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Prostrate Biopsy

sylvan75
Posts: 30
Joined: Sep 2009

I am a 65 year old male, I have a Prostrate Biopsy scheduled for July 13, which I am not sure if I want to go through with it. I have just read a report from John Hopkins that states " Nearly 75% of the time no cancer is detected in the samples because the elevated PSA levels were due to another condition. My last PSA done in April 2010 my PSA was 5.11, my Kidney Doctor is not a believer in the PSA ratings as he feels they are flawed. I am having this done at the Philadelphia VA Medical Center. The only urologist I have spoken to is an intern and there wasn't a high level of confidence sensed. In Dec of 2009 I had a partial Nephrectomy for removal of a 2cm tumor, which went well and my follow-up 6 month MRI showed I was clean. The Urologist who performed my surgery was affiliated with the Univ. of Penn. and was excellent, but since he is not directly associated with the VA I have never spoke with him, just to the interns.

I am looking for some advice, should I go ahead with the Biopsy or not?

TKS

Sylvan75

Swingshiftworker
Posts: 658
Joined: Mar 2010

Without a biopsy, you'll never know if you have prostate cancer (PCa) or not and, even if you do have PCa, the biopsy could miss it. PSA tests aren't perfect either and an elevated PSA level does not necessarily mean that you have PCa but, if your PSA level consistently rises and begins to rise rapidly over a short period of time, it's a good reason to have a biopsy done in order to rule out PCa.

FYI, I'm 59, had a 4.1 PSA and they found PCa in me. The biopsy procedure is done under anesthesia in about 30 mins. However, you can experience rectal bleeding and some blood in your urine and/or ejaculate for a week or so following the procedure. So, the procedure is not without side effects.

You do not indicate any prior PSA test results, so whether a biopsy is indicated based on your PSA level pattern is unclear but, given your age, prior kidney tumor and slightly high PSA level, I think that you should get the prostate biopsy done.

DanKCMO's picture
DanKCMO
Posts: 42
Joined: Apr 2010

Have your doctors ruled out other possible reasons for your high PSA such as prostate infection (some patients are put on antibiotics to see if this lowers PSA). Also sex or digital rectal exam just before PSA test can show elevated levels.

Do you have a history of PSA tests that show a rise or was this an isolated test?

Good luck.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Swingshift gave you some good advice. A single PSA reading isn't of much use unless it is very, very high and yours doesn't fit that category. More important than a single reading is a PSA trend over time. At 65, you have likely had several PSA tests over the years as part of the blook workup in your regular physical. If those readings indicate an increasing trend, I would urge you to get the biopsy done. If they're usually low and a single higher reading shows up your urologist may be comfortable with you waiting a few months and doing it again.

Several things can cause an elevated PSA besides prostate cancer. Having sex within a day or two of the blood draw can cause the readings to go up. An enlarged prostate condition or a condition known as BPH can cause elevated readings. Sometimes the sacs in the prostate get inflamed and that could cause PSA to go up. Also, PSA tends to gradually increase with age. Another thing that can cause the PSA to elevate is the manipulation of the prostate during the DRE. Be sure to have your GP draw your blood BEFORE he does the digital rectal exam.

If you have a record of several PSA readings (these should be in your medical records) then you can use a nomogram (look at the Sloan Kettering cancer website) to plug in the values and the dates and it will calculate a PSA velocity and PSA doubling time. PSA velocity is the speed at which your PSA is increasing and the doubling time is the estimate of the time that it should take your PSA level to double. While not definitive for prostate cancer, these readings could help you make a decision. A low PSA velocity and a long (greater than 6 years) doubling time probably means that even if you have PCa, it's most likely a slow growing variety which gives you time to seek other opinions.

Many doctors are uncomfortable with using PSA alone as a precursor to a biopsy as it has a poor record of correlation to diagnosis and many believe that over reliance on the PSA test has led to much over treatment. On the other hand, other methods of detecting early stage cancer are no more reliable so at this point it's about all we have. The other positive thing about using the PSA as a decision point in proceeding with a biopsy is that thousands and thousands of men had their cancer discovered at an early stage when they have the most options to treat and cure it.

