Need Help-Biopsy Decission

Tudpock: Thanks, that does answer a big question. I didn't even realize there where saturation biopsy's that range from 14 and up. The only biopy that was going to be set up as the first one was an (forgive me if I spell this wrong) Steotatical transperinial biopsy. I think it is something like 30 and up depending on the size of the prostate and is mapped with a brachytherapy grid. This is when I got nervous and posted thinking this might be overkill. Maybe th question I needed to ask the radiogy oncologis who want to perform this is why not saturation of 14-24 instead of 40-50?

Are most saturation biopsy's done transrectally? Any done like the STRP?

The only thing I like about transperinal is the lowered rsk of infection especially ecoli resistant ones.

Why did your doctor decide on 16 cores instead of 12?

I have even met a gentelman whos doctor performed 24 on first one. He ended up going with proton therapy and is cancer free 7 years so far. That is promising. I did not ask but would have loved to ask his URO, why 24 on first one.

I would love to know how many people have has saturation biopsy's as an initial one and why? I am not against it, matter in fact this is why the question even came up. Our problem is that my husband had no previous PSA and what if it did jump bigtime from a year ago, along with the abnormal DRE and urinary symptoms.

Just curious, does anyone know how long you can go between biopsy's.
Is it uncomon for people to have a 12 core lets say that finds Gleason 6, but have a saturation after to see if there is an 8 lurking like 142 (moderator)had?
I have to remember to write these questions for Friday:)

Nosywife,

It's good your husband went to have the PSA and DRE, the earlier PCa can be detected the more treatment options available in most cases. I went down a similar path when I went in for my 50th birthday annual physical. My family physician did his normal physical and ordering bloodwork, but during the DRE he felt a nodule on the right side of my prostate. Even though my PSA was always low and never higher than <0.85 he felt an opinion from the urologist was in order. The URO felt the same nodule on the right side and recommended a 10 core biopsy. The biopsy revealed no positive cancer cells found but some suspicious atypical cells. My URO recommended I wait 6 weeks and have a 24 core saturation biopsy to gather a more definitive answer and find any PCa if it was missed by the 12 core biopsy. After the saturation biopsy only 1 core came back with 20% cancer cells but that was enough to start the decision process of treatment. The 24 core biopsy actualy turned into 22 core since my URO obtained the number of specimens from all of the necessary regions of the prostate. Neither of the two different biopsies were that painfull and I was under sedation for the saturation biopsy.

In my case I was glad to have the 22 core biopsy completed as early as possible instead of going along the path of waiting 6 months and doing another 10-12 core biopsy, then if negative repeating again and again. For me this also helped get the answer quicker and not leave lingering thoughts of waiting until the next test for a possible answer. After discussing the results of the saturation biopsy and treatment options with my URO, Family Physician, Radiation Oncologists, family and most importantly my wife I chose to have the Robotic Surgery performed last October 4, 2011.

You have found a great place to come to ask questions and gain comfort while making decisions. Of course we are only offering what our experiences have been and not rendering a professional opinion.

Hopefully you and your husband can find comfort in discussing his journey here.

 

AS is simply monitoring the cancer if it is a low risk cancer and only treating when it shows signs of progression. Focal therapy is treating only the cancer and not the entire prostate by either cryosurgery of HIFU. In both cases it should be confirmed that the cancer is indeed small and not dangerous and a saturation biopsy is one way to confirm that.
Brachy and seeds are the same thing and treat the entire prostate; it is an alternative to surgery or external radiation.
I did have what you described, a psa of 4.4 and a hard spot on the prostate and after a free psa of 15 my first biopsy was a standard (at that time) 6 core biopsy which was repeated at 6 to 12 month intervals when they all proved negative. My free psa ranged from 7 to 16 which was a red flag; PCA3 was not available then.
A Combidex is a nono particle MRI scan which identifies cancer in the lymphnodes. It is not available anymore and should only be used when lymphnode cancer has a high probability, a psa of over 20.

I have had several biopsies. I realize a lot of guys have been diagnosed using the standard trans rectal biopsy. However that being said I have also had a saturation biopsy. All of which to this point have been negative.

