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Prostatectomy Following Elevated PSA and MRI

JFG2019
Posts: 13
Joined: Aug 2019

Sorry if this topic has already been addressed.  I am wondering if anyone on the forum had his prostate removed following an MRI i.e. without a biopsy of the prostate ever having been completed?  My MRI showed three lesions that were judged very high probability of significant cancer, one with a capsular bulge.  I know that the biopsy is needed to confirm the cancer diagnosis before treatment options are considered.  But, I am interested in deviating from the standard approach.  I am also wondering what provider (e.g. Hopkins, Mayo, Northwestern etc.) may have allowed a patient to take this path, knowing the risks involved.

icemantoo's picture
icemantoo
Posts: 3211
Joined: Jan 2010

The fear is worst than the procedure

 

 

 

 

 

 

 

 

icemantoo

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3295
Joined: May 2012

JFG,

Medical protocol will be tricky there.  Not only the cancer center, but more likely the INSURANCE carrier may object, or who knows, may not.

I am speculating, but it seems possible that the significant tumor involvement may justify R.P, even without a confirmed cancer diagnosis.  But, I've had both, and a biopsy  is not 1/1,000 the ordeal of the surgerical removal.   

In the overall experience, it seems wishing to avoid biopsy at all costs is straining the gnat to pass the camel...

 

Clevelandguy
Posts: 456
Joined: Jun 2015

Hi,

Before I would let anyone perform surgery or do radiation treatments I would want a biopsy, the only definitive call on cancer yes or know.  The biopsy will also grade the cancer(very important) to determine how aggressive the cancer is.  If done property the biopsy is no more than a few pinches and a little discomfort for a few days. As Iceman said not that big of deal.

Dave 3+4

JFG2019
Posts: 13
Joined: Aug 2019

The biopsy will delay the possibility of surgery by 4 to 8 weeks minimum.  The delay could be longer if there are issues with the biopsy such as infection, inflammation of tissue etc.  I really don't want to wait.  I am not looking for concurrence.  So, judging from the responses, the answer to my question, so far, is no one has any evidence that I can find a great surgeon to do the surgery without a confirming biopsy.

Georges Calvez
Posts: 275
Joined: Sep 2018

Hi there,

I have had the biopsy and a prostatectomy and I would say the biopsy is a walk in the park before the main thing.
The procedure itself was pretty painfree in my case but I felt like I had been kicked in the bottom a few hours later, I was fine the following day and I had some blood in my urine for a few days, semen for several weeks.
Prostate cancer grows slowly so a delay of a couple of months for the biopsy and recovery does not make any difference in most if not all cases.

Best wishes,

Georges

Tech70
Posts: 53
Joined: Nov 2017

I have had 3 biopsys that were essentially painless, except for a couple of hours of minor discomfort afterwards.  I wouldn't want someone operating on me who can't do a proper parapostatic block.

JFG2019
Posts: 13
Joined: Aug 2019

Thanks all.  BTW, roughly how long did it take to receive the results from the prostate biopsy?

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3295
Joined: May 2012

JFG, prostate biopsy results typically take a week or a little longer to get back. It varies by lab and cancer center.  Part of this is scheduling in the doctor's office, part is the testing technology itself.  It can be done faster, since when on the operating table, a pathologist can tell the surgeon whether or not there are positive margins in a few minutes. Doing this is standard O.R. proceedure. However, I suspect that what they can know in 30 minutes is much less definitive or detailed than what can be done more leisurely in a lab.

You wrote above that a biopsy would delay your surgery 'a month or more.'  You must have special complications if that is the case.  I cannot think of any reason a prostectomy could not proceed two days after a biopsy, and the only reason it would take that long would be for scheduling a room in the hospital.  Conversely, there is likely no reason to rush.  Rarely, a biopsy will induce some simple infection, the liklihood of which is reduced by giving pre-surgical antibiotic, but incipient infection would in no way preclude surgery -- consider what transpires in appendix removals, for instance.

JFG2019
Posts: 13
Joined: Aug 2019

Thank you.

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