The biopsy itself is unpleasant and for me, at least, painful, even though a local anesthesia was used. On the other hand, as Swingshift points out, you won't know for sure whether or not you have PCa unless you get one and even if your biopsy comes back negative, you will wonder if it's negative because you don't have cancer or negative because the missed sampling a portion of your prostate that had cancer.

One statistic to be aware of: About 50% of men in their 50's in the US have indolent PCa and don't know it. 60% of men in their 60s, 70% of men in their 70s and so on. Overall, 1 in 6 men in the US will be diagnosed with PCa. The good news is that only about 1 in 35 actually die from it.

More troubling than the question of whether or not to get a biopsy is the whole question surrounding your medical care and access to a knowledgable urologist. As a veteran, if you are eligible for Tricare I would urge you to find yourself another physician outside of the VA hospital that you seem to be tied in with. At 65 I would think Medicare might have some options for you as well.

Over the long haul, if you do have PCa, you need a medical team you can trust to help you through the process.

Best of luck.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Everyone here has given you excellent insight for this. It seems most people have an experience that the biopsy is uncomfortable...for me it was not painful one bit...in fact my phone rang while having the procedure and the doc said if you can reach your phone go for it...as he proceeded to take 8 samples I was listening to a voicemail left...we were all laughing will he was doing it. After you check all the instances above to see if there could be another reason for your elevated PSA and rule out sex, BPH, DRE prior to blood draw I would definitely go ahead with the biopsy...for the single true fact that early detection means many more treatment options to choose from and better outcomes with most every treatment for PCa.

I would search out a very confident and specific center that deals with prostate cancer for the best possible urologist that is more confident and does many biopsy's to potentially have a better experience. The procedure should last only about 15-20 minutes max. If you have an experienced biopsy urologist the pain should be minimal as well as the after effects.

Kongo mentioned that only 1 in 35 die from prostate cancer..but if you do the math in 2009 there was a death from prostate cancer every 19 minutes in the US. And just about as many men die each year from Prostate Cancer as women die from breast cancer. This is serious stuff if left unchecked and ignored. My advice is to do what you need to in order to rule out the beast or find the beast early so your chances of eliminating it from your life come with much higher odds.

My Path to date:

52 years old
PSA 9/09 7.25
PSA 10/09 6.125
Diagnosis confirmed Oct 27, 2009
8 Needle Biopsy = 5 clear , 3 postive
<20%, 10%, 10%
Gleason Score (3+3) 6 in all positive cores

11/09 Second Opinion on Biopsy slides from Dr. Koch
(4+3) = 7 5%
(3+4) = 7 10%
(3+4) = 7 10%

Endorectol MRI with Coil - Indicated the Palpal tumor was Organ confined

Da Vinci performed 12/29/09 - Dr. Hollensbee & Scott
Sling installed at time of Da Vinci – not sure what name of it is but not the 800 that is causing all the problems. Attached to Coopers Ligament.

Post Surgery Pathology:
Prostate size 5 x 4 x 3.5 cm Weight: 27 g
Gleason: Changed to (3+4) = 7
Primary Pattern 3, 80%
Secondary Pattern 4, 18%
Tertiary Pattern 5, 2%
Tumor Quantitation:
Greatest Dimension, Largest tumor focus: 19 mm
Additional Dimension 18 x 15 mm
Location, largest tumor focus: Right posterior quadrant
Multifocality: Yes
Greatest dimension second largest focus 10 mm
Location: second largest focus: Left Posterior quadrant
Extraprostatic extension: Yes
If yes, focal or non-focal: Nonfocal
If yes: location(s) right and left antero-lateral
Seminal vesicle invasion: No
Cancer at surgical margin: No
If no, closest distance with location: less than 1 mm, right posterior quadrant
Apex involvement: No
Bladder involvement: NO
Lymph-vascular invasion: No
Perineural invasion: Yes
Lymph nodes: 9 from right pelvic 0/9 positive
Stage: pT3a, pNo, pMX
All nerves sparred - found two additional pudendal arteries

