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Are we sick or what

dcirrotti
Posts: 33
Joined: Aug 2012

My Dad lived to 97 and died of a heart attack with prostate cancer and never had a PSA or biopsy and his cancer tumor was found at age 88 during turp surgery for urinary flow.
Now my Doc has put me on Active surveillance and wants to do repeated biopsies every year. This worries me because of scaring of the prostate that can make future treatment more complicated and most of all needle tracking that can spread the cancer to other parts of the prostate. I am 70 and found my Gleason 6 because of PSA testing and not Turp surgery at 88 and now I am looking at some 25 years of worry I hope!! Are we sick or what ????
Any comments on repeated biopsies and needle tracking.

Swingshiftworker
Posts: 626
Joined: Mar 2010

I believe that you are well justified to be concerned about repeated biopsies -- infection, cancer migration and prostate scarring are all real possibilities.

On the other hand, there is currently no other way to determine with any certainty the extent of the cancer in the prostate. There are "active surveillance" programs (and certain studies in the past) that have used annual biopsies to track the course of the cancer BUT (although the risks exist) I haven't read anything about any negative effects of such a program (or study) involving repeated biopsies.

My "feeling" on this is that "routine" annual biopsies are unnecessary and that a re-biopsy should only be done if your PSA scores suggest a growth of the cancer. This does not place a specific time limit on when a re-biopsy would occur and should still give you the info you need to act further without unnecessary delay.

However, I'm with you about the continued "worry" involved in the need to take repeated PSA tests but the only thing you can do is go on and live your life w/o dwelling on it too much.

In my case, I've been taking quarterly PSA tests since my treatment almost 2 years ago and each test has been worrying for me because my scores were initially so erratic and still have not dropped below 1 (which is the primary indicator of "success" for radiation treatment).

I find that I do not think about it all that much until I take each quarterly test and then have to assess the result. Is it up, down or about the same and what does that mean?

I've already suggested to my RO that I get a re-biospy after my PSA test in September (which marks the 2nd anniversary of my treatment w/CyberKnife). He's not all that hot about the idea BUT (after 2 years of inconclusive PSA test results) I want to know if there's still any evidence of cancer in my prostate or not.

My PSA scores do not indicate a growth BUT there doesn't seem to be any explanation for why my scores still have not dropped below 1 except for the fact that my prostate still seems to be "functioning" because I am still able to ejaculate a fair amount of fluid (which is NOT supposed to happen after "successful" radiation treatment).

A negative re-biopsy would reassure me that the cancer was destroyed, even though there is the possibility of a false negative result and even though my prostate is still producing fluid.

We'll see . . .

hopeful and opt...
Posts: 1293
Joined: Apr 2009

"My "feeling" on this is that "routine" annual biopsies are unnecessary and that a re-biopsy should only be done if your PSA scores suggest a growth of the cancer. This does not place a specific time limit on when a re-biopsy would occur and should still give you the info you need to act further without unnecessary delay."

A great statement,

I wonder if a mathematical model can be developed to help determine when to biopsy those on Active Surveillance (and post treatments such as yours) using PSA's, Free PSA's, PCA3, DRE, and any other current diagnostic test available that will be more effective than a specific time limit. There are various diagnostic tests under development that might be incorporated in the near future to improve this model.

Thinking about this, there are currently some mathematical models in place, incorporating molecular information from previous biopsies along with other diagnostic information such as gleason, psa, etc. Unfortunately the specificity and sensitivity of the results of the molecular analysis are not at the level to really help, so better diagnostic tests are needed to be effective in this quest.

crhoads
Posts: 7
Joined: Dec 2010

"I believe that you are well justified to be concerned about repeated biopsies -- infection, cancer migration and prostate scarring are all real possibilities."

There is absolutely no evidence to support the theroy of "cancer migration" from a biopsy. This is an opinion and not a medical fact.

Swingshiftworker
Posts: 626
Joined: Mar 2010

I think I made it clear that the statement you've quoted was based on my personal opinion and "belief."

The original poster's concern was the possible effect of annual biopsies in conjunction with an Active Surveillance program and, in that context, I expressed my "feeling" that annual biopsies were not warranted given the risk of infection and the possibility of cancer migration.

I don't know of a study that has established a connection between prostate biopsy and the spread of cancer elsewhere in the body. However, just because there's no "proof" of it, doesn't mean that it might not actually occur and, unless you can prove that cancer migration following prostate biopsy NEVER happens (which I don't think is possible), it's still a legitimate cause for concern.

That concern didn't stop me from getting my initial biopsy nor has it stopped most other men from theirs either. It also won't stop me from getting the follow up biopsy (2 years after treatment) that I've already requested from my RO but, again, that doesn't make it any less a cause for concern.

However, IMHO, if annual biopsies in conjunction with an Active Surveillance program (or medical study) are proposed, the risks of infection and the possibility of cancer migration should be carefully considered.

Just my 2 cents. Take it for what it's worth to you and, if that's nothing, so be it.

Ciao!

laserlight's picture
laserlight
Posts: 165
Joined: May 2012

This is my personal experience on the above. I had a biopsy and 4 weeks later surgery to remove prostate. The surgery report came back indicating that there was some trauma to the prostate and the doctor indicated that this could of been caused by the biopsy.

When I was preping for the biopsy the doctor was very clear about taking the antibotics and explained that this was due to infection risk.

As far as cancer migration that is good question.

Right now I am post surgery and under an AS program, which is intense at times. I find my self living from psa test to psa test. My psa levels are slowly moving, but is still considered to be undetectable.

hopeful and opt...
Posts: 1293
Joined: Apr 2009

This subject has come up at various times in the past at this site, and there have been differences of opinion, in each case.

I personally spoke with several oncologists, and all have stated that there is no migration. Additionally some have published, (i.e. Dr. Scholtz, "the prostate snatchers"} that there is no migration, in fact Dr. Scholtz, stated in his book that it is an urban myth. I have also heard talks by prominent doctors, Myers, and Bahn who state that there is no migration due to a biopsy. I had checked the internet in the past, and did not see any documentation to support migration.

Of course there are some lay people who still have concerns about cancer migration due to biopsies. I have no doubt that there will be those at this site who will present a viewpoint different than mine.

At any rate, I believe that the vast majority of those with an opposing viewpoint will agree that the benefits of getting a biopsy will far outweigh their perceived risk of migration.

Additionally I would like to add in agreement with all, that there is a real medical risk resulting from possible infection due to a biopsy, and all care needs to be taken during a biopsy; and additionally, it is very important to determine that there is a real need for having a biopsy before getting one.

hopeful and opt...
Posts: 1293
Joined: Apr 2009

http://www.youtube.com/watch?v=iyVyxfy4MjY

4 to 6 weeks according to Dr. Samadi, m.d., a prominent robotic surgeon.

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