Biopsy without any bleeding
I'm not complaining, just curious. Had transrectal targeted biopsy (5 sites) with no blood in urine or semen. After all I've read about blood lasting for weeks, has anyone not experienced much bleeding? A pre-cancerous HG_PIN neoplasia was found. So cancer free for now!
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I experienced blood in my semen after both of my transperineal biopsies.
If you had targeted biopsies only, then you had approximately 14 fewer biopsies when compared to those who had targeted + random. It does make sense you would have less bleeding. I expect there is going to be a move towards targeted biopsies only (fewer or no random sampling) as the reliability of MRI progresses in regard to diagnosing significant disease only.
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Ken,
Good for you. I had no blood in my urine but did have the rusty semen. It might be the few cores that your Doctor took. I had 15 cores takes, 3 from a PIRADS 4 lesion that turned out benign. It was good thing my Urologist in my case did the additional grid random as that it where my cancerous cores were.
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I asked about the random but the radiologist said he only does targeted. (My urologist does random but I wanted an in-bore MRI biopsy which he recommended). So I wonder if they missed something?
My PSA is low (spiked to 8 from Covid then back down to 2.8). Was your PSA higher? Did the MRI show anything suspicious where the cancer was found?
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i did have a MpMRI and nothing else suspicious was seen. My urologist did the biopsy and it was a MRI fusion guided biopsy so he went first to the PIRADS 4 lesion. When I met with him a week later for the results, he even expressed his surprise at what was found. I imagine a interventional radiologist probably just goes for the lesions.
i would watch your PSA . I don’t recall my exact numbers right now but for years it was at 1.9, then went to 3.0. My Doctor then retested in a month, went down to 2.7, quarterly check down to 2.4 (thought I was out of the woods) on my next quarterly I though maybe back to my number, but surprised back up to 3.2. We continued quarterly checks with it bouncing around. Then we did an ExoDx urine marker test and it found cancerous markers that would place my cancer more aggressive. That was thrn off to the MRI. My PSA never went over 4. I would make sure for at least the foreseeable future you get quarterly PSA checks and ask your Doctor about the ExoDx test. You can google it. If your number was high above their threshold low risk, you might want to consider discussing with your Doctor about another biopsy. It is not unusual for cores to show the cancer that were not targeted cores.0 -
The value of prostate biopsies is being questioned but in a light to reduce unnecessary one’s that determine a person’s cancer is low risk or a Gleason 6. The PSA may be heightened or risen but not extremely and too often everyone is rushed into the biopsy even though the result then turns out low risk. That is why they are turning to newer tests all to try and find out if the cancer likely is clinically significant before the decision of the biopsy then if so at that point to get the Gleason grade of the clinically significant cancer. That is the purpose the non invasive ExoDx urine test checking for biomarkers that are associated with aggressive prostate cancer. If it comes back low risk, a biopsy for the time being can be avoided.
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It is all well and fine for folks (not here in this Discussion Board, but in general) to say that many biopsies are unnecessary, after the results of the biopsy are read, and it turns out to be only Gleason 6. BUT, what about the rest of us who discover that we have serious PCa after the biopsy results are read?
We must acknowledge and remember that more aggressive forms of PCa can have a lesser impact on the PSA reading. I had a PSA of 5.2 when I was advised to get a biopsy, and my biopsy revealed Gleason 4+3 throughout most of my prostate, along with a very good chance that it had also migrated outside of the prostate. In all probability, I'd probably be dead now, if biopsies were not available or restricted by some administrator.
BTW, I did not have any post-biopsy bleeding, but it took 4+ hours to stop the bleeding associated with the procedure itself.
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Thanks Josephg! Yes, I fully understand. Glad that it has helped the both of us and more.
Does anyone have intermittent red/rust/pink color in their ejaculate, aka (****)? My urologist says it is OK. Sometimes mine is white and sometimes red/rust/pink in color. I am 3 years out from my biopsy.
What do you and all men with a previous prostate biopsy think? Does this "color" ever happen to you? Thanks!
