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Need for Biopsy

Posts: 30
Joined: Sep 2009

I am 68 years old, and my PSA levels since Nov. 2011 until Jul 13 3013 have been pretty consistent although high. 4.07, 4.82, 4.45, 4.32, although they are high they have actually lowered slightly. I have no other symptons and have no problems urinating. The last 2 times the urologist checked my prostrate with his finger, he said it felt fine.. Now as a result of my last psa of 4.32 they want to do a biopsy. I do not want to go through it, as frankly I am afraid of the side effects. So since my psa has been level if anything is coming down and taking into consideration the questions relating to the accuracy of the psa test  ang with no other symptoms is a biopsy really necessary?

Posts: 261
Joined: Sep 2010

I really don't know if you need a biopsy.  Have you had other tests done (ie. scans, free PSA, etc.) that may impact your decision?  How big is your prostate ... could your PSA be accounted for by a large prostate? Or an infection?

If you have only had the DRE and the PSA I can see why you may think you do not need a biopsy.  

I had two biopsies, with no side effects or other problems.  I felt that the biopsy risk was small with regard to the rewards (a more definitive understanding of the probability of having PCa).  I think that each guy has a different take on this, and that it is a fairly subjective decision.

If my doctor wanted to do a biopsy, and I did not agree with him, I would get a second medical opinion or get another doctor.

Wishing you all the best as you move forward.

hopeful and opt...
Posts: 1951
Joined: Apr 2009

To add, I wonder if there are other factors that are relavent to your case?

Do you have more PSA historical information, or is there any other relevant information?

There is a urine gene test, PCA3 that many use as an indicator to determine if a biopsy is indicated

 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.

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 preformance has been established by Bostwick Laboratories. It should not be used as the sole evidence for or against the diagnosis of prstate cancer. Clinicco-patholological correlation is indicated.

VascodaGama's picture
Posts: 2501
Joined: Nov 2010

I believe that you should "explore" other ways to get closer to a final diagnosis before engaging in a biopsy.

The above tests suggested by the above participants are valid options and quite accurate. You could also have a DNA profile test to look for genes associated with prostate cancer. This test can provide you with details of aggressivity, in case you got or are prune to have PCa.

For the moment, the chronology of the PSAs indicates a velocity of zero but you could get a PSA density if you have done an image study of the prostate to measure its volume. Smaller glands are more prune to be cancer positive in small variations of PSA. Read this link for the details;

The PSA of 4 ng/ml is considered "normal" in guys in the age range of 60 to 69, however, the number means nothing in an indolent type of cancer. This may be the reason for your urologist to recommend a biopsy, but it is more common to check for other possibilities such as an inflammation or chronic UTI. Typically one is administered antibiotics for one month to "clean" the system, and then subjected again to PSA total and free tests.

In any way, only a biopsy would diagnose you with precision.

Remember that you have not been diagnosed with cancer yet. I hope you do not become a member in our boat.

Best wishes.



Kongo's picture
Posts: 1167
Joined: Mar 2010

Sylvan, in your post you indicate that after a fairly steady set of PSA readings "they" want to do a biopsy.  Who is "they."  Is this the urologist or your primary care physician?

Frankly, I think the PSA range is fairly normal for a 68 year old man and since you have no other symptoms I would be aggressively questioning why "they" want you to undergo a biopsy.

There is a statistical liklihood that a biopsy will reveal "something."  Studies where biopsies of men who died of other causes indicate that 70% of men in their 70s, 60% of men in their 60s and so on had some form of indolent prostate cancer and were unaware of it.  These cancers were almost always indolent and posed no threat to the man.  

One of the disadvantages of the many advances we have made in medicine is that we are now able to detect suspicious areas that we never saw before.  Prostate cancer and the PSA test is one of those areas where cancers are being detected and treated that never pose a threat to the individual.

If you do a biopsy and they find "cancer" you will then undergo serious pressure to "do something" to treat it.  Maybe it will be an aggressive cancer that does indeed neet treatment but given your PSA history it could well be an indolent cancer that will never grow or metastasize and never pose a threat to your life.  You will still be under pressure to get treatment.

In my lay opinion, the epidemic of over treatment we have in the United States flows from cases that seem exactly like yours.  Doctors do biopsies as a business development move and then expand their income on highly priced procedures to treat conditions that never pose a threat to the patient.  The potential side effects from a biopsy and follow-on treatment are often much, much worse than the condition itself.

Four years ago before my diagnosis I would have done exactly what the doctor suggested.  After all, they're the doctor right?  Knowing what I know now I would defer a biopsy in the absence of anything worrisome on a DRE and continued steady PSA readings at the range you have and I would continue to take regular PSA tests.

I would recommend you read "The Big Scare:  The Business of Prostate Cancer" by Anthony Horan.  You can download this from Amazon.  I would also seek a second opinion.

Good luck to you.



Posts: 694
Joined: Apr 2010
After reading your previous thread/posts from a few yrs ago, I understand your trepidation about going forward with a prostate Bx. You beat cancer once--congrats on being a survivor. Is it possible that the fear of being dx'd with the big C again is paralyzing and preventing you from moving forward on a decision to obtain a Bx?
You have received some good advice here about PCa, PSA, tests & biopsy.  That info pertains to "most" 68yo men who haven't had a previous cancer dx and who need to make an informed decision about having a Bx to screen for PCa. IMHO and with due respect, you're not in the "most men" category because of your history with kidney cancer. When you shared that info back in 2010, CSN members provided great advice then (as well as now) about biopsy. You even noted that a date was scheduled for your Bx (after Medicare kicked in). Guessing from this current thread that you did not go through with the procedure.
My lay opinion is that obtaining a prostate Bx would be a very prudent, proactive and wise decision on your part, especially considering just your cancer Hx alone. 
I hope you are able to schedule consults with an experienced/skilled oncologist AND a urologist for their expert 2nd opinions.  I also hope this process helps you arrive at a reasonable and rational medical decision about obtaining a prostate Bx. Only then will you know what you might, or might not, be dealing with. 
Knowledge is power. Wishing you good luck and peace of mind. 
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