Duration between biopsies

hopeful and optimistic · August 2010

As part of my active surveillance treatment, in March 2009, had a 12 core random biopsy; 2 of 12 cores were positive with 5 percent involvement in each , 3+3=6.....2nd opinion confirmed results.

Aureon molecular test on first biopsy, 97 percent chance(RR: 0.21) will not progress in next 8 years....Additonally , the patient has a hign probablity (78%) of having favorable pathology.

In June 2010 had a 15 core MRI directed biopsy( that is, an MRI was taken first and 3 suspecious lesions were targeted)....no positive cores found, however one was a high-grade prostatic Intraepithelial Neoplasia.

Note: The median risk recorded on the literature of r cancer following the diagnossi of HGPIN on needle biopsy is 24.1% which is not much higher than the risk reported in the literature for a repeat biopsy following a benign diagnosis. The majority of publications which have examinded in the same sturdy the risk of cancer following a needle biopsy diagnossi of HGPIN to the risk of cancer following a benign diagniss onneedle boppsy have shown no differences between the 2 groups. Clinical parameters do not help in stratifying which men with HGPIN ae at increased risk of being diagnosed with cancer. IT IS RECOMMENDED THAT MEN DO NOT NEED A ROUTINE REPEAT NEEDLE WITHIN THE FIRST YEAR FOLLOWING THE DIAGNOSIS OF UNIFOCAL HGPIN ON EXTENDED BIOPSY. IT MAYBE REASONABLE TO PERFORM A REPEAT BIOPSY THREE YEARS FOLLOWING AN INITIAL HGPIN DIAGNOSIS ON NEEDLE BIOPSY AS A RESULT OF THE UNCERTAINTY AS TO THE LONG-TERM SIGNIFICANCE OF THIS FINDING. (Journal of Urology (March) 175:820-34, 2006 and Journal of Urology (January) 175:121-4, 2006)

As I understand my doc wants to do another biopsy next june......I wonder, is this appropriate......if a wait, how much would my chance of non discovery increase?

Any informational sources can you direct me to?

Any other comments

Thanks,

Ira

Kongo · August 2010

Second Opinion?
Ira, nobody in this forum knows AS better than you and I understand your hesitancy about another biopsy. When I was doing my research prior to treatment I recall that the key to AS is the ACTIVE part and that annual biopsies are part of the protocol. On the other hand, we all know that having another biopsy is no guarantee that they will find anything and what you're really looking for is a core that might prompt you to leave AS and follow another course of treatment with a more worrisome Gleason score.

I've since come to suspect, and this is really my own opinion and not shared by a lot of the medical community (although there are some studies that suggest it), that the very act of inserting the needle into the prostate is a factor in spreading PCa to other parts of the body. I've read studies that indicate strong evidence of cancer forming along needle tracks on prostates that were removed. Likewise, I think that the surgical procedure of RP is another factor of spreading PCa and may be part of the reason why nearly 30% of men with RP see their PSA return after surgery and require follow-on radiation and/or HT treatment.

If I knew then what I know now, I would never have agreed to a transrectal biopsy and would have had it done via the perineum where there is much less risk of infection or other complications.

I know its a tough decision but if you go along with the AS concept, and you seem to be in a great program at UCLA, you kind of have to drink the whole glass of Kool-aid. Or not. But if you forego the biopsy, what indicators will you be looking at for a possible change? Just PSA? Is there some other indicator (I know there are some other tests emerging) that they would use to help you make a decison to come off AS and seek treatment?

Tough choices, but you have a year to research it.

hopeful and optimistic · August 2010

Kongo said:
Second Opinion?
Ira, nobody in this forum knows AS better than you and I understand your hesitancy about another biopsy. When I was doing my research prior to treatment I recall that the key to AS is the ACTIVE part and that annual biopsies are part of the protocol. On the other hand, we all know that having another biopsy is no guarantee that they will find anything and what you're really looking for is a core that might prompt you to leave AS and follow another course of treatment with a more worrisome Gleason score.

I've since come to suspect, and this is really my own opinion and not shared by a lot of the medical community (although there are some studies that suggest it), that the very act of inserting the needle into the prostate is a factor in spreading PCa to other parts of the body. I've read studies that indicate strong evidence of cancer forming along needle tracks on prostates that were removed. Likewise, I think that the surgical procedure of RP is another factor of spreading PCa and may be part of the reason why nearly 30% of men with RP see their PSA return after surgery and require follow-on radiation and/or HT treatment.