Although the guided saturation biopsy is a bit more involved I feel it is a safer and more definitave test. It greatly reduces the risk of infection and provides a much better mapping of the prostate.

nosywife, I had a 16 core biopsy, using a local novacaine-like swab on the rectal wall. There was only mild discomfort with the insertion and manipulating of the probe, (only as much as could be expected from having an inch diameter probe run up your hind end ) The biopsy plugs themselves weren't any problem, pain wise, until he got to the 13th one, which was going deep into the apex area of the gland, 13 thru 16 increased in pain, until I told him that 16th one was enough, which was where he was stopping anyway. He explained that the apex area is more 'pain sensitive' than other parts and combined with the angle and manuvering he had to do to access it, made for a more painful sampling. In all,the last 2 or 3 was very painful. However, when compared to the use of 'putting under' drugs, the prep needed before, the need higher trained people and maybe even a hospital surgery unit setting, and the recovering from them afterwards, the short period of pain was a good trade off for me. If I were having yearly biopsy like with AS, I probably would take a good long look at maybe changing my mind.



Regarding the Rapaflo, its use is to reduce the size of the gland, which has BPE. That's standard care at this point. Most docs would also have run him thru a 3 to 4 weeks course of antibiotics along with that, then retested. If the PSA was still high, then they would proceed to the biopsy. At that point, the need for the biopsy overrides the number of cores taken. If insurance approves, then usually the standard care would be a 12 or 16 core biopsy. If nothing was found, then it would be time for a saturation biopsy. As you have read here, even then there is the possibility that any cancer can not be found. Usually that undetected cancer can be found lurking in the transition zone of the apex. Now all that is just a description of what the route would be in my area, and in general practice nation wide from conventional, main stream uro's. Also, there is no reason why a first time guy couldn't have a saturation biopsy, it's really just a decision to be made between the patient and the doctor. Some uro's think that saturation is the way to go, as it reduces the number of biopsies required, if the 12 core one doesn't detect any. Generally speaking the saturation guys tend to be the more advanced prostate specialists, whereas the 12 core guys are the local, regular practice local guys. Not that there's anything wrong with the local guys approach. That you have a choice indicates the good luck to be in an area that offers a good choice. Lots of guys don't get this advantage. In any case, it's not really a world changing decision either way, so he can make his decision with what he is comfortable with. Good luck....

Gregz263:
As you can see in my original post that was my main question. I think the only reason a guided saturation biopsy was even offered was because it was coming from an RO that like James said specializes in it. I do agree it is tempting to do out of the gate so that you might not have to go through multipal biopsys. If the only way to do BRACHY was with a guided saturation biopsy and he would need it anyway, then I think he might have gone that route. Since members here said that you do not need that type of biopsy for that treatment, I think thats when he wanted a URO's opinion. I don't think my husband is ready to go under general at this point if it is not necessary. If he had a negative 12 core at the start, it would be his next choice. His insurance said it was covered, but was not completely sure since something like a STRB biopsy might only be covered if there were previous negative ones. Would have to double check on that one.

James:
Not sure why he decided not to add the antibiotic. I wish I had asked that question.This visit confused me a little. Maybe after DRE and total PSA result he was leaning toward biopsy anyway, just waiting for fee PSA? would you be more resistant at the time of biopsy if you are already on an antibiotic for any length of time, say 4 weeks then right ino a biopsy? I would hope he would be on an antibiotic a couple of days before a biopsy anyway.Yes we are deffinately more worried about the infection thing. I think after the URO's visit he is convinced to go the standard route, but my big question is do you go back to RO who still wants to do the STRB biopsy and ask why? let him know you went to a URO and he said it is not idicated? That might stir up a contraversy. I am sure you are correct that the answer from them will be less infection, better mapping, more difinitive? How do you respond to that? Thank you for your detailed biopsy experience, didn't want you to have to re-live it. Do most URO's know about the transition zone of the apex and try to go there on a 12 core? Hope so

Had a 3D mapping, MRI fused, color doppler with elastrography biopsy done on Friday. A total of 14 cores were taken, 12-core traditional plus two from a suspected spot noted on my MRI report. Color doppler US did not show any additional suspicious area.  All done with local anesthesia. It took about 40 minutes (twice as long as traditional grey scale US biopsy) as sampling locations were all recorded on the computer, a copy of which (on disk) will be given to me in about two weeks. Prostate sampling part was not painful, the probing part was painful but bearable.

