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Saturation biopsy

dcirrotti
Posts: 33
Joined: Aug 2012

I am going in for a Saturation biopsy, as many as 50 cores and a mapping

of the prostate. This is after PSA doubling two times to 4.9 in one year and

a previous Gleason 6 in one of 12 cores from the first biopsy.  I am very worried

about this procedure spreading cancer cells around and if it is too aggressive at

this time. Any advise greatly appreciated.  

 

hopeful and opt...
Posts: 1282
Joined: Apr 2009

please list the dates of your PSA's and the PSA score.

I don't remember your digital rectal exam showing anything abnormal, is that right?

dcirrotti
Posts: 33
Joined: Aug 2012

09/08/09 = 1.6

08/27/10 = 2.15

09/29/11 = 2.65

12/07/11 = 2.79

07/27/12 = 3.52

12/11/12 = 4.2

03/20/13 = 4.9

Digital rectal exam showed normal,

hopeful and opt...
Posts: 1282
Joined: Apr 2009

http://nomograms.mskcc.org/Prostate/PsaDoublingTime.aspx

I placed your numbers in the nomogram chart from sloan kettering

onths
Slope Log (PSA) 0.03
Doubling Time 27.70 months
Velocity 0.07 ng/ml/mo
Years
Slope Log (PSA) 0.30
Doubling Time 2.31 years
Velocity 0.86 ng/ml/yr
 
 
Anyway the doubling time of 27.70 is of some concern, but not a lot.  This rate of doubling is not critical. In fact my rate is somewhat similar(click my name to see my results). My doc is not overly concerned about my numbers...heard said that sometimes there is a quick increase.......He keeps on saying that he focuses on the biopsy. I have not had a biopsy for almost two years. I will be having one in June.
 
I(n my opinion a saturation biopsy of 50 is invasive. Did you ever have a PCA3 test which is an indicator of whether or not a biopsy is needed?
 
Also depending on your medical coverage, there are ways of getting a better , less invasive biopsy,  that is targeted. ..The state of the art one is an MRI targeted biopsy. Basically there is a high definition MRI using a 1.5 or a 3.0 magnet to determine suspicious lesions. Sample cores are taken of these lesions in real time, also using the same MRI machine. Generally there are about 4 or 5 cores taken, which is very effective.
dcirrotti
Posts: 33
Joined: Aug 2012

Just called and scheduled the PCA3 test. I live in Orlando Florida and they do it here, will only take 3 days to get the result. If it is negative

What then ???? 

hopeful and opt...
Posts: 1282
Joined: Apr 2009

The results of the PCA3 are on a continuum, so it adviseable to speak with your doc first about your results, and the need to biopsy now.

At this meeting you might want to discuss "an MRI guided biopsy" for the future, and determine if the doctor has these resources available, and what he thinks about it.

dcirrotti
Posts: 33
Joined: Aug 2012

I don't understand this, repeated PSA'S are on a continuum, so the PCA3 be repeated if the biopsy is delayed.

hopeful and opt...
Posts: 1282
Joined: Apr 2009

Sorry that I wasn't clear.

When you get the results for the PCA3 test, the lower the result number the better.....they want to see a number under 35, but your number can be an 8 or a 33 or a 48 or a 67., so your doctor and you need to look at your speiific results. I think that Iwrote something about PCA3 in my about me page. If your number is very low your doctor and you may wish to delay getting a beopsy.

By the way with reference to your Gleason, you mentioned in this thread that yours was Gleason 6...I remember that you had a second opinion from Johns Hopkins, that determined there was no cancer.

dcirrotti
Posts: 33
Joined: Aug 2012

John Hopkins said  (suspicious for "high grade prostatic intraepithelial neoplasia"PIN)

hopeful and opt...
Posts: 1282
Joined: Apr 2009

http://www.ncbi.nlm.nih.gov/pubmed/17233800

This study shows that there is am 80 percent chance of a future biopsy of 10 to 12 cores will show cancer. Please understand that this a small sample and not statistically significant, but may show a tendency.

yankeefan
Posts: 69
Joined: Mar 2013

i think you are wise to be concerned but you should really get a 2nd opinion from a competent urologist, preferably board certified...not laymen like us.....

ralph.townsend1's picture
ralph.townsend1
Posts: 350
Joined: Feb 2012

Why at a Gleason "6" . I'm crazy about PC, but let a specialist look at this and make a decision. WHY not get a 1000 points of undiscision.

I know your trying  to make a good decision?????? Second Opinion

God Bless!!!!

shipjim's picture
shipjim
Posts: 130
Joined: Apr 2006

Wow ist there a prostate left to take out?

starr15
Posts: 31
Joined: Oct 2011

With regard to high grade pin, there is some comtroversy, but one core of HGPIN is not that worrisome anymore. 50% of men over 50 have HGPIN or PCA at autopsy. I think that HGPIN is only concerning if it is in multiple cores.

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