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Pre biopsy stage

farmerdave's picture
farmerdave
Posts: 3
Joined: May 2013

My PSA in October 2012 came back 4.01, so the doctor put me on antibiotics in case of an infection.  My May 2013 PSA came back 9.  I will see the urologist in a couple of days, and I know he will want to do the biopsy.  I know it's early in the game, but it's hard not to think negative thoughts.  I am the kind of guy that wants to know every possible piece of information before proceeding, and I don't know if that is good or not.  I read about a test called PCA3 urine test to detect prostate cancer.  Is it reliable? Anyone have any experience?  Should I ask for it?

I'm only 57, so the whole side effect issue is a big deal for me.  I read the trial information that said that for every one necessary case that was treated by one of the procedures, 48 were unnecessary.  How do I make an informed decision?  I guess I just need to wait for the biopsy results and go from there. I know many people here have much worse scenarios, so I don't want to overreact at this point.  I just need some feedback, because this might be just the beginning.  Thanks.

Dave

hopeful and opt...
Posts: 1278
Joined: Apr 2009

PCA3 test
This test is a new investigational ( only an indicator) urine gene test that is available. The test is a molecular biologic assay. This test has a specificity of 75% and a sensitivity of 57%. (What that means is that among 100 bad tumors, for example, they only can identify 75 of them. And among 100 good tumors, they identify them as bad in 57). The test is done by a doctor who does a DRE and vigorously massages(the fun part...my doc is very experienced, has muscles on his finger, and can make a grown man cry) the prostate; the patient gives urine and the results are sent to Bostwick Laboratories(the only laboratory that does this) for analysis. It is a pretty expensive test, at I think about $500.

So the way the results work, 35 is the magic number, so the less one score is below 35 the better. Mine was 8.3 "Prostatic cells are present but do not over express the PCA3 gene", "value of 35 or greater suggests a high likelihood of prostate cancer"

It is also stated that only a prostate biopsy can diagnose prostate cancer. The test's performance has been established by Bostwick Laboratories. It should not be used as the sole evidence for or against the diagnosis of prostate cancer. Clinicco-patholological correlation is indicated.

The PCA3 test is used as one factor in determining the need for a biopsy.

.......................

PSA's are indicators only. There are various causes for bumps in PSA to include, but not limited to sex before the test, vigorous exercise such as bike riding, manipulation of the prostate before the PSA test( a hard stool). By the way did the doc do a Digital Rectal Exam (finger wave), was this before or after the PSA test,  what were the results?

A urinary track infection can cause a rise in PSA, high dose of Cipro over a month can be prescribed. If this does not work other medication might work to reduce the PSA.

Dave, relax, good idea to see a urologist, just take one step at a time...cross each bridge when you come to it.

 

 

farmerdave's picture
farmerdave
Posts: 3
Joined: May 2013

I appreciate your information. I can see I have a lot of homework to do, but it will still be a difficult decision if the biopsy is positive.  I have a feelint the urologist would rather perform the biopsy than anything else.  I just want to explore every option as I go along.

My GP did the DRE about five days before the blood sample was drawn to do the PSA.  He indicated my prostate felt 'slightly enlarged, but otherwise seemed normal.  I assume the urologist will want to do a new DRE himself.  I have had no symptoms as in weak stream or pain in urinating. Everything seems to work as it should.  Thank you, lots of wonderful people here.Smile

 

tp23
Posts: 11
Joined: Apr 2013

Farmerdave -

     I had a biopsy performed back in early April, not just because of PSA but due to an abnormal DRE and other symptoms.  I opted for local anesthesia only.  Antibiotic before/during/after to safeguard against infection.  Aside from some (maybe a little more than some) soreness for a few days to a week there were no issues.  It doesn't take long - longer to prep and fill out all the paperwork than the actual procedure.  Took about a week/ten days before I saw my urologist about the results.  I'm only 50 by the way.  I was a bit skeptical about the whole PSA, DRE, biopsy process as well.  If I hadn't had it performed when I did, I would likely be facing a much worse scenario.  Early detection can be your best ally at this point.  What you do with the information afterward is entirely up to you, but early detection will give you far greater options.  Of course, it is a surgical procedure and none is without risk - but the risk of detecting prostate cancer too late can be far greater.  Your urologist should be able to allay your fears or concerns.  Just my experience.  And to be honest, my first visit to the urologist was about 1-1/2 years ago when I was 48.  In retrosepct, that was likely too late for me to start seeing one.

     Good Luck !

jmbraunling's picture
jmbraunling
Posts: 2
Joined: May 2013

I recently had the prostate biopsy which came back positive followed by a bone scan which came back negative: I have been told my cancer is, as are most prostate cancers, slow growing. I will have time to educate myself before I need to take any action. I am finding out that there are many different treatments; and many more being researched. They are also saying that at my age (68), I should consider, as well, doing nothing more than frequent monitoring of my condition. I am still learning.