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Josephg,
I think these cancer investigators, clinicians, and clinical trials who are trying to diminish unnecessary biopsies Do Not want to miss your clinically significant cancer and are aware of that and cases like yours. We have Active Surveillance of Gleason 6 today because of these advances where in the past standard of care in those cases was even radiation or patients picking prostatectomy. It is absolutely true only a biopsy can identify a Gleason but even then, their are errors. In the past we did not have MpMri before a biopsy and in the thousands and thousands of these scans they are beginning to get a statistical picture of the Gleason scores compared to the actual biopsy and whether it’s necessary just from the scan, the likelihood of having a clinically significant cancer. That though is in conjunction not just with a lower PSA that might still harbor significant cancer, but combined with other testing such as the ExDxo testing which again through thousands and thousands of biopsies compared with ExDxo genomic urine testing markers are all changing the landscape that a biopsy is absolutely necessary to determine the clinically significant cancer. It is like once you have determined to have a clinically significant cancer, the other genomic testing such as Decipher testing is helping direct treatment. Once you have reached a point of concern and needing further evaluation due to an increased PSA and then getting MRI’s and genomic testing if everything points to not at this point in time not needing a biopsy why not avoid it for the time being. It becomes in a way like staying in active surveillance knowing you have cancer. At this point you would similarly be under surveillance until a biopsy was necessary. Now that being said in the real world whether biopsies or not, cancers will be missed, the goal is to minimize that.
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You make some good points about the ongoing evolution of PCa diagnostic practices, which I support, but let's be totally clear about this. The REAL objective of this effort is to reduce medical/insurance costs associated with the millions of biopsies that are currently occurring for PCa. IMO, everything else is currently simply a cover-up for the justification for that objective. Once there is a new gold standard for positively identifying PCa and its aggressiveness, not just a statistical assessment based upon probabilities (as there will always be outliers like me), I will re-adjust my thinking on the necessity of a biopsy, but not until then.
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Regarding Marlon post, at one point in time, DREs were often part of the annual 'physical'. In fact, that is how I was told (about ten years ago) something was amiss with my prostate. More in general, a general practitioner should consider several factors whether to do a DRE; age, family and urinary tract issues are some of them.
Let's have some input on the question whether a DRE played a part in finding YOUR prostate cancer.
Digital Rectal Exam (DRE): What To Expect
PS: my apologies for this being 'off topic'
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Old Salt,
For me, my DRE was always fine. It was just my PSA which went up to just below 4, but jumping around. MY annual PSA was always around 1.9 for years until it started some bouncing into the 3’s. That is why I do understand Josephg’s concern about having a significant cancer which I did, but still a low psa. I don’t believe the primary objective of the medical establishment in trying to reduce biopsies is to reduce costs. I do believe it is to keep patients from unnecessary biopsies. Clearly less biopsies reduces costs, but I do believe everyone behind this believes in what is best for the patient. Now that is not an endorsement of insurance companies and this certainly benefits them, but that is secondary in this case.
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Yes, a DRE can be the first step in identifying abnormalities it the prostate gland. But, let's remember 2 very important points about the effectiveness of a DRE.
(1) A DRE can only 'touch' part of the prostate, as almost half of the prostate is inaccessible for the touch, due to its close proximity to other body parts.
(2) A DRE must be performed by somebody who knows what they are looking for, and that knowledge comes from direct experience. For example, I had DREs from my PCP physician for 5+ years, where my PSA fluctuated between 3.2 and 4.3. My PCP did not refer me to a Urologist, until my PSA went to 5.3, because he said his DRE did not 'feel' anything abnormal.
When I saw the Urologist, he was about 5 seconds into the DRE, when he stopped and told me that he going to do a biopsy right now. That shows the value of experience versus inexperience.
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All my DREs were negative, had 3 or 4. My first MRI was negative. Rising PSA led to blind biopsy which found cancer at 49. I'm pretty lucky my GP even did PSA that early with no particular reason. He said they started checking PSA earlier than recommended to find the more rare early cases. Might lead to unnecessary biopsy and might find cancer early in patient otherwise oblivious to condition. I think the lesson from my situation is stay persistent if PSA is rising and initial tests are negative.
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