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Thread: Should I get a prostate biopsy?

  1. #1
    Newbie New User
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    Should I get a prostate biopsy?

    Hello.

    I'm new to this, so I apologize if I am asking something stupid or something that has already been discussed.

    I am almost 51 years old, and my urologist recommended a prostate biopsy. I almost always follow a doctor's recommendation, but after reading about some of the possible effects of a biopsy, I am a bit hesitant. Also, my PSA scores do not seem that elevated, based on what I have read.

    My first PSA was 2.51.
    My second PSA (three months later) was 2.13.
    I do run a lot, which I hear might raise the PSA level.
    Digital exam did not detect any enlargement.

    Anyway, I was just curious if anyone had any ideas about whether the doctor is being too cautious (if there is such a thing), or whether I should just suck it up and get the test.

    Thanks.

  2. #2
    Welcome Dutchman90! Glad that you have arrived at The Forum without a PCa Diagnosis! There is a wealth of info available here along with multiple friendly and supportive members.

    Since none of us are MDs or qualified medical professionals, we can't dispense medical advice. But we will gladly share our experiences and suggestions.

    A few questions:

    - What reason(s) did your URO MD provide for wanting to do a biopsy?

    - Do you have a family history of prostate cancer (PCa)?

    It certainly is possible to have PCa at a normal PSA level. Your PSA appears to have gone down from 2.5 to 2.1. Likely, your PSA is bouncing up and down slightly - which is not unusual. Typically, but not always, a PSA that is rising due to PCa tends to continue to rise vs drop.

    Unless there is a strong suspicion or a cogent reason to rule out PCa, I would ask about first having a MP 3T MRI to identify any areas of suspicion. If any detected, the MRI can then be "fused" with the Biopsy (Bx) ultrasound. Not all insurers will cover the MRI prior to the 1st Bx.

    Bx is not without risks or adverse events. Also, Bx does not always detect exisitng PCa. PCa foci can be missed during the Bx procedure.

    IF/when Bx is required, the vast majority of us found it to be uncomfortable but certainly not unbearable. The anticipation can be worse than the actual procedure.

    Keep asking questions and demand correct answers! And keep us updated.

    MF
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  3. #3
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    Thanks for the response, Michael. The reason I started seeing the doc was an increase in the number of times I needed to urinate throughout the day and night. I have no family history of PCa; at least none that I know of. I will definitely ask about the other test. I am just nervous about the possible complications and after-effects of the test (and, of course, I am nervous about the results).

  4. #4
    I'm a do the biopsy guy.

    I've never had anything felt on a dre and my MRI found a pirads 1-2 on the left side and a 3-4 on the right side. Cancer was found in the random biopsy of a different area than what showed up on the MRI. So I'm skeptical about the whole accuracy of the MRI thing.

    I am one of those guys where nothing is clear. One test will set off sirens flashing and another will point to nothing being wrong.

    I just see a lot of younger guys (I'm 48 ) getting diagnosed early and the consequences of believing you're okay when you're not are high.

    I say do the biopsy. Yes it sucks out loud but it could save your life. If you prefer to go the route of the MRI and fusion biopsy (if anything lights up the MRI) my strong suggestion is that you then make them do a random after they target anything found on the MRI. Had I not asked for that 'after you're done' random, I would be sitting here with two biopsies that said not cancer.

    Good luck. I've had two biopsies and except the bloody urine and semen, no complications at all. If it gives you and comfort, I am that one in a million patient they talk about in textbooks as "this is your worst case" and i survived.

  5. #5
    Top User
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    Get a biopsy. Biopsies are more accurate the smaller the prostate.

  6. #6
    I'd be inclined to do it. You are already under care of the urologist and he's familiar with your symptoms and that.

    Just on the basis of PSA and DRE, I wouldn't think there would be much point to it. But this is the doctor that you have already entrusted with your plumbing, and he sees something in your health record and that.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  7. #7
    I have had six biopsies, two of which tripled my psa and hurt for up to six months.

    I just read a thread elsewhere where a man got sepsis from a trans rectal biopsy and has been in and out of intensive care for three weeks. That happens in about 5 percent of biopsies.

    IMHO, ideally, I would recommend a 3T MRI as your next step, to see if there are any suspicious areas for a biopsy to target. If none, in your case, forget the biopsy and have a PHI test (more extensive PSA) in six months.

    If your doctor won’t order the MRI, or your insurance won’t pay for it, try to arrange to pay for it in cash.

    If none of the above is available, the latest, safest, and most accurate prostate biopsy is the Precision Point transperineal system. No chance of infection, no antibiotics, and access to the anterior of the prostate. See if that is available now in your area.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA 4.4, fPSA 24, PHI 32
    Hopefully, I can remain untreated. So far, so good.

  8. #8
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Posts
    7,214
    Welcome to the forum, DM, with great hopes that you do not become one of us who have been diagnosed with PC.

    At this point, I see no need to have a biopsy, especially since your PSA actually went down. At your age, the increased urination is "probably" due to BPH, which is not cancer. Did the doctor note anything about an enlarged prostate after doing a DRE (digital rectal exam)?
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  9. #9
    Quote Originally Posted by ASAdvocate View Post
    I just read a thread elsewhere where a man got sepsis from a trans rectal biopsy and has been in and out of intensive care for three weeks. That happens in about 5 percent of biopsies.

    .

    Just to be clear, do 5% of biopsies cause a serious enough infection to land the patient into the ICU? Or is it just 5% requiring some intervention because of infection, not necessarily that serious?
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  10. #10
    The most recent studies show infection rates up to 7 percent, and sepsis rates at 3 percent. Sepsis can be fatal, and requires hospitalization.

    However, the trends are upward, due to increased antibiotic resistance.

    I would add that I had all the pre-testing and prescribed antibiotics at JH, and still had two very rough biopsy aftermaths.

    https://www.renalandurologynews.com/...-is-infection/

 

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