Does it matter who performs biopsy?

Is there skill involved when taking cores and what should one consider when seeking a doctor for this specific purpose? In another thread I've described my experiences to date with my high PSA and first biopsy. I had a conversation with the pathologist from Mayo who analyzed my slides and he made the comment that my next biopsy would ideally generate many nice long tissue cores. The "many" could apply to anyone but I'm wondering if it takes skill to get "nice long tissue cores".

My first biopsy was only 10 cores and it appears only 7 slides were sent to Mayo. During the last visit with my urologist he raised the prospect of doing a saturation biopsy so I guess my question would pertain to both conventional and saturation biopsies.

My wife made an interesting comment the other day that it may have been fortunate that I was at the stage when a "bump" could be felt by the urologist during the DRE, because he then knew exactly where he wanted to focus during the biopsy.  All six cores taken from that left side area showed cancer.  When there is no "bump" or "nodule," it seems to me there is no area of focus and that cancerous areas could be missed more easily.  After surgery, just two months later, cancer was found also on the right side, where the biopsy had found nothing wrong.  He didn't have a specific target on that side during biopsy.

fulltlt said...
I sure wish I would have had a stereotactic transperineal prostate biopsy. There are so many advantages to going that route. The standard transrectal biopsy was the worst.

Sounds as if the uro was one of those who doesn't bother with such trivia as his patient's comfort. Those who do bother can and do perform biopsies with little or no pain.

Something we should all learn is that we are in charge. Be insistent. Be unpleasant if necessary. Or just fire the medic and go elsewhere. I've done all these and know that it works.

Mavica said:

" Not everything in life goes smoothe. Going to the dentist is more troublesome than a prostate biopsy, IMO. We learn to 'get over it.' "

Oh, give me a break! I got to love those folks who post with so much authority, stating things like they are absolute facts.

If you read reports, experiences range from a walk in the park to excruciating. I had them put me out (twilight) and it was not a problem. I have 2 friends who said if they had to have another biopsy, they would do it only under those circumstances. It's different for every one. Telling someone to just get over it is uncalled for.

Mel

i freaked out over the biopsy and tho i tried didn't get the level of sedation that i wanted, but i am in the 90% that thinks the biopsy really wasn't that bad. however, i would much rather get a root canal because i can get any level of sedation i'm willing to pay for.  and then there's the potential complications from prostate biopsy.

ed

It mattered to my husband and I. He decided, with my research to have a potential biopsy done only in conjunction with color doppler and only by a Dr who was highly skilled in reading CDU. In the end [no pun intended] no biopsy was required.  Cooper

To answer the question that started this thread: Doing a prostate biopsy is a very elementary urological procedure. If you don't trust your urologist to do it, then you need to find one that you do . It's considered a very routine procedure.

And to Mel, I think you are making too big a deal out of what Mavica said, and it was his opinion, and subjective opinions are what this place is all about. I agree, that for probably 90% of men, having the biopsy is uncomfortable and foreign to our normal thinking. Pain is subjective as is fear. I had 3 done, 1st without anything numbing, 2nd with numbing - the shots to numb hurt me bad, and the 3rd time, told the dr. forget the numbing, lets get it over. With all I have been through, the biopsies for pain rated a 1-2 on the scale. But that's me.

There are the rare exceptions, where it goes wrong, or there is a lot of temporary pain involved, but again, not the norm, but the exception. The fear part can simply get out of hand inside of the persons mind. I know men that are afraid of getting a simple shot like a flu shot, and my ex-boss literally faints at the sight at a drop of blood.

Mavica's IMO in terms of contract law, was all he needed to say to qualify and limit his post as his opinion. Case dismissed. lol.

david

A bit of anesthetic is cheap insurance against pain. What's to lose?

Besides, if the patient is comfortable and not tensing up, the uro's job should be easier.

Purgatory, you answered my question regarding this being fairly routine.

I'm not sure how I feel about my current urologist which is one reason for me asking. He is a very nice man and isn't rushing me into anything. He talks frankly which I like. What I didn't like is the fact that he only wanted to do 10 cores when a few more seem to be standard practice. He is also only able to do open surgery and doesn't want to start with robotics due to his age and the number of operations it takes to get proficient (i'd estimate he is upper 50s). I also had a pretty unpleasant experience with the first biopsy. I wasn't given any type of sedative or even offered one. I did get a few shots to help numb the area but the cores were taken immediately after and the first half of them hurt like hell. At the dentist they usually take 4-5 minutes to let things numb but in this situation it was more about getting it done as quickly as possible perhaps to move on to the next room where the next patient was waiting.

I've identified someone else local that works in robotics, is a urological oncologist and came recommended from someone I know. This isn't to say that I'm sold on robotics if I need treatment but at least it is an option that can be discussed.

Why are they suggesting a saturation biopsy? You've only been diagnosed with PIN in one core. Saturatuin biopsies are very invasive and require a general anesthetic. You really need to find a new urologist. Go to Northwestern and see someone there, but not just anyone. Do research first and pick who you want to see. Be strong and make sure you do not let Nortwestern assign you a doctor. In the alternative, make the five hour drive to Mayo.