If I knew then what I know now, I would never have agreed to a transrectal biopsy and would have had it done via the perineum where there is much less risk of infection or other complications.

I know its a tough decision but if you go along with the AS concept, and you seem to be in a great program at UCLA, you kind of have to drink the whole glass of Kool-aid. Or not. But if you forego the biopsy, what indicators will you be looking at for a possible change? Just PSA? Is there some other indicator (I know there are some other tests emerging) that they would use to help you make a decison to come off AS and seek treatment?

Tough choices, but you have a year to research it.

Kongo
I agree with your comments, that I have time to research this, in Jan I have an appt. to see my doc......as part of their active surveillance protocol....and I know that I signed up to drink the whole glass of "kool aid" , ....but, I might come up with something to bring to the table.......doing the biopsy is not a terrible thing to me, but more I can space them out the better, providing there are minimum consequences.

One thing that I notice in the candian study below is that they spaced out the biopsy between 12 and 36, I wonder why?

I will print this out for my doc for comment.
--------------------------------------------------------------------

Here are some results of Lawernce Klotz,MD, well respected
new
active sureilance expert

protocol:

PSA and DRE every 3 months
Prostate ultrasound every 12 months
Repeat biopsy at month 12 and 36

After 8 years:

- 55% remain untreated with stable disease

- 36% decided to have treatment(eventhough they did not have progression)

- 9% treated with surgery or radiation for increase in psa or gleason score

- none have metastatic disease
< 1% men died of prostate cancer

---------------------------------------------------
Analysis of Bill Axelson by Lawernce Klotz, MD
Journal of clinical Onchology 2005

. lower gleason
. less than 1/3 cores and none >50%
. PSA < 10 and not rising
. PSA density < 0.15
. no palpable diesease
. early treatment for any progression

FOR LOW RISK, 100 SURGERIES WILL SAVE 1 LIFE 10 YEARS IN THE FUTURE

Kongo · August 2010

hopeful and optimistic said:
Kongo
I agree with your comments, that I have time to research this, in Jan I have an appt. to see my doc......as part of their active surveillance protocol....and I know that I signed up to drink the whole glass of "kool aid" , ....but, I might come up with something to bring to the table.......doing the biopsy is not a terrible thing to me, but more I can space them out the better, providing there are minimum consequences.

One thing that I notice in the candian study below is that they spaced out the biopsy between 12 and 36, I wonder why?

I will print this out for my doc for comment.
--------------------------------------------------------------------

Here are some results of Lawernce Klotz,MD, well respected
new
active sureilance expert

protocol:

PSA and DRE every 3 months
Prostate ultrasound every 12 months
Repeat biopsy at month 12 and 36

After 8 years:

- 55% remain untreated with stable disease

- 36% decided to have treatment(eventhough they did not have progression)

- 9% treated with surgery or radiation for increase in psa or gleason score

- none have metastatic disease
< 1% men died of prostate cancer

---------------------------------------------------
Analysis of Bill Axelson by Lawernce Klotz, MD
Journal of clinical Onchology 2005

. lower gleason
. less than 1/3 cores and none >50%
. PSA < 10 and not rising
. PSA density < 0.15
. no palpable diesease
. early treatment for any progression

FOR LOW RISK, 100 SURGERIES WILL SAVE 1 LIFE 10 YEARS IN THE FUTURE

Canada
I wonder if the Canadian timeframe is related to the national healthcare guidelines in that country?

mrspjd · August 2010

Kongo said:
Canada
I wonder if the Canadian timeframe is related to the national healthcare guidelines in that country?

ira
(I had originally posted this in another thread, but I think it is more appropriate in this thread, so if you've already read this, sorry...)
Ira,
Once you settle on an appropriate time to obtain your next biopsy (or whenever you decide to have your next biopsy), was wondering if you've considered having a targeted biopsy by the Dr in Ventura (I think you know who I am referring to) who is considered to be an expert in PCa color doppler utrasound imaging? He uses the color doppler utrasound to pinpoint the areas that show more blood flow and therefore, could be PCa, then takes the biopsy from those areas that are lit up (showing the blood flow). I know you had the MRI/MSRI in conjunction with your last targeted biopsy @ UCLA, but thought next time you might consider going outside the UCLA AS study to get another opinion. If you eventually chose this procedure, it might be interesting to compare the latest targeted biopsy results from UCLA to the one with the color doppler ultrasound. Just a suggestion. Either way, best to you.

steckley · August 2010

Duration Between Biopsies
IRA,

You ask ..."if a wait, how much would my chance of non discovery increase?"

