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Should I have a biopsy just because of 1 or 2 high psa score ?

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Posted 7/10/2012 1:16 PM (GMT 0)
Hi folks, I went to the docs because some times when working I feel weak and have the urge to munch on a biscuit which helps to bring my sugar levels back, anyway I had some blood test the Diabetes wasnt taken by the mistake of the doc not ticking the right box but I was called in and sent to the uro specialist because my PSA was 5.3 at the age of 50 was told to be high, I had a physical test which I was told felt normal and more blood and water was taken for testing, results should come back when I go for this biopsy.

After researching this marvellous forum and videos I find that biopsy can have there complications and the right process is to keep a eye on your PSA and Free Psa levels, so Im thinking that Uro specialist is taking a bit of a drastic track by taking a biopsy by using one or two PSA score taken within 2 weeks. I have done another blood test for sugar levels and PSA with which results should be with the doc this Friday. I dont have any problems with water works, get up in the night now again, Ive been told is just me drinking far too much tea.

My question is if the PSA score is still the same should I ask for the Free PSA score and why didnt they take this into consideration as Ive learnt the Free Psa is just as important?

Should I go for a biopsy just because of one or two blood test within 3 weeks that show a PSA above normal? .. After reading the complications that can happen with a biopsy Im really reluctant to have it until there's a detail blood count over a reasonably amount of time.

I understand that there's ultrasound scan that can be done to see the size of prostate, usually they do this while taking the biopsy, shall I just ask for this and not the biopsy ?

I do have private health care and Im thinking maybe I should ask to be refereed to another specialist, I really think Im being rushed down a track where there should be more investigation over a time period
Posted 7/10/2012 1:31 PM (GMT 0)
Mr_G

Welcome to our little family of amazing wonderful brothers and sisters.

To me, the most important thing you said - "I really think Im being rushed down a track where there should be more investigation over a time period"

Take your time - have the investigations done. Ask questions of your medical team, make sure you understand what they are saying. Doctors tend to speak their own language - to many people it may as well be Martian.

Ask whatever you will here!

Bud

We will ALL beat this crap!
Posted 7/10/2012 2:16 PM (GMT 0)
Cheers Bud, thanks for the welcome, if the rest concur with my time statement Im thinking maybe the specialist should be checking if there's other test they should be taking like hormone, yeast infection or even even if being diabetic may course high PSA reading. Im certainly going to ask them to look into it more over a time period before the biopsy.
Posted 7/10/2012 2:17 PM (GMT 0)
Complications from biopsies are minimal to rare…. Your PSA is above normal.

But, if in six weeks your PSA is still where it is – a biopsy would be something worthwhile to consider.
Posted 7/10/2012 2:26 PM (GMT 0)
First welcome to our forum where I am sure you would rather not be.

I am not a doctor nor an expert but IMO at your age 5.5 PSA is high. I assume you have not had previous PSA tests that would have established a baseline for the 5.5?  A high PSA is not always indicative that you have prostate cancer as other things can be the cause such as prostatitis which is a bacterial infection of the prostate. Most URO's will prescribe a 3 to 4 week dose of Cipro antibiotic before a biopsy to rule this out with a PSA test after the run of antibiotics. An enlarged prostate (BPH) can also be the cause of a high PSA. Other things to factor in is if you have any family history of PC, which can increase your chances of getting PC by as much as 50%. With no family history the odds of getting PC is 1 of 6 men over 50 in their lifetime. PC is not really an old man's disease as with better diagnostic tools like PSA blood testing and ultrasounds more and more younger guys under 50 are being diagnosed and for most early enough to be successfully treated. In most cases by the time a man becomes symptomatic of PC it has spread from the prostate to other parts of the body, so the earlier is can be found the more successful the treatment can be.

In my case at age 61 last year my GP referred me to my URO with a 3.5 PSA and after 3 weeks of Cipro my PSA was at 5.25 and triggered my biopsy which confirmed my  PC. My PSA 2 years before the URO visit had been under 2 and all of my digital rectal exams (DRE) had been negative and I had no other symptoms of PC but my tumor turned out after surgery to have been 60% of my prostate and an aggressive Gleason 7. Fortunately, so far for me, I got it in time before it escaped the prostate to spread.

