Results from my Seventh Prostate Biopsy

ASAdvocate

 

Last Friday I had biopsy number seven as part of my twelve years in Johns Hopkins’ Active Surveillance program. This biopsy was different, as I requested the imaging be done in real time using the ExactVu micro-ultrasound. After nine previous MRI’s with gadolinium contrast, I didn’t want any more of those chemicals. The cores were taken with the Precision Point transperineal access system, under local anesthesia. No antibiotics necessary.

 

Just got the report on MyChart. No cancer found. Twelve systematic cores plus two identified as targets by the micro-ultrasound PRIMUS software (similar to PIRADS). One core had HGPIN, but that is a non-concerning typical finding for me.

 

I have had Gleason(3+3)=6 cores found on several previous biopsies. But, subsequent negative biopsies are apparently common for men on AS.

 

For a prostate cancer patient, I am very fortunate. My wish is for all of you to see encouraging results in your future.

eonore

Thanks for the update, and congratulations on the continuing good news.  I really think that your continued exposure of the possibility of active surveillance has helped a lot of men who have come to this forum. 

Eric

VascodaGama

Successful story

I am pleased for the good news. I consider AS the best option to tackle PCa but unfortunately to many this way is not the most recommendable. Surely one needs the gouts to continue life sleeping everyday with the enemy. You did it and I congratulate you.

Best wishes for continuing success.

VG

hopeful and optimistic

Congratulations

The transperinel compliments the transrectal MRI. Well done!

Can you talk to your experience with the transperinel biopsy. How dose it differ from the transrectal?

As the proportion of men increase to seek out active surveilance, I think that  ExactVu micro-ultrasound  and unit like this will be more in demand, since the MRI biopsies will not fill the requirement for demand.

 

ASAdvocate

hopeful and optimistic said:

Congratulations

The transperinel compliments the transrectal MRI. Well done!

Can you talk to your experience with the transperinel biopsy. How dose it differ from the transrectal?

As the proportion of men increase to seek out active surveilance, I think that  ExactVu micro-ultrasound  and unit like this will be more in demand, since the MRI biopsies will not fill the requirement for demand.

 

Transperineal versus Transrectal

Most of us were probably originally diagnosed by a transrectal (TRUS) biopsy, which accesses the prostate through the rectum. The risks of fecal contamination, infection, and sepsis are obvious. Antibiotic testing and antibiotics are essebtial. Even still, the rates of sepsis due to antibiotic resistance have been increasing, and many people want to avoid taking Cipro. Until recently, transperineal biopsies were mostly used for saturation biopsies after TRUS failed to find cancer despite rsising PSA. Those TPUS biopsies often involved taking 20 or more cores, up to 100, and required an opertaing room and general anesthesia.

A few years ago, the Precision Point transperineal access system became availabe, which allows freehand biopsies in an exam room with local anesthesia. It is now standard for AS patients at Johns Hopkins and MSKCC. No risk of infections, and no need for antibiotics.  Basically, the patient is placed in stirrups in a childbirth position, and the biopsy needles are inserted below the testicles. A rectal probe is inserted in the rectum to guide the needles, same as with a TRUS.

The ExactVU micro-ultrasound is a rectal probe with a small processing unit and a screen. It does realtime imaging of the prostate at about six times the clarity of a normal ultrasound. In my case, it substituted for an MRI, in finding suspricious areas to target with the needles. The ExactVu system is highly mobile, and easily moved around a room. Compare that with an MRI!

Like an MRI, the micro-ultrasound evaluates several findings, and has a PIRADS-equivalent scoring scale from 1-5 for suspicious lesions. Unlike an MRI, however, it does not need a contrast dye like gadolinium.

From the SEER and other databases, it appears that about 50 percent of low risk men are now choosing active surveillance, and that increases to eighty percent for men at multi-disciplinary centers. Clearly, the smaller urology practices favor surgery, despite all the medical associations recommending AS as the default option for low risk men. But, that's another soapbox speech for me

hopeful and optimistic

Thank you

ASadvocate

Thank you for the informative answer that you gave. It's appreciated....You deserve the name "ASadvocate".

Most doctors still do transrectal biopsies. It would be great if change to transperineals will happen sooner than later. As I understand, medicare pays the same for eachtype  biopsy. It would be great if medicare paid doctors more for  transperineals to give incentive to switch.

Also, another challenge is that  tranperineal machines cost, I think about 150,000. How would the average urologist outside a center of excellence afford this, and why would they if there is no incentive such as financial or patient desire.

......

Like you, I'm also for Active Surveillance and advocate it. When we were diagnosed , I think that approximately 10% of men who qualified, entered an active surveillance program. Now, men are  more knowledgeable and there has been an increased percent of men who seek active surveillance. Eventhough all medical organizations recommend AS, many men do not out of fear and misdirection by many doctors trying to turn a fast buck by surgery or radiation. Hopefully the trend toward AS will continue to increase.

Best

Max Former Hodgkins Stage 3

Bravo

ASA,

Glad to hear such wonderful news for you.   I have an older friend, about 77 now, who has been on A.S. perhaps 12-15 years now.   His doctor does not biopsy him often, due to extremely low PSA history, and the biopsies he has received were all transrectal.  After his first two biopsies showed minimal Gleason 6, all subsequent ones for about 7-8 years were wholly negative, with no cancer detected.   He had his most recent biopsy about 1.5 years ago after a spurt in PSA, and it found Gleason 6 regions again.  He continues with A.S. now, with the doc recommending no curative therapies at this time.   The doctor did tell him that if he ever receives any treatment, it will be hormonal only.

You show the readers that the PCa path varies dramatically, from man to man.