FIRST PSA TEST 2-11-10 <0.1 NON-DETECTABLE

Virtually Pad free 2-20-10

SECOND PSA TEST 5-26-10 <0.1 NON-DETECTABLE

Notes on Recovery: Was at my desk working (from home office – sales) 6 days following my surgery. No pain to speak of (very lucky as many have some pain) I think because I took the Tramadol they gave religiously and found it to be the best drug in the world. BM’s where the trickiest part and most uncomfortable in the early stages but improved with time – follow the diet they give you!...I strayed off and the next BM helped to get me back on track – I like food very hot and spicy - don’t recommend that for at least a month following surgery. Cream soups, mushroom, celery, and chicken worked great the first week following surgery. Mashed Potatoes…Ah the first time following surgery it was heaven!...the first really solid food I ate…..you will learn to appreciate food all over again as you add back your favorites following surgery when the time is right. Take all the help from everyone around you…it might be a while you get that opportunity again to be waited on hand and foot. Liquids are a concern but some affect people differently it seems reading through the discussion board…I found anything carbonated would cause much leaking…alcohol was not good either…but I justified doing it thinking It’s my training method to work on my bladder control!...lol I love homebrewed beers too much! And am an admitted hop head.

ED path:
Early on started on Viagra 100mg pills cut into 4ths so 25mg per day dose then a full 100mg on every 7th day.
Also bought pump and used sporadically to get blood flow to member. Within about three weeks or 5 weeks from surgery (cannot remember but probably posted on CSN somewhere) had usable erections.

Currently only need ¼ pill to get usable . Day 150 am starting to get semi hard without any drug.

Day 163 had usable erection without any drug!!!

Not finding I can go drugless permanently yet day 169 post surgery.

Randy In Indy

BRONX52
Posts: 156
Joined: Apr 2010

I TOO STRUGGLED WITH THE BIOPSY QUESTION.I AM 58 AND. MY PSA WAS 5.1 AND THE DRE WAS NORMAL. BUT I KEPT ASKING MYSELF--WHAT IF ???. I WAS LUCKY ENOUGH TO HAVE A FEW FRIENDS WHO HAD PROSTATE BIOPSIES DONE AND THEY EXPLAINED THE PROCEDURE AND SIDE EFFECTS IN GREAT DETAIL. THEIR PSA'S WERE SIMILAR---ONE LOWER AND ONE HIGHER. THEIR RESULTS WERE THE SAME. BOTH HAD PROSTATE CANCER !! I DECIDED TO HAVE THE PROCEDURE DONE JUST TO GIVE ME PEACE OF MIND. I KNEW GOING IN THAT IT WAS POSSIBLE TO HAVE A CLEAN BIOPSY AND STILL HAVE CANCER, OR A CLEAN RESULT CAUSED BY SOMETHING OTHER THAN CANCER. BUT I FIGURED THAT IF IT WAS POSITIVE, I MIGHT HAVE A CHANCE OF CATCHING IT EARLY THEREBY INCREASING MY CHANCES OF A CURE. HAD IT DONE IN DEC-2009. FOR ME IT WAS A BIT UNCOMFORTABLE BUT TOLERABLE. AS IT TURNS OUT, IT WAS POSITIVE AND I HAD THE SUBSEQUENT SURGERY AND ADJUVANT RADIATION. PSA IS UNDETECTABLE SO FAR AND FEELING GREAT. EACH OF US HAD TO MAKE THESE BIOPSY DECISIONS AND IT WASN'T AN EASY ONE. FOR ME, I JUST HAD TO KNOW WHAT WAS GOING ON DOWN THERE SO I MOVED AHEAD. IN HINDSIGHT, IT WAS THE RIGHT DECISION FOR ME BUT IT COULD HAVE TURNED OUT DIFFERENT AND I COULD HAVE BEEN SECOND GUESSING MYSELF. THIS PROSTATE JOURNEY THROWS A LOT OF CURVEBALLS AT YOU AND YOU HAVE TO MAKE IMPORTANT DECISIONS ALONG THE WAY. DO THE RESEARCH, TALK TO YOUR DOCTORS AND GET A SECOND OPINION, IF YOU KNOW ANYONE PERSONALLY WHO HAS HAD THIS PROCEDURE, TALK TO THEM ABOUT IT. ONCE YOU HAVE ALL OF THE INFORMATION YOU NEED I AM SURE YOU WILL MAKE THE DECISION THAT IS RIGHT FOR YOU. GOOD LUCK AND GOD BLESS---DAN