As I read the information you presented, you had "discovery" in March 2009. It would appear to me that your second biop missed the PCa tumors(s)discovered in the first biop. Based on the low grade of your PCa and the multi-focal aspect of many PCas I would not think this would be unusual. It took two tries before they hit my PCa tumors.

I know that the 2006 study you sight says to wait three years; however, I know this would be real hard for me to do (anxiety), and I would probably go with the docs recommendation of June.

Its great to base decisions on studies, probabilites and fact; however, sometimes its hard to turn the numbers you have into decisions.

Good luck in sorting this out and best wishes.

hopeful and optimistic · August 2010

mrspjd said:
ira
(I had originally posted this in another thread, but I think it is more appropriate in this thread, so if you've already read this, sorry...)
Ira,
Once you settle on an appropriate time to obtain your next biopsy (or whenever you decide to have your next biopsy), was wondering if you've considered having a targeted biopsy by the Dr in Ventura (I think you know who I am referring to) who is considered to be an expert in PCa color doppler utrasound imaging? He uses the color doppler utrasound to pinpoint the areas that show more blood flow and therefore, could be PCa, then takes the biopsy from those areas that are lit up (showing the blood flow). I know you had the MRI/MSRI in conjunction with your last targeted biopsy @ UCLA, but thought next time you might consider going outside the UCLA AS study to get another opinion. If you eventually chose this procedure, it might be interesting to compare the latest targeted biopsy results from UCLA to the one with the color doppler ultrasound. Just a suggestion. Either way, best to you.

color doppler test
I've heard a lot about this doctor and the color doppler test that he gives..Various men showed me a copies of the test that they have taken, which looks very impressive...I hear that he is an expert in this. At the prostate forum in Fullerton which I hope you made a connection with, and are on their email distribution list, many men swear by him, and use his services. Last year the Ventura doc spoke at the prostate forum, I would bet that he is speaking this year as well.

That said, when I was diagnosed, on two different occassions, I approached a doc that I was seeing at that time at UCLA about getting that test.....basically he did not think much of the test. He told me that ucla has that machine but only uses it for those who are not able to get an MRI....To be honest, he went into detail about why he did not recommend this test, but it went over my head at that time.

I think that it is worth re-considering this test in the future

Also, if I get another biopsy from UCLA, the three dimensional biopsy machine has the ability to go back to a location that had previously done.

142 · August 2010

hopeful and optimistic said:
Kongo
I agree with your comments, that I have time to research this, in Jan I have an appt. to see my doc......as part of their active surveillance protocol....and I know that I signed up to drink the whole glass of "kool aid" , ....but, I might come up with something to bring to the table.......doing the biopsy is not a terrible thing to me, but more I can space them out the better, providing there are minimum consequences.

One thing that I notice in the candian study below is that they spaced out the biopsy between 12 and 36, I wonder why?

I will print this out for my doc for comment.
--------------------------------------------------------------------

Here are some results of Lawernce Klotz,MD, well respected
new
active sureilance expert

protocol:

PSA and DRE every 3 months
Prostate ultrasound every 12 months
Repeat biopsy at month 12 and 36

After 8 years:

- 55% remain untreated with stable disease

- 36% decided to have treatment(eventhough they did not have progression)

- 9% treated with surgery or radiation for increase in psa or gleason score

- none have metastatic disease
< 1% men died of prostate cancer

---------------------------------------------------
Analysis of Bill Axelson by Lawernce Klotz, MD
Journal of clinical Onchology 2005

. lower gleason
. less than 1/3 cores and none >50%
. PSA < 10 and not rising
. PSA density < 0.15
. no palpable diesease
. early treatment for any progression

FOR LOW RISK, 100 SURGERIES WILL SAVE 1 LIFE 10 YEARS IN THE FUTURE

biopsy interval
I read this to say that you have a biopsy at month #0, the next at month #12, the next at month #36. Probably they have some indications that if it is not found in the first 2 biopsies, that they give you a rest if all other things remain the same.
I would suspect that if any of the 3 month interval DRE/PSA visit results went off the chart, everything would change.

I had the same concern (spread of PSA by "residue") as Kongo when facing the first biopsy, but saw equally convincing material (none I have here to quote chapter and verse) that it was not an issue. I suppose if you came back with a negative or very low grade Gleason, that could remain a concern over time. My Gleason and # of positive cores were collectively very bad, so surgery was the next step I chose.

Duration between biopsies

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