57 (16% of total). My prostate size is 68 cc, so my PSAD is 14.4%, I have significant urinary symptoms including frequency, urgency and nocturia (once per night). Every doctor I have seen is advising me to have my first biopsy, my GP in the UK, my GP, Surgeon and Urologist in Oman and I am seeing a second urologist in Muscat, Oman at 7 pm today as he will be the one to carry the imminent biopsy, I cannot wait any longer, I need to know because I could suffer from a PCa with XXXXXXX Score equal or higher than 7 which is potentially fatal in my normal lifespan, so I do need to rule it out. I hope you agree, please have a look at the PSA figures above!
I will wait for your answer on the last point and then close the discussion. Thank you very much for your valuable advice.
Kind regards,
XXXX
Brief Answer:
Prostatic hyperplasia
Detailed Answer:
Dear XXXX,
You did not give earlier the details about prostate. You are doing a right thing to see a urologist. He will perform digital rectal examinnation and if required ask you to have biopsy of the prostate. PSA is definitely on the higher side which could be because of simple prostatic hyperplasia or otherwise.As per pain in ankle and your thought of having it because of malignancy could have been ruled out by MRI. However I am confident that your pain is not of malignant nature, but prostatic problem needs to be ruled out.
Regards,
Dr. J. Ticku
Prostatic hyperplasia
Detailed Answer:
Dear XXXX,
You did not give earlier the details about prostate. You are doing a right thing to see a urologist. He will perform digital rectal examinnation and if required ask you to have biopsy of the prostate. PSA is definitely on the higher side which could be because of simple prostatic hyperplasia or otherwise.As per pain in ankle and your thought of having it because of malignancy could have been ruled out by MRI. However I am confident that your pain is not of malignant nature, but prostatic problem needs to be ruled out.
Regards,
Dr. J. Ticku
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many thanks for your answer and re-assurance, I hope you are right and it is still BPH which I have suffered from for years, in fact perhaps since 1994! I have had more than 4 DREs by different doctors including 2 urologists in the last year, all of them negative so I guess if my PCa was advanced, someone should have felt it.
I am still worried because of my PSA Doubling Time (more than 100% increase in less than 12 months). This is NOT a good sign, Dr Catalona in the USA claims that any increase in total PSA in one year of more than 2 mg means not only prostate malignancy but a very high risk of an aggressive cancer, what are your thoughts on that before I close the discussion? Dr Vickers refutes Dr Catalona's research and findings, are you really telling me that my 68 cc prostate could generate such a large total PSA increase in less than 12 months???
XXXX
I am still worried because of my PSA Doubling Time (more than 100% increase in less than 12 months). This is NOT a good sign, Dr Catalona in the USA claims that any increase in total PSA in one year of more than 2 mg means not only prostate malignancy but a very high risk of an aggressive cancer, what are your thoughts on that before I close the discussion? Dr Vickers refutes Dr Catalona's research and findings, are you really telling me that my 68 cc prostate could generate such a large total PSA increase in less than 12 months???
XXXX
Brief Answer:
Prostatic hyperplasia
Detailed Answer:
Dear XXXX,
What I told you is that the leg pain is unlikely due to cancer and if if it was because of cancer it could have been picked up by MRI. No body has advised you that because they also thought that the leg pain is not of malignant nature.
Prostate is definitely a concern which needs to be investigated as recomonded by your urologist but the psa levels are still not so alarming and could be simple prostatic hypertrophy.In this condition malignancy is a chance and should certainly be ruled out as recomonded by your urologist.
Please dont be nervous, get investigations done and further advices will follow.
Truly,
Dr. J. Ticku
Prostatic hyperplasia
Detailed Answer:
Dear XXXX,
What I told you is that the leg pain is unlikely due to cancer and if if it was because of cancer it could have been picked up by MRI. No body has advised you that because they also thought that the leg pain is not of malignant nature.
Prostate is definitely a concern which needs to be investigated as recomonded by your urologist but the psa levels are still not so alarming and could be simple prostatic hypertrophy.In this condition malignancy is a chance and should certainly be ruled out as recomonded by your urologist.
Please dont be nervous, get investigations done and further advices will follow.
Truly,
Dr. J. Ticku
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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