sylvan75
Posts: 30
Joined: Sep 2009

Thank you all for your help and I wish you all well. My PSA has increased over the past 2 years from 3.5 to 4.1 to the current 5.11. I guess I really needed someone to talk to and again thank you all for your input.

My main concern is since I do not have health insurance, I get all my medical needs at the VA hospital and although I have had good results thus far, I have a confidence problem with them doing the biopsy. IN july I will be eligible for Medicare and maybe then I go outside the VA.

sYLVAN75

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Sylvan,

One other note...I have a close friend who had a biopsy done at the VA hospital and there was a mixup and the biopsy needle gun had not been properly cleaned from the previous use and my friend almost died from the follow-on infection. As you probably know, most biopsy's are done with a device that collects prostate core samples with a needle gun that goes through the wall of the rectum into the prostate. There is a procedure that does takes the biopsy samples by going through the pareneum instead of the wall of the rectum that eliminates the potential of that type of infection. (The still would have a ultrasound probe in your rectum to see the prostate and help position the needles but the actual biopsy procedure would get to the prostate by that space between the anus and the scrotum.

There is a small, but measurable number of infections from biopsys each year. When I had mine done I took an antibiotic before and afterward and had to do a fleet enemea a few hours before the procedure.

Knowing what I know now, if I were to do it all over again, I would have the biopsy done via the paraneum and would request to be sedated. I don't know if the VA hospital would give you that option.

After effects from a transrectal biopsy were a small amount of blood in the urine for a few days, about a day or two of a small amount of blood in the stool, and about a month of blood in ejaculate which gradually cleared.

If it were me, I would wait a few weeks until I had insurance through Medicare and visit a urologist that knew what he was and could manage my overall progress through the process. From my 30-odd years in the navy, I know that frequently when you visit a military hospital that you get a different doctor each time, or get one that is still learning the specialty and is working under the general supervision of a specialist. I was more comfortable seeing the same doctor each time so that I didn't have to start all over again each time I had an appointment in explaining the history, etc. Your PSA rise is something that should be addressed but I don't expect that another few weeks will make much difference one way or another.

fathersson's picture
fathersson
Posts: 121
Joined: Nov 2009

Like you, I struggled as to whether to get the biopsy done or not. I elected to do. PC was discovered and I had robtic surgery a month ago. Yesterday my post PSA came back and confirmed I am prostate cancer free. A great feeling. Interestingly, the post op pathology report revealed tat the volume and aggressiveness of the cancer was deemed a little more that what was first suspected..so I am glad I moved when I did.

For whatever it is worth.. took me almost 5 months between confirmation of PC via the biospy and the surgery.

Hope you go forwqard with it and doubt if it would be injuriousto you to wait a little while if you had to.

Best regards and good luck.

