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Posted 12/12/2013 12:36 AM (GMT 0)
I'm new to the forum and was directed here by an associate who has been through the prostate cancer ordeal to include its removal.  I am currently in the decision process as to whether orf not to have the subject biopsy.

Two years ago my PSA went from below "normal" to 5.1.  A biopsy was done and involved taking a sample in 12 places on the gland.  It came back negative.

This past summer my PSA was at 18.  The young urologist (I refer to him as "Doogie Houser" due to his youth) now wants to do a saturation biopsy which involves up to 40 samples.  At this point I am saying WHOA!!! HOLD YOUR HORSES and am on the verge of cancelling the procedure.  My rationale:  1)  There are no other signs of a problem, i.e., good urine flow, everything feels normal, no "masses" felt on the gland and it's not that enlarged.

I will be 70 in April and am in perfect health...no prescription drugs at all.  I am a bicycle rider and rode close to 1000 miles this past summer.  Rather than cancel my appointment, I am considering asking for the old 12-sample biopsy instead of the invasive sounding one.  I may just cancel altogether.

Has anyone heard of the "satyuration" biopsy?  Prostate cancer victims have spoken with have not.  I am very leary of it.  Has anyone out there been through it and am I justified in wanting to call the whole thing off?  I know that a PSA number is only a risk indicator and may not be a sign of cancer.

Posted 12/12/2013 1:00 AM (GMT 0)
I've heard of saturation biopsies, but didn't know it involved 40 hits. I too am a big bicycle rider and had my share of elevated PSA tests. I'm assuming you've been the antibiotic route before. The red flag for me was that in the past my elevated PSA would always return to its old reading after a round or two of Cipro. In late 2011 early 2012 it didn't, so I asked for a biopsy and the rest is history. My PSA was always in the "normal" range, but the jump from 2.5 to 3.9 bothered me. I don't know about the wisdom of a saturation biopsy, but I'd rather know if I was dealing with cancer or not while its still early and I had the best chance for a cure.

Best of luck to you,
Tom
Posted 12/12/2013 1:05 AM (GMT 0)
I think a saturation biopsy is in order. Don't be too concerned about the number of cores. You PSA has tripled in a years time, a potentially dangerous sign, especially if there is no evidence of infection.

With a saturation biopsy, there is little chance that the biopsy will miss any hidden cancer. I have heard of this type of biopsy with more than 60 cores.

I think you doctor is on the right track. I wished I had one done.

I had a 12 core, negative. A year later, 12 core, negative. Both times, the 12 cores simply missed the cancer. 2 months later, had 7 core into some CT shadows, and hit pay dirt, and found the mother lode of PC that was there all along. Had I had a saturation biopsy in the first place, my outcome may have turned out more favorably than it has.

Just my opinion, I would go for it if this is what your doctor feels best in doing.

David
Posted 12/12/2013 1:22 AM (GMT 0)
Find out if you will be out. I had a 26 core and I would never go through that again. A saturation biopsy is also pretty expensive. I would investigate a Color Doppler Ultrasound or an MRI.
If you are going to get a saturation biopsy make sue it is transperinal and not trans rectal. There are areas that a trans rectal biopsy will not reach regardless of the number of cores.
Posted 12/12/2013 2:16 AM (GMT 0)
Hi OkieHick, and welcome!

Firstly, congratulation on doing close to 1,000 miles on your bike last summer.

Second, I've gotta ask a couple of the low-hanging questions first before jumping to a saturation biopsy.  Some of these are probably so obvious to some other the others who already responded that they forgot to mention them...but they may not be so immediately obvious to a newcomer.

Question one is related to your biking.  Biking, you may realize, (or more specifically sitting on a bike seat) "massages" the prostate.  The massage releases abnormally increased amounts of PSA into your bloodstream (it is absorbed and diminishes over time).  A PSA test soon after biking would result in an abnormal reading, but one with an "assignable cause" and not an indication of a problem.  But, if the doctor (and the patient) were not aware of this situation, the elevated result might cause some initial alarm.  A result of 18 ng/mL is not outside the range of this type of artificial elevation.  Furthermore, there are other patient activities which can similarly cause a short-term rise in PSA in the blood, including (for example) sexual activity.  If one has sexual activity the night before a PSA test, it is certain to be artificially elevated.  Anyhow, your comment about biking raised this red flag in my mind.

