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Thread: Perineal Biopsy

  1. #1
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    Question Perineal Biopsy

    Hi all. First time poster and I'm looking for info from folks who've had perineal biopsy's. I'm currently doing active surveillance and was diagnosed in 2008 when my PSA left the 1-2 range and made the huge leap to 3.5. This was enough for the doc to advise a 12 core biopsy. Have since had 3 - 12 core and 1 MRI of the prostate along with multiple PSA's and 3xPCA3's. Results: 1st biopsy 3% in one core only, 2nd biopsy 10% of one 12mm core, 3rd biopsy negative followed by the MRI which was negative. Last 3 PSA's were 3, 4.24, 3.59. PCA3's 34, 55, 99, in that order.

    My issue now is do I go for a 48 core perineal biopsy to try and better locate the cancer and if so, what side effects have others experienced. Since I have an enlarged prostate and already medicate to ease urination, I expect I'll need a catheter if there's any post swelling. There you have it. Any info on your experience will be gratefully received. Thanks, Jim

  2. #2
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    I am new to this but have spent an inordinate amount of time researching my own situation. You don't mention what your Gleason score was. If 6 or less, in the limited amount found, active surveillance would still seem appropriate, unless you had a much higher psa. You're saying the psa went up to 3.5 in 2008 and is still about the same?

    Typically that type of biopsy is done when there is a significant rise in the psa but the biopsies are coming back negative. Anyway I don't have an answer for you but I am interested in what others have to say about it. At least I avoided that type of biopsy with my loaded results
    56 Yrs Old
    2007 PSA 2.9
    2011 PSA 5
    2012 PSA 5.6
    Nov 2012 1st Biopsy 12 core
    8 of 12 Positive 5%-40%
    Apex/Base T2c Perineural Involvement

  3. #3
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    Thanks for reply

    Gleason has been 6 all along. I'm thinking Active S is still the way to go for me. My unanswered questions: is there more, how much is there, were the first two biopsy's a fluke (really don't think so due to the PCA3's)??? Too many questions unanswered, so will likely do the Perineal of 48 or more, but would sure like to hear from others who've gone this route as to side effects, swelling, any issues encountered, etc... before I pull the trigger.

    Recap:
    Age 70
    Prostate enlarged
    PC Diagnosis 2008
    PCA3 12/2012 - 99
    PSA ranging in the mid 3's
    Gleason 6

  4. #4
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    Persuader,

    Welcome. Looks like you are a perfect candidate for AS. Your age, biopsy, G6 and PSA all indicated your cancer is indolent. In my layperson's opinion, a saturation biopsy is an overkill and you don't need the complications that comes with it.

    Best wishes and good luck.

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    Reply to newporter

    Quote Originally Posted by newporter View Post
    Persuader,

    Welcome. Looks like you are a perfect candidate for AS. Your age, biopsy, G6 and PSA all indicated your cancer is indolent. In my layperson's opinion, a saturation biopsy is an overkill and you don't need the complications that comes with it.

    Best wishes and good luck.
    Thanks for the reply. Not sure my doc (surgeon) agrees with you. LOL However AS is the path I've chosen. The issue though is "how extensive is the Ca"? It's my understanding the normal 12 core biopsy can only sample a very small portion of the prostate and pretty much ignores the side it can't reach (I'll call it the underside). Because of the last biopsy and then MRI showing negative, doc is recommending perineal to determine the extent by sampling a greater portion of the prostate. His thinking is the prostate could have extensive CA on the underside and we'd never know it. Wish there was another way, but I haven't heard of it. Thus the reason for reaching out to others who've experienced this type of biopsy.

  6. #6
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    Look into a TRUS guided biopsy using color doppler ultra sound. I have no personal experience with them but I remember reading somewhere they can view tumors with more precision then standard ultra sound, thus allowing a more targeted biopsy.

    I would look into that as a possible option to the one you are thinking of, hopefully others with more knowledge about them will comment
    56 Yrs Old
    2007 PSA 2.9
    2011 PSA 5
    2012 PSA 5.6
    Nov 2012 1st Biopsy 12 core
    8 of 12 Positive 5%-40%
    Apex/Base T2c Perineural Involvement

  7. #7
    I would get a Color Doppler Ulltrasound before a saturation biopsy.
    1. It is much less expensive.
    2. It can see into the anterior much better than an MRI
    3. It will provide a baseline for continued Active Survelience
    Even travelling to a well known CDU radiologist like Dr Duke Bahn or Dattoli would be less expensive and less traumatic than a saturation biopsy. A saturation biopsy would be the way to go if your were considering a focal treatment, but for monitoring AS, a CDU would be better.
    psa at diagnosis 40 in nov-08
    gleason 6 and 7
    Treatment choice seeds and IMRT

  8. #8
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    Thanks for the info

    Quote Originally Posted by LL Fauntleroy View Post
    Look into a TRUS guided biopsy using color doppler ultra sound. I have no personal experience with them but I remember reading somewhere they can view tumors with more precision then standard ultra sound, thus allowing a more targeted biopsy.

