Too many Biopsy's ?????

chrisz · Regular Joined: 09 Apr 2007 Posts: 31

I just don't understand this whole Biopsy/PSA mess.

From what I have learned there are only two reasons for a continuing rise in PSA levels. 1: Chronic or acute Prostatitis 2: Prostate cancer

If you have a continuing rise in PSA AND you DO NOT have Prostatitis,
then it must be cancer.

Why put so many (like me) through so many biopsy's. It seems to me the sooner you treat the Prostate for cancer, the better off you are.

A negative Biopsy does not mean you DO NOT have cancer. So what does it mean ?

I switched Urologists, he done a prostate squeeze and found alot of white
blood cells in my serum. Sounds like prostatitis too me and to him. But
my PSA fell from 7.2 to 5.6 and now they want to do another biopsy.
I already had a 24 core done, although, I believe it was only 12 by my
count. I guess the doctor gets more money for the cores. So he cut them
in half and submitted 24. I truly believe this is what has happened.

I read where so many people are put through biopsy after biopsy and
I don't want to go down that road. They sometimes continue to show
up negative, while all the time you still have cancer...... and its growing !!

I personally think that giving biopsy's is a cash-cow for doctors and that's
why they do so many. I just wish you could trust the doctor to do the
best for YOU and not FOR him !!!!

Beware all of you. Do your homework. Be firm. Don't let the docs do
unnecessary tests. Research. Ask questions. Watch them squirm.

I got an appointment with my new UR (he's the one who found the white
blood cells in my seminal fluid) they want to do a biopsy next. But....
the next logical step is to recheck my fluid and find out if there is still
a lot of white blood cells there. If so, the the prostatitis is not cured !!!!
That will be my question.

Chris

rlee · Site Admin Joined: 15 Jan 2006 Posts: 245

chrisz,
Some centers have been investigating the use of ultrasound guided prostate biopies. You may want to consider this procedure and discuss this with your team of doctors. Best Wishes,
_________________
RLee, MD

Any information provided is NOT intended to provide specific medical advice to users but rather to provide users with information to help them better understand their health condition and related care. All readers are strongly encouraged to consult with a qualified physician for answers to their personal medical questions.

johnw100 · Posted: Tue Apr 10, 2007 6:01 pm Post subject: Re: Too many Biopsy's ?????

The prostate naturally produces PSA: larger the prostate is the more PSA can be produced.

Size of your prostate needs to be factored in to give better meaning to PSA reading.

" PSA density" takes account of gland size, and is calculated by simply dividing the PSA reading by the prostate size. The figure is best under .15

"Free PSA" test if available is also used to gauge proportion of PSA being naturally produced.

A lot of the PSA under 10 could be due to enlargement.

John

chrisz · Regular Joined: 09 Apr 2007 Posts: 31

I did have a Ultrasonic Guided Biopsy. (24 core). The results were
Hyperplasia, no cancer found. This was done in 2004 when my PSA
rose to about 4.

I am so confused. I read that 85% of the men with a high PSA
DO NOT have cancer. You can have a normal size prostate with
a low PSA and have high Gleason grade cancer OR you can have a
HIGH PSA and a normal or large Prostate and NOT have cancer.

I was totally shocked when I GOOGLED this phrase :

Prostatitis high PSA

Seems like it is very hard to diagnose some forms of Prostatitis that
cause many men to get many biopsy's. They don't have cancer,
never did.

No wonder PSA testing is banned in many countries.

But then again, many lives have been saved by PSA testing.
But even more lives have been extremely upset by the same test.

I'm not so sure doctors are sure what to do sometimes.

Chris

rlee · Site Admin Joined: 15 Jan 2006 Posts: 245

chrisz,
You hit it on the money, the PSA test is not perfect and far from it. The physician needs to balance the utility of the test with the clinical scenario. The value of 4 for PSA or greater was used with a 25% positive predictive value. In other words, 25% of people with a PSA above 4 will have prostate cancer. The cutoff was used in order to balance the number of true positive from false positives. Hopefully, at the end of the day, this will help save lives. Unfortunately, you've had to go through many of the drawbacks of an imperfect test.
_________________
RLee, MD

Any information provided is NOT intended to provide specific medical advice to users but rather to provide users with information to help them better understand their health condition and related care. All readers are strongly encouraged to consult with a qualified physician for answers to their personal medical questions.

chrisz · Regular Joined: 09 Apr 2007 Posts: 31

Do you think that skipping all those biopsy's and getting a TURP
with and examination on the tissue may be a better route. It appears
that many undetectable cancers are detected after a TURp.

What do you think ?

Chris

rlee · Site Admin Joined: 15 Jan 2006 Posts: 245

chrisz,
Honestly, I'm not sure what to think. Thus in such situation, I always seem to fall back onto a common answer, 2nd opinion. Consider one from a major academic center. I'm not really sure a TURP would get at the question of do you have prostate cancer. If it was normal, I'd still wouldn't be sure as it will only sample a limited portion of the prostate. Sorry,
_________________
RLee, MD

Any information provided is NOT intended to provide specific medical advice to users but rather to provide users with information to help them better understand their health condition and related care. All readers are strongly encouraged to consult with a qualified physician for answers to their personal medical questions.

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