Question two is about possible infection.  A 70-year old who has a history of below "normal" PSA then rise to 5.1 and then to 18 ng/mL very probably (in my savvy layperson's experience) has some other benign contributing factors; that rise would be highly unusual to be caused solely by PC.  One could be from prostatic activity, as described above, but another could be infection which is very common and can occur concurrently with other issues.  Infections tend to make PSA rise (and sometimes fall) quite rapidly.  You didn't mention in your post whether your urologist took steps to identify whether infection was present, or steps (antibiotics) as a first course of action.  I would absolutely pursue this avenue first, if it hasn't already.

AUA (American Urological Association) "best practices" call for the elimination of non-cancerous possible causes of elevated PSA prior to biopsy.  I hope this helps frame the bigger picture for you.

best wishes...

Posted 12/12/2013 5:05 AM (GMT 0)
remember, I am only endorsing the saturation biopsy, if infection is or has been ruled out for that rapid PSA rise. and aware that cycling does a number on the prostate and can cause a rise by itself.

david
Posted 12/12/2013 5:31 AM (GMT 0)
Welcome to HW, sorry you need to be here but it's a good place to be.

If you're going to do a second biopsy, a saturation one would a good way to go. Some of our guys here have had that.

But as has been mentioned, have you really ruled out all the other causes?

Also have you done a retest on the PSA? You might want to retest and confirm that high number - lots of things can push PSA up and sometimes due to infection, BPH, a bad day at the lab, etc will cause a false reading and a second test might come back lower.

Keep us updated on your progress.
Andrew
Posted 12/12/2013 12:29 PM (GMT 0)
Thanks for the responses! I failed to mention that my PSA was 18 after 3 weeks of cipro. It was initially 23 at my annual physical. I am concerned about infection, bleeding and the extended effects of the saturation biopsy on the gland. I am still tempted to wait 'till my next physical in June, but I will be immersed in biking again by then and will probably have the same result. I'm NOT going to stop biking. It's keeping the rest of me healthy.
Posted 12/12/2013 1:15 PM (GMT 0)
Good advice on here, but before you go second guessing your own doctor and canceling a procedure I would recommend you get a second opinion from another doctor. At the least, talk to your current doctor about the information you found on this and other sites.
Posted 12/12/2013 1:29 PM (GMT 0)
Greetings OkieHick, and welcome.  I'll add my two cent's worth to this as well.

If I were in your shoes, before I submitted to another biopsy I would for sure rule out all other potential causes of the elevated PSA first.  Good to know that you went on the Cipro with respect to possible prostatitis. 

Now moving on to the issue of what NOT to do before a PSA draw.  First of all believe me, I get it about wanting to stay with the exercise routines to stay healthy - I'm a bit hooked on that as well, cardio every morning, weight training at night - but you need to be sure to stay off the bike for at least 48 hours prior to a PSA blood draw; same goes with any sexual activity - nada for at least 48 hours - anything that can jostle the prostate gland around.  Two or three days off the bike seat is worth it to help ensure an accurate PSA reading, don't you think?  Also, be sure that as part of this process IF a DRE is included the blood draw should be done BEFORE any poking around in there. . . .

If all this goes through and your next PSA is still elevated, I would follow your Dr's advice and go with the saturation biopsy - it's simply far more accurate at locating potential cancerous cells - and also by the way does not carry the same risk of infection as transrectal biopsy.

Stay with us, we're not medical professionals but we've been around the block - lots of experience and knowledge here.

Best of luck to you.

Posted 12/12/2013 1:32 PM (GMT 0)
Hi Hick, welcome aboard!

The other guys are giving you excellent advice. I also had 3 biopsies before having the cancer discovered. I was getting pissed being poked around every couple of years but I guess I was expecting my day would come.

First off, most of the times there is no symptoms of cancer. Mine was found doing a routine physical. I was not over weight, normal flow, etc.

Second, a 18 PSA needs to be investigated. Mine was 18.5 and after my surgery it was discovered that the tumor was beginning to leave the capsule. I asked my surgeon what would have happened if I waited a year before having surgery. He said he probably could not have helped me.

I truly hope you do not have PCa and I am not saying you do have it but it would be much better to find out now what is going on rather than later. PCa is a very slow growing cancer but your numbers are jumping pretty fast.