With the biopsy there can be some side effects like infections but they only happen about 2% of the time. It is slightly uncomfortable for 1 day but it  is still the best way to determine if you have prostate cancer and how aggressive and wide spread it has become.

If you do have PC it is not the end of your life and you  have many good treatment options which most of us here have experienced and can lend various opinions on to help you through this. 

Terry The Water guy 

 

Posted 7/10/2012 3:35 PM (GMT 0)
I never had a previous PSA test so cant tell a base line,and no family memebers have had a PC. I know 5.3 is high, the complications with biopsy im more worried about is not only the problems bleeding and infections, but if it harms the cells in the prostate and to cancel out any other systems before had. Ill ask if a 6 week period and see if Cipro (Ciprofloxacin)would help.

The URO ask if I had any questions but it was a matter of days since the doc referred me to him, and didnt do any research about my problem .. so glad I fount this place, now I have whole list of questions to ask. URO said the biopsy is easy enough process and I wont feel anything, but I only want to take it when further checks have been done and cancelled out hormone or even being Diabetic... the Doc even said her self that PAS level can go up from riding a bike or having sex, so surly more blood test have to be done over a suitable time, aswell the Free PSA reading... thanks for your input guys

Post Edited (Mr_G) : 7/10/2012 9:38:25 AM (GMT-6)

Posted 7/10/2012 4:01 PM (GMT 0)
Hi Mr. G:

I am in a similar situation, I am 58 yrs. old and my PSA went from 2.8 to 3.36 in 15 months, my first Uro wanted to do a biopsy right away after a course of antibiotic that did not bring down my PSA level.

I went to another urologist and so far have done Free PSA, PCA3, and Dynamic Contrast Enhanced MRI. The insurance company denied the Color Doppler Ultrasound claiming it is experimental and no value to the diagnosis. My MRI shows a suspicious spot and I am scheduled for a biopsy for August 3rd. I am still going to do the 3D mapping Color Doppler Elastrography biopsy, I will have to pay out of pocket for whatever cost the insurance denied.

My case may be different than yours because my PSA is lower, but just to let you know that there are tests that you can request before you decide on a biopsy.

Akai

 