At this point, you want someone who is an expert in prostate relAted issues - a specialist. I'm not an expert or a physician, but I would think that you need a 12 or 15 core needle biopsy from someone who does many of these. Make sure you ask before hand about a local anethetic and a seditivelike Valium if you're truly frightened based on your last experience.

But please, dump this urologist and go to a cancer center. You're fortunate to bin Chicago. You have many convenient choices. And, ideally your urologist will not be the same person who performs the surgery should you need treatment and select surgery.

Trevor T. said...
Why are they suggesting a saturation biopsy? You've only been diagnosed with PIN in one core. Saturatuin biopsies are very invasive and require a general anesthetic. You really need to find a new urologist. Go to Northwestern and see someone there, but not just anyone. Do research first and pick who you want to see. Be strong and make sure you do not let Nortwestern assign you a doctor. In the alternative, make the five hour drive to Mayo.

At this point, you want someone who is an expert in prostate relAted issues - a specialist. I'm not an expert or a physician, but I would think that you need a 12 or 15 core needle biopsy from someone who does many of these. Make sure you ask before hand about a local anethetic and a seditivelike Valium if you're truly frightened based on your last experience.

But please, dump this urologist and go to a cancer center. You're fortunate to bin Chicago. You have many convenient choices. And, ideally your urologist will not be the same person who performs the surgery should you need treatment and select surgery.

No you are obviously not an expert. A 3D saturation mapping biopsy along with color doppler is state of the art. True they require sedation and after mine I awoke with a catheter for a day. But in comparison to your normal 12 pin biopsy they make those seem archaic. They will locate the cancer more precisely and the amount of the PCA. For Targeted Focal Therapy for low risk PCa they are essential. TFT is a clinical study treatment that I was successfully treated with going on near 3 years now. I wish it were available for all along with saturation biopsies , but I digress. The reason saturation biopsies are far superior is the amount of cores taken which are decided by the size of the prostate. In my case 45 although I've heard up to 90 from others. They are also placed by a grid.

Your recommendation that he find a better urologist who won't give him a saturation biopsy is downright laughable. I advise him to stay with the doctor he has for many would love a saturation biopsy if it were available. After said biopsy he will know much better as to his Pca than you and most others here know/knew of theirs. That's an irrefutable fact. At that point he may decide on treatments and doctors with much better knowledge of his PCa.

http://alprostate.com/Documents/TFTMAPPING.pdf

I see you're fairly new here. If you feel the need to give future advice fine, but be sure you know what you are advising about.

I'm glad you feel that this invasive and risky procedure was right for you. I see that you're no expert either since this "state of the art procedure" is not recommended for a a person with a low PSA and a negative core biopsy. It's simply too invasive and too risky.

Using your logic, he'd proceed with surgery based on the recomendation of one urologist. The only thing laughable is your arrogance and your pseudo expertise. That's the scary thing about doctors who've obtained their medical degrees from the University of Google

Oh, and I did investigate having this procedure done as I was considering active surveillance for my own case. I investigated it thoroughly with a team of physicians from one of the best cancer centers in the country. But, you seem to be the real expert in risk taking as well as saturation biopsies. I see you were treated with a non traditional therapy. I'm glad it worked for you. Personally, I'm not comfortable with risk. Only a fool would subject themselves to an invasive procedure like a saturation biopsy without further advice and investigation and certainly not without a preliminary finding of cancer.

Trevor T. said...
I'm glad you feel that this invasive and risky procedure was right for you. I see that you're no expert either since this "state of the art procedure" is not recommended for a a person with a low PSA and a negative core biopsy. It's simply too invasive and too risky.

Using your logic, he'd proceed with surgery based on the recomendation of one urologist. The only thing laughable is your arrogance and your pseudo expertise. That's the scary thing about doctors who've obtained their medical degrees from the University of Google

Oh, and I did investigate having this procedure done as I was considering active surveillance for my own case. I investigated it thoroughly with a team of physicians from one of the best cancer centers in the country. But, you seem to be the real expert in risk taking as well as saturation biopsies. I see you were treated with a non traditional therapy. I'm glad it worked for you. Personally, I'm not comfortable with risk. Only a fool would subject themselves to an invasive procedure like a saturation biopsy without further advice and investigation and certainly not without a preliminary finding of cancer.

Your rudeness and arrogance are appalling. Your advice is frightening.

First of all I admit I was under the impression he had a single positive core. But other than that your arrogance is frightening and you really shouldn't be giving advice. Yeah yeah I know you checked with an unknown group of doctors from one of the best cancer centers. Where was that? At least my advice is based on a named university and includes my doctors presentation to the American Urological Association. As far as it being a risky procedure I will tell I know there's been over 100+ done with no adverse reactions or even an infection. My advice is from actual experience while yours is hearsay from an anonymous expert cancer center. But you're not comfortable with risk eh? It's a hell of a lot riskier going by a normal 12 pin biopsy in knowing its location or the volume of PCa to base your treatment decision on.