YTW's picture
YTW
Posts: 65
Joined: Apr 2010

Fathersson: I've reading this site and posts for some time now. I was torn between daVinchi and Cyberknife. Decided on the latter. My PSA was 5.5 in 1996 and has been jumping up as high as 11.5 a few years ago but then back down to a low of 6.0 The 1st two biopsies came back negative and the last on in March showed 1 core positive (40%)and 11 cores negative. DRE was negative. After my 2nd biopsie the URO told me that I most likley had PCa but he couldnt find it and couldnt treat me until he did find it as he did on 3rd biopsy. (Gleason score 4+3=7)
My URO suggested that I obtain a 2nd opinion which I did. This was done at the University Hospital group here in Cleveland, Ohio. The URO there said that I was beyond their protocal, he would have me treated with CK. My Radiation Oncologist is an MD + PHD. He said that he was comfortable treating me with (cyberknife) CK. I will start my treatments in early July.
By the way, my age is 71 and am a retired firefighter, kept myself in good shape. I can still bench press 225 lb. I used to press 400 lbs but that was when I was younger.

My reason for mailing you is two fold. First, best of luck with your choice of options. I would have probley taken your position if I were much younger.

My 2nd opinion for writing is that you seem to have mastered the 5 string banjo. I tried for years (2) to master that thing but finally gave up. I lacked the two most important qualities to be any good on the 5 string...ability & talent.

Best Of Luck/Jimmy

YTW's picture
YTW
Posts: 65
Joined: Apr 2010

fathersson:

Sorry to have info that I not included in my first post to you. Vitamins & supplements. My URO told me that even though he suspected PCa, my supplement choices may have contributed to keeping the deamond in check.

Since I have been taking supplemets since 1996, I feel that although I probley have PCa,
it was kept in check by what I have been taking on a dailey basis.
Here they are in case you may be interested.

Vitamin C 1gram/day
Vitamin E 400 I.U./day
Selenium 200 mcrg 1/day
lycopene 40 mg. 1/dau
multi vit 1/day
have just added Pomgranete 250 mg 2/day

hopeful and opt...
Posts: 1362
Joined: Apr 2009

good idea to delete selenium and the vitamin e supplements.....a recent major studies shows that they are contributors to prostate cancer.

we have developed threads on diet , etc which you may wish to read

Ira

gkoper's picture
gkoper
Posts: 174
Joined: Apr 2009

The previous posts are loaded with good information. But I'll just say that I had my biopsy just before my 65th B-day. My PSA had doubled in a year which set off the alarm. I had to know, one way or another. As it turned out I had 4 of 12 samples affected. I proceded with surgery & radiation. 13 months post surgery & 6 months post radiation my PSA is 0.1. I can only add that if I had passed on the biopsy, I would have worried myself to death. And the biopsy may be negative.

Good luck,
George

sylvan75
Posts: 30
Joined: Sep 2009

thank you all for your replies. I probably will have the Biopsy done, but I will wait a couple of weeks until July when I get on Medicare, and have the procedure done outside of the VA system. Again thank you all and I wish you all the best.

Sylvan 75

hopeful and opt...
Posts: 1362
Joined: Apr 2009

I wonder, where do you live? There are better doctors in various part of the country that some of us that accept medicare as full payment.

Also, there are institutions , I think UCSF that may put you in a clinical trial and give you a free MRI with a spectrocopy.....I believe that they like virgin prostates.

Also there are a few institutions that give a three dimensional guided biopsy, so that the doetor can go back to exactly the same spot in the future ...it is better than the two dimensional that the vast majority of us have had.

Ira

sylvan75
Posts: 30
Joined: Sep 2009

I live outside of Philadelphia, and although my partial Nephrectomy and all other procedures are done at the Philadelphia VA hospital. However, the VA hospital does not have their own urologist so the Doctors from the Univ. Of Penn., are the ones actually doing any surgery. So when my medicare kicks in I will probably be going to the Univ of Penn. direct/

Sylvan

shane59's picture
shane59
Posts: 86
Joined: Jan 2010

I JUST TURNED 50 PSA LEVEL ONLY 2.8 DOCS NOT CONCERNED I DIDNT FEEL HAPPY WITH IN MY MIND WENT TO A UROLOGIST ENDED UP GETTING BIOPSY . GUESS WHAT I HAD THE MAGIG PROSTATE CANCER .SO YOU DON,T KNOW ABOUT THESE THING THEY SNEEK UP AND BITE YOU ON THE BUM. SO JUST DO IT
SHANE59

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