I was 61 when DX of PCa. My uro was in his 30's, younger than one of my sons. I first thought he was mighty young to be dealing with this but after my surgery, I went back to him, shook his hand and thanked him for the text book way he handled my case. He suggested surgery but didn't push me and gave me a reference to a radiologist.

Good luck

Bill from Florida cool
Posted 12/12/2013 2:41 PM (GMT 0)
OkieHick,

I had three biopsies.....my third one in September of this year was a Saturation one with 24 cores taken in an office visit.  It wasn't that uncomfortable.  They finally found Pca and on 11/05 I had surgery to remove the same.

My PSA kept rising over the years too.  I'm glad my wife encouraged me to have the Saturation Biopsy.

Your on the best site for Pca.  I think you'll find all the information you need here.  I know I did.

Best Regards and Welcome Aboard............Berk

Posted 12/12/2013 3:53 PM (GMT 0)
I had a 45 core biopsy. It's the best there is for determining how much and where your PCA is. Below is a link from where I ha dit and my TFT done. I don't know why I can't post a live link anymore on HW? Something here has changed. Oh well copy and paste it.

http://www.precisionprostatecare.com/precision-biopsy/
Posted 12/12/2013 5:20 PM (GMT 0)

OkieHick, thanks for your update.  So clearly from what you provided, there has been some benign factors influencing your elevated PSA.  18 is still abnormally high.  Chronic inflammation can be a real challenge to eliminate and sometimes requires multiple antibiotics, so do keep that in mind.

Another important perspective to know which not all newcomers are aware of is the fact that 70% of 70-year olds have cells in their prostates which have grown to a shape & pattern which today we call “prostate cancer.”  It’s considered a part of aging.  This statistic was found through prostate autopsies of men who died from other causes; the general finding was that the percent likelihood of finding PC was about equal to a man’s age.  So, about 70% of 70-year olds, if they looked hard enough (or their doctors did), would find “prostate cancer” in their prostate.

But 70% of 70-year olds have not been diagnosed with prostate cancer, nor do 70% of 70-year olds die from prostate cancer…far less.  Most of those men did not encounter a set of circumstances which led to a prostate biopsy, which is the only way PC is actually diagnosed.

This implies that many, many men carry around forms of PC which they never know about and cause them no harm.  Prostate cancer is a wide spectrum of disease...a small percentage of cases are dangerous, a larger percentage probably aren’t.

The “take away” knowledge from this is that as a 70-year old if you look hard enough (or your doctor does), you will probably find some “prostate cancer.”

I am not at all suggesting not to look…only helping to kick-start your education about men’s health issues so that you can be properly prepared if and when you do look further.

18 ng/mL is high, and follow-up is warranted.  My suggestion is in line with the AUA “best practices” which is to work with your physician to be “a detective” by eliminating possible benign contributing factors as your “step 1,” and be an informed patient along the way.

Best wishes…

Posted 12/12/2013 6:23 PM (GMT 0)
By chance did you do a free PSA (fPSA) blood test?
Posted 12/12/2013 6:46 PM (GMT 0)
With a psa of 18, a negative biopsy, and a course of Cipro, you would have to suspect a transition zone tumor. This is why your doctor is recommending a saturation biopsy, as this is the only way to sample a TZ or anterior tumor.
Posted 12/12/2013 6:51 PM (GMT 0)
No.

I am also concerned if all this poking, stabbing and prodding of the gland isn't maybe causing problems. Let's face it, senior citizens are cash cows to the medical community. I wonder how many actions are taken by that community are simply "knee Jerk" reactions and are unnecessary. I agree that some are as evidenced by this thread, but I doubt that they ALL are.

It was suggested that I consult with a 100% urological clinic. We have one it Tulsa. To me that's a guaranteed outcome of other "procedures" and actions. It's like a mechanic that advertises a "free winter inspection". Yeah right! THAY ARE GOING TO FIND SOMETHING TO GET YOUR MONEY TO PAY THEIR BILLS.

I know. I'm a complete cynic.
Posted 12/12/2013 11:45 PM (GMT 0)
Okiehick: an Oklahoma friend from Tulsa here - who also happens to be a 7 year patient at the urology clinic you mentioned. I have had two 12 core biopