Biopsy, yes or no?

First, welcome to the group nobody wants to be a part of. Sorry for the loss of your father to this dreadful disease.

Second, considering your family history and doctors recommendation, I would think a biopsy would certainly be a course of action. In my particular case, at 41, my doctor monitored my rise in PSA and prescribed Cipro, thinking that my rise in PSA might be related to an inflamed prostate. In the end the Cipro did nothing, cause the rise in PSA wasn't from inflammation, but cancer. I have no family history of any type of cancer, so went into the biopsy with a very positive "let's just do this to confirm it's some type of infection" attitude. We went ahead w/the biopsy and sure enough the cancer was in there. At least I was glad I had a reason for m PSA rise!

The biopsy itself wasn't painful, just a bit uncomfortable. Make sure the Doc uses the lidocaine, and you won't really feel much at all. The side effects I had were blood in the urine, although it's not like urinating straight blood, for a few days. And some blood in the semen for about a week. That somehow scared me more for some reason, not sure why. I've never heard to ED or incontinence as a side effect of a biopsy though. Possibly for a prostatectomy, but not a biopsy. At least in my experience. The debate over whether cancers spread after being biopsied is one that will rage on for years, in my opinion, and is debated regarding all tissues in the body, not just the prostate. I thought about it as well, and in the end decided that i'd rather aggravate the demon when it's small then wait till it spreads by itself and is way more difficult to track down and sample.

In the end the decision is yours, and only you can decide with your doctor how to treat your symptoms. But if it were me, I would have the biopsy. It seems like you and your dad talked about this, what do you think he'd recommend you do?

in good health,

First of all, welcome.  Secondly, I’m sorry to hear of the recent loss of your father to advanced PC. 

Thirdly, congratulation for “failing” the PSA test.  It’s good that you got an initial baseline number, but the result is indeed low and (generally) favorable.  Start keeping records of all your test results, and make sure that the test methodology is consistent from test-to-test because different test manufacturers use different methods, and results cannot be meaningfully compared across different methodologies.  Note that one thing to continually watch is the change (PSA velocity) in the test results.

The PCA3 result is a bit troubling.  The most common use of PCA3 is for men in the “gray area” of PSA results between 2.5 and 10.0 ng/mL (to help determine whether to go forward with needle biopsy), which is much higher than you, or for men with low PSA but a positive DRE (you did not indicate that yours was positive).  Men with a family history and low PSA (like you) is, however, another use of PCA3 although there is no scientific evidence supporting the use of the assay in this subject population.

Your doctor said “you have no choice” (about moving to a biopsy), and although I am not a doctor and can only give patient-to-patient wisdom & inputs, I think you do have a choice for a less invasive procedure before undertaking the larger step to needle biopsy, or likely saturation biopsy in your case.

Before further discussing your possible alternative, you should know that the biopsy is not definitive in ruling out cancer.  If they find cancer, it is definitive, but if they do not, it only means that their sampling did not find cancer…it may or may not still be present.

The alternative I mentioned above is called the color Doppler ultrasound biopsy.  This technique uses imaging on new blood vessel growth to help locate and estimate the size, shape and location of PC.  While I never had the procedure, there are others here who might also respond to this thread on their patient-to-patient input about this.  Either way, I would suggest discussing this with your urologist.

I hope this helps…

 

Go for the biopsy. It will give peace of mind knowing if you have it or not. With your family history I think you should. My husband said the biopsy wasn't that bad. Take your antibiotics prior to so you don't get any infection. Good luck to you.

Yes

I am in similar situation as you -- father died of CaP at about same age as your dad. I have had psa tests since age 40. Results: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.6, 1.5, 1.5, 1.5. Free psa around 30 percent, though studies have not validated significance of fpsa with total psa values below 2.0. I have done a very substantial amount of reading -- several books, a couple of hundred articles, etc. I consulted with a nationally reknown prostate cancer expert who told me he does not suggest a biopsy or a pca3 test. A second urologist said the same, as did an oncologist with prostate cancer expertise. So, for now i just continue to sit tight -- getting psa tests every 6 months. I considered going on dutasteride for prevention. Still considering that, but havent done it yet. There's a raging debate among experts about that, and i have gotten strong advice to do that, and not to do it. So who knows. Anyway, i am surprised that with a .72 psa, a negative DRE and as best i can tell from your post no sign of significant psa velocity, your doc is so insistent about biopsy. But i am no doctor, so what do i know. Good luck.

I also believe CDU is of value [Dr Lee & Dr Bahn being two of the best] If at all possible get the CDU from one of these Drs, as it will clarify if and where biopsy is needed...........My husband had one from Dr Lee, made a big difference in decision process..................Cooper    

 So sorry for the loss of your Dad

CDU=Color Doppler Ultrasound

Good Luck with the decision.

Also please research who the "artists" [as JohnT refers to them] are that do CDU! The two I know of are Dr Fred Lee & Dr Duke Bahn,in MI & Ca respectively...........I do think there are a couple more,but only a handful that are very good...........  Cooper

Post Edited (cooper360) : 6/14/2011 7:16:12 AM (GMT-6)

New, and definitely not trying to stir any pot - but I asked my doc about this - the 'sampling' issue. My question to him was "where would you sample?"
His answer was a bit murky - part of it involved possibly repeating the Bx, etc...it was definitely NOT reassuring in any way.

It seems clear that a better method of Bx 'guidance' is needed - perhaps the CDU is that method, I'm still learning about it.


Decided to defer on my Bx pending further study of new(er) techniques and hoping that my fPSA of 30% has some validity as a means of
distinguishing those in the PSA "grey area" - those truly needing a Bx and those that may not.

What I've learned so far is that precious little involving the Prostate is definite or 100%.


As to the original post - it would seem reasonable for him to have a Bx done soon, based on his info.


Almost forgot - here's a link to a fairly new (May 2011) article about "targeted biopsies" - using MRI + ultrasound in combination.
My doc got rather upset when I simply mentioned this article to him - merely asking his opinion on it.

Sounds promising - but doesn't it always?

http://www.eurekalert.org/pub_releases/2011-05/uoc--ntf051111.php

Post Edited (Tikvah) : 6/14/2011 11:58:40 AM (GMT-6)

im scheduled to have a prostate biopsy on 7/7/11. the doctor has prescribed an antibiotic called Cipro 500mg to take a day before the procedure. I'm hoping all goes well. Thank you all for your comments and i will keep you posted on the results.

Hope all is well with all of you. So 7/7/11 came and went and i did not have the biopsy done for one reason, i took Motrin for a headache the night before and the doctor had said four weeks earlier that i could not take Aspirin or Motrin seven days prior to the procedure, but i totally forgot about this. I'm a firm believer that everything happens for a reason and the reason this happened is because i am too young for a biopsy as everyone i know is saying, and also i noticed that my doctor was going to do some medical research with my procedure. Before i mentioned that the i had taken the Motrin, he had an assistant who advised me if i wanted to participate in the research. My urologist being a researcher i guess wanted to have a biopsy on a healthy, fit 40 year old with low PSA number but with a family history of PC (my dad). After i mentioned the Motrin he said he did not want to risk the biopsy bleeding and getting infected "especially since i'm a healthy young man" WHAT!!!??? thats what he said. So if i am a healthy young man why was he so inclined to do the biopsy in the first place. Thank God i didn't have it done yet. Im going to get a second opinion from another urologist. Thank you.