Posted 7/10/2012 4:08 PM (GMT 0)
Mr G,
You are correct in that you are being rushed into a biopsy. Yes you have a high reading, but not that high. 75% of all biopsies are negative and many doctors immediately pull the biopsy trigger without investigating other options.
1. Free psa test
2. PCA3 test
3. PSA density (DRE estimates prostate size. PSA divided by prostate size in cc = psa density. If 1 or less it is normal.)
4. A second psa reading after a course of Cipro.
If any of these are abnormal then a biopsy is warrented.
Biopsies are not benign, they can cause serious infections, result in temporary ED, and serious bleeding leading to hospitalization. They are also costly, about $1,000 or more.
I'm not anti biopsy as I have had 13, more that anyone else I have heard of; but I have found that most uros are somewhat lazy and it is much easier, less liability, and more revenue to just go immediately to a biopsy without first screening for more benign causes of high psa. Annually there are over 1 million biopsies done in the US of which 500,000 are unnessarry.
JohnT
Posted 7/10/2012 4:12 PM (GMT 0)
Hi Akai, Im certainly going to ask for it as Ive been paying for top medical cover now for 15 years, so Ill look it to this Dynamic Contrast Enhance MRI and 3D mapping .. whats PCA3 ?
Thanks
Posted 7/10/2012 5:32 PM (GMT 0)
Hi Mr_G,   I have taken a break from this site more than a month ago, so when I read your post your I related to your questions .   I was called during a meeting that my PSA is high, and like you, I was told to go to a Uro for biopsy.   You can read my journey from diagnosis to treatment, and see how I dealt with the diagnosis, and why I am not a proponent of biopsy (and I would not underestimate the risks associated with it). https://www.healingwell.com/community/default.aspx?f=35&m=2383730 Not being a medical professional, I only offer my opinion on what could be some options.   Ø   Your PSA is elevated when considering a threshold; however, it does not mean necessarily cancer, benign prostatic hyperplasia is a possibility as well. Ø   You may want to ask the doctor to have a PC3 test which has a better correlation with cancer than simple PSA (free and total); this test was approved by FDA this year. http://www.pcf.org/site/c.leJRIROrEpH/b.7984201/k.3063/PCFFunded_Discovery_Results_in_a_New_Diagnostic_Test_to_Diagnose_Prostate_Cancer.htm   Ø   Regarding the imaging techniques, you may consider the Collor Dopller Ultrasound (which differentiate the tissues based on the blood vessels) is more accurate than the simple ultrasound, but it was offered to me only in conjunction with a biopsy (after my original biopsy);   MRI with spectroscopy (better than simple MRI) is not accurate enough to detect small cancers, and it is used mostly used after biopsy to detect the extension of macroscopic cancer. Ø   Circulating tumor cells is another FDA-approved test for diagnosis, which may replace current test in the future. If you are close to one of the two centers that offer it, you may look into it: http://www.pcf.org/site/c.leJRIROrEpH/b.7976929/k.1AE4/CTC_Technology_Detects_Presence_of_Cancer_and_Serves_as_a_Less_Invasive_Diagnostic_Tool.htm   I hope that you will end up not having prostate cancer.   But if you do, you should not panic, as there are a few treatment alternatives and you may choose the treatment that fits your case, as no treatment is perfect.  
Posted 7/10/2012 10:09 PM (GMT 0)
I totally agree with what JohnT had to say. Biopsy should be carried out because that is what is indicated after other possible causes of an elevated PSA have been investigated and eliminated. However I would not be spooked by the stories of biopsy complications. They are not very common and do not carry a much greater risk than do most invasive medical procedures.
Bill
Posted 7/11/2012 11:19 AM (GMT 0)
Hi Bill, I missed JohnTs comment and agree in every word he says .. It seems to me the only alternative the NHS uro wants to do is put you in for a TRUS even thou I seem to be healthy have no water works problems physical exam seems normal, I just hope the water sample they took is part of the cancelling out any other problem than PC... I really could do with a list of the best Uro specialist in the UK.
Posted 7/13/2012 11:28 AM (GMT 0)
Just to report back to let you guys know that my recent PSA blood test has gone to normal reading of 2.83. Ive the told the Uro that I wont need the biopsy but still want to speak to him next Thursday consultation.

This just shows you that if I didnt do my own research and find this fab forum I would had a biopsy done that didnt need doing, so big thank to you guys for keeping this place updated.
Posted 7/13/2012 3:45 PM (GMT 0)
Waiting for another psa test after some antibiotic certainly makes sense, nobody wants a needle biopsy, but that is about the only way to tell for sure if you have PCa. You are far better finding out as soon as you can if you have it. The biopsy is no fun, as most will tell you, but it isn't as bad as you might be imagining either. 5.5 at your age is concerning so see this though without delay.
Posted 7/13/2012 6:38 PM (GMT 0)
I am newly registered but have been lurking for the past couple of months because of a jump in my PSA score. URO didn't waste any time with the biopsy but with the results I suppose it was for the best. For what it's worth the biopsy wasn't that bad, only sore the day of procedure. Hope that helps for anyone recommended to get a biopsy.

Just being 2 weeks out from my prostatectomy, got to find humor where you can, but if I were to go to a URO now I would have to answer yes to all those questions that were all no's before, ie getting up in the night, ETC.

So it goes......
Posted 7/13/2012 7:56 PM (GMT 0)
I had a psa of 4.0, 30 days later 3.9, and then six months later, 4.6. A biopsy confirmed ca. The uro explained all the risks of complications from a biopsy but my only thought was do it asap. Like a lot of tests, it sounds unpleasant, but it's not that big of a deal to get through it. Better then wondering what in the world is going on inside my body.
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