Good luck on your test,

Jerry 

hopeful and opt...
Posts: 1278
Joined: Apr 2009

I am sorry for your diagnosis. Hopefully we can be of some help to you.

I suggest that you start a new thread listing specifiics about your situation.

Here are potential questions for you.

What were each of the PSA numbers and dates

What did the Digital Rectal Exam show, was it normal?

How many cores were taken in your biopsy?

How many were positive? What was the Gleason score and percent involvement(that is what was the percent) of each core that was positive

Do you have a copy of the pathology report?

Did you get a second opinion by a world class pathologist on the pathology of your biopsy

Aside from the bone scan, did you have any other diagnostic tests?

 

Look forward to your post on a new thread

 

Raltrt41's picture
Raltrt41
Posts: 16
Joined: Mar 2013

Dave,

   I had a rise of PSA from 1.38 to 2.6 in one year. Free Psa was 21.2. Then, a slightly suspicious DRE. I insisted on a PCa3 test before consenting to a biopsy. It came back a 46, so I had a 12 core biopsy on 4/4/13.  It came back Negative. Turns out the 12 core biopsy only samples less than 1% of prostatic tissue, so false negatives are a real issue.  Also a pre-biopsy 3T MRI showed two suspicious areas in the left hemisphere.

 

Now I'm going to pass on a saturation biopsy. Instead, i will have an MRI-guided biopsy of the suspicious areas only...probably 3-5 cores taken. I should have done this to start with, and that is my strong suggestion to you. If you decide on a biopsy, do all within your power to have an MRI-guided biopsy. More accurate, less pain, better diagnosis.

 

Best of luck,

Bill

Raltrt41's picture
Raltrt41
Posts: 16
Joined: Mar 2013

Dave,

   I had a rise of PSA from 1.38 to 2.6 in one year. Free Psa was 21.2. Then, a slightly suspicious DRE. I insisted on a PCa3 test before consenting to a biopsy. It came back a 46, so I had a 12 core biopsy on 4/4/13.  It came back Negative. Turns out the 12 core biopsy only samples less than 1% of prostatic tissue, so false negatives are a real issue.  Also a pre-biopsy 3T MRI showed two suspicious areas in the left hemisphere.

 

Now I'm going to pass on a saturation biopsy. Instead, i will have an MRI-guided biopsy of the suspicious areas only...probably 3-5 cores taken. I should have done this to start with, and that is my strong suggestion to you. If you decide on a biopsy, do all within your power to have an MRI-guided biopsy. More accurate, less pain, better diagnosis.

 

Best of luck,

Bill

Raltrt41's picture
Raltrt41
Posts: 16
Joined: Mar 2013

Dave,

   I had a rise of PSA from 1.38 to 2.6 in one year. Free Psa was 21.2. Then, a slightly suspicious DRE. I insisted on a PCa3 test before consenting to a biopsy. It came back a 46, so I had a 12 core biopsy on 4/4/13.  It came back Negative. Turns out the 12 core biopsy only samples less than 1% of prostatic tissue, so false negatives are a real issue.  Also a pre-biopsy 3T MRI showed two suspicious areas in the left hemisphere.

 

Now I'm going to pass on a saturation biopsy. Instead, i will have an MRI-guided biopsy of the suspicious areas only...probably 3-5 cores taken. I should have done this to start with, and that is my strong suggestion to you. If you decide on a biopsy, do all within your power to have an MRI-guided biopsy. More accurate, less pain, better diagnosis.

 

Best of luck,

Bill

Raltrt41's picture
Raltrt41
Posts: 16
Joined: Mar 2013

Hey guys.....sorry for multiple posts.......can't type and drink !

farmerdave's picture
farmerdave
Posts: 3
Joined: May 2013

I really appreciate your advice from your experiences.  I think that is what gives us strength in knowing what to choose.  I will see the urologist tomorrow.  I live in a small community here in Idaho, so I don't know if an MRI guided biopsy is even available, but I can see that having complete and accurate assessment is essential.  Whichever biopsy is done, I will ask to have a second opinion at Johns-Hopkins, even if my insurance won't pay.  In a way, I hope the Urologist will want another PSA test as well as a thorough DRE before a biopsy. I'm sure everyone on this site can relate to stressful wait on the biopsy results.  With a PSA of 9, I do expect they will find cancer, so I'm just going to cling to the hope that it will be early detection and slow growing, so that i have some time to weigh what is the best course of action.  I do feel much better today because I am better informed, so thanks to all of you who are so willing to share and encourage.  Best of luck and God bless you!

Dave

 

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