Perhaps my type of biopsy is a compromise between a traditional 12-core vs. the saturation. The uro only takes additional samploes on suspicious area. I do not know if this type of biopsy is available where you live though.

Akai

 

Well, the first thing is you gotta start trusting your chosen medical plan, including the docs, pathologists and everyone along the way. Blind faith?- no, trust they will do the right thing? yes. Otherwise you are in for a very nerve racking experience. I know it's scary and high stress right now, but you gotta be willing to trust people to do the right thing, otherwise your gonna be in sad shape before this is over. What if's will drag you down...... The best advice given here is to study, research and decide on the best option for whatever it is for you, then when the decision is made, don't look back and second guess, unless overwhelming evidence surfaces later.

The DRE is a big part in the process of determining a biopsy, with or without high psa. That's the first tip off for the examining doctor to look further.

The process for getting a second opinion on the slides is to contact whichever lab you want, find out what they require in the way of sending them and to give that info to your path lab, if the second opinion lab doesn't take it from there by themselves. It is unlikely that you will be given physical control of the slides, although at least one guy here has done that.

No fun when you aren't getting 100% consistent messages from the doctor(s). Can see where this is driving you nuts. Even, heaven forbid, there is an aggressive cancer hidden there, I don't see much real danger in waiting one more month, getting through the antibiotics, and re-testing. That free PSA is pretty high actually, but without any long PSA history to follow, as you indicate, even that's a tough call. If you can make it through the month, and the PSA is as high as it is now, or higher, then there would be no reason I can think of for the doctor to not want to do the biopsy. I must admit, that mentally, with so many unknowns still, a month can seem a long time.

david in sc

My prostate was 110 gms. at surgery, and as i said, I had BPH and prostatis for 15 years prior. Here's my numbers leading up to surgery.


08/00 3.9
08/01 4.8
11/01 4.1
01/03 3.9
01/04 4.1
01/05 4.2
01/06 5.2
06/06 4.2
04/07 7.6
06/07 6.7
open RRP


A months wait won't make much difference one way or the other and no one, even the most experience doc, can promise a definite outcome. If the biopsy is a worry, then it would be logical to try all avenues to avoid it, and the antibiotics and BPE meds route is a logical first step. So there's no real hurry to do anything beyond that. The thing we all have to remember about PCa is it is an entirely individual disease, and no 2 cases are exactly alike, so there's no way we or he can predict anything. The best we can do is to use the diagnostic tools available to us and go from there with the knowledge gained. No one can tell you if it's BPE or PCa, or even the sex or bike ride the day or night before his first test. The main thing is to find a course to follow and to stay on that path, wihout changing directions at the drop of the hat, or change of the wind, or even something written on some health support forum..


Don't be rushed into and don't rush into anything, take your time and evaluate things, then proceed in a planned course of action.

N:

You are going to drive yourself nuts with all the possibilities. If he has PC, then there are even more possibilities. It's a miserable time.

Try and arrive at a plan and stick with it. Your PSA Free of 24% is in a grey area.

Doing the antibiotics and retesting is a good standard plan.

You should still ask about a PCA-3 test. It is easy (urine test after a DRE) and very specific for PC. This is now a well-known test.

After that, if you are still in a grey area, it would be time for a biopsy and 12-core is standard. I see no reason not to do the standard.

(But, of course, none of us are doctors and we have all travelled similar yet different paths). But try and keep calm because this could end up being a long road; hopefully it's a short one!

Mel

Is there a teaching hospital near you.

I am disappointed that the uro eschews the PCA-3 test. It is designed precisely for folks who are in this grey area.

Maybe you can google it and get more information?

I did and here is the first link I saw:

http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=810&pageaction=displayproduct

Mel