    I would look into that as a possible option to the one you are thinking of, hopefully others with more knowledge about them will comment
    Will research. Jim

  9. #9
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    Quote Originally Posted by johnT View Post
    I would get a Color Doppler Ulltrasound before a saturation biopsy.
    1. It is much less expensive.
    2. It can see into the anterior much better than an MRI
    3. It will provide a baseline for continued Active Survelience
    Even travelling to a well known CDU radiologist like Dr Duke Bahn or Dattoli would be less expensive and less traumatic than a saturation biopsy. A saturation biopsy would be the way to go if your were considering a focal treatment, but for monitoring AS, a CDU would be better.
    Now that's two of you for TRUS. My doc mentioned that and stated he wasn't that much of a fan of the procedure so I never followed up to look into it. Not that he doesn't have my best interests at heart, I do have to keep reminding myself that he's a surgeon and the saturation is done at his place by one of his partners. So I'll do my due diligence. My thanks to you and LL Fauntleroy.

  10. #10
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    Hi there

    I had the Perineal Biopsy 8 months ago and was diagnosed with PC. Since its a procedure done under full anestecia there is absolutely no pain or discomfort associated with the procedure. As its was done as an out patient I was home a few hours after arriving at the hospital.

    After the procedure there was no pain at all only slight discomfort for a couple of days - probable 1.5 out of 10 at the most. There was a bit of blood in my semen but nothing in my urin.

    I was very happy with the procedure and happy my surgeon suggested it. If you have any question don't hesitate to ask.

    Good luck
    Dunbar
    Born 1968
    Family history of PCa
    March 16, 2012 PSA4.8, Free PSA 4%
    March 26, 2012 PSA5.6 Free PSA 5%
    April 4, 2012 Biopsy
    April 5, 2012 PCa diagnosed
    Gleason 3+4 = 7, T2b, Cancer in 6 of 18 cores
    Da'Vinci June 12, 2012 by Dr Stricker, St Vincents Hospital, Sydney
    Post Surgery result: 3+4=7, T3a (upgraded from T2b) Negative Margins, No Seminal Vesicles/Lymph Node involvement
    Cath out July 12 = 4 weeks
    First PSA 0.01 (5 weeks)
    Second PSA <0.01 (6 months)
    Third PSA <0.01 (12 months)
    Fourth PSA <0.01 (18 months)

  11. #11
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    Hi Dunbar. I like that last line, PSA 0.01. That's great!

    Thanks for the info on the PB, much appreciated. If I understand correctly, you had an 18 core biopsy. Because of my enlarged prostate, any swelling due to a 48 core biopsy will likely interfere with urination (been there, done that with hernia surgery). Did you experience any issues along that line? Thanks

    Quote Originally Posted by Dunbar View Post
    Hi there

    I had the Perineal Biopsy 8 months ago and was diagnosed with PC. Since its a procedure done under full anestecia there is absolutely no pain or discomfort associated with the procedure. As its was done as an out patient I was home a few hours after arriving at the hospital.

    After the procedure there was no pain at all only slight discomfort for a couple of days - probable 1.5 out of 10 at the most. There was a bit of blood in my semen but nothing in my urin.

    I was very happy with the procedure and happy my surgeon suggested it. If you have any question don't hesitate to ask.

    Good luck
    Dunbar

  12. #12
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    Hi mate

    I had no issues with urination at all. Before the procedure I had no idea what I was going in to - seems to be very little information out there - but it was a "good" experience, no pain, no discomfort. They did give me some Panodil Forte for pain, but I didn't eat them all.

    Dunbar
    Born 1968
    Family history of PCa
    March 16, 2012 PSA4.8, Free PSA 4%
    March 26, 2012 PSA5.6 Free PSA 5%
    April 4, 2012 Biopsy
    April 5, 2012 PCa diagnosed
    Gleason 3+4 = 7, T2b, Cancer in 6 of 18 cores
    Da'Vinci June 12, 2012 by Dr Stricker, St Vincents Hospital, Sydney
    Post Surgery result: 3+4=7, T3a (upgraded from T2b) Negative Margins, No Seminal Vesicles/Lymph Node involvement
    Cath out July 12 = 4 weeks
    First PSA 0.01 (5 weeks)
    Second PSA <0.01 (6 months)
    Third PSA <0.01 (12 months)
    Fourth PSA <0.01 (18 months)

  13. #13
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    Perineal

    Quote Originally Posted by Dunbar View Post
    Hi mate

    I had no issues with urination at all. Before the procedure I had no idea what I was going in to - seems to be very little information out there - but it was a "good" experience, no pain, no discomfort. They did give me some Panodil Forte for pain, but I didn't eat them all.

    Dunbar
    Thanks again. Just messaged my doc to find out why he was less than enthused about me doing a Targeted Biopsy vs. the one you had and is recommended for me. It's hard researching this stuff. Coming from a sales and marketing background, I'm always looking at the suggestions as a sales or marketing pitch. They need to make money, so how much of what is out there is factual. Filtering the hype isn't easy for a layman. Fortunately I have the time that many don't. Jim

 
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