Question about biopsy after possble treatment failure

Steve1961

So I’m five years out of radiation therapy. The failure limit is 2 ng from your lowest point. Mine is up almost one point from its lowest point I know they’re being cautious but since something showed up on the scan are they going to need to take a biopsy or Since I had cancer there before, is it just an automatic diagnosis?

Steve1961

Nevermind I did some research and I just watched a video. Apparently the new PSMA scan is very precise the fluid that’s injected a actually adheres or sticks to cancer cells so they answered my question but I guess I’m wondering obviously it’s probably the same cancer as before and gkeason score I take it unfortunately, mine was of cribiform which is aggressive.

centralPA

It almost begs the question, should aPSMA scan precede a biopsy? Assuming it can discriminate between cancerous and healthy prostate cells.

Josephg

https://csn.cancer.org/discussion/comment/1706870#Comment_1706870

PSMA scans are extremely expensive, and current insurance guidelines do not pay for PSMA scans prior to biopsies in most cases. If you have the funds available to pay the total cost yourself ($10,000-$15,000), you can get a PSMA scan anytime that you want.

Steve1961

https://csn.cancer.org/discussion/comment/1706879#Comment_1706879

Im sure they must have got authorization from my insurance beforehand

Steve1961

https://csn.cancer.org/discussion/comment/1706890#Comment_1706890

Really no sense if you took a biopsy and you positive for cancer, why would you be a scanned and if they took a biopsy and they didn’t see anything they need you to scan in case they missed

Steve1961

Opinions PLEASE . oh I had a meeting with the radiologist and I wasn’t too pleased. He said the lesion is on the front of the prostrate away from the urethra and rectum… he said he could fix it of course then he went on to say I could do double breakytherapy or possibly may be surgery Also cryotherapy Baaba blah this is my concern. He suggested that I get a biopsy. I asked him point-blank really why it doesn’t matter what the Gleason score is, I’m gonna treat this if it was aggressive before, most likely, it’s going to be aggressive again, if not worse and he said no, not necessarily it’s a different tumor. It could be Gleason six or even benign that’s when I started getting suspicious, and I think he’s full of it. he went on to say it’s very very small. I said it’s still inside the prostrate he goes is hard to tell. It’s either on the inside edge or the outside ….To me this is extremely important right he also went on to say that there is a doctor there who’s an expert at biopsies. He should be able to locate that. When I asked him id it would not tend to be more aggressive if it’s outside the prostrate even though it’s local and that’s when he said I should see Dr. Carol the top urologist for a consultation ..he didnt answer my question so I made the appointment for the biopsy which is Tuesday the 8th and then I have the appointment with the urologist on Wednesday the 9th to my better judgment. I’m canceling that biopsy appointment.for biopsy The last thing I need is for this guy poking around like crazy and maybe poking a tumor on the outside and having it leak maybe it’s me but I’m playing it safe. What does everybody think ? I asked the radiologist what does he think would be my best treatment option for a cure and he said well I’m a radiologist so I was a breakytherapy just like he did five years ago when he should’ve suggested that I have surgery but he didn’t.

Rob.Ski

I'm not sure any scans confirm PCa, so biopsy would confirm you need treatment. If you don't trust your doctor, get a second opinion.

Old Salt

Rob hit the nail on the head.

Steve: You wrote:

The last thing I need is for this guy poking around like crazy and maybe poking a tumor on the outside and having it leak maybe it’s me but I’m playing it safe. What does everybody think ?

This 'statement' is excessive. Yes, a biopsy has some chance of side effects but the chance of that happening is quite low. You can ask for a transperineal biopsy and/or a biopsy guided by MRI to minimize side effects. Ask the urologist for his recommendation.

Steve1961

had a consultation with the surgeon .45 years experience.i should have listened to him 5 years ago i would jot be in this mess now anyway …...he said he was not alarmed nothing tooo concerning .lhe said that this is a a persistent tumor ..it has been there all along ..my question is do i really need another MRI and biopsy..the tumor before was 4-3 cribiform..no way its going to be 3-3 now .it maybe worse . I have an mri from 5 years back ..why cant we just treat it NOW as if it is aggressive..why wait 9 WEEKS for a mri yes OCT 21 but i am on cancellation list ….then another 2 weeks for a biopsy then 2-3 more weeks to meet with surgeon just to find out it is aggressive again and the start treatment….i think this is a fair question to ask..any opinions ..he says this is a slow growing tumor 0.1 grow rate a month …doesnt seem slowmto me that 1.2 a year everywhere i read more than 1.0 a year is most likely aggressive ..damn i feel like a cash cow to them..its just stressful all this waiting ..this is when it all went to **** for me last time when i found iut it was aggressive 7 months after being diagnosed..sorry just venting

Rob.Ski

I would think the tumor is not what it was after radiation. So, maybe it is lower grade right now. Biopsy seems necessary to know what they are dealing with. 9 wks to get MRI seems kind long. The waiting definitely sucks

bdhilton

My two cents after 15 years of surgeries and radiation x2, I would seek out a recognized medical school and request they take over your case. I've worked with department heads at Northwester, UCSF and UC Davis (a Hartmann reversal not cancer) over the last 15 years. Good medical schools are on the bleeding edge of treatments etc. Most Doctors are "just practicing" are doing just that, "just practicing" not research...Granted, you might have to share a hospital room sometimes, at a teaching hospital but I see that as a small price to pay for expertise….Anyway, that’s my two cents..

Good luck in your journey

Steve1961

Sooo onn i go Wait wait wait …all started back on june 25th..ct scan Another ct scan MRI and last monday 16 snip biopsy …hopefully i get lucky ..seem to be contained to the prostrate thats a good thing . Another tood thing is that my PSA dropped from 1.9 somehow down to 1.65 Probably a bad sample or mustead but I will soon find out the results should be in soon just don’t know how I can go from being 3+4, cribiform two only 3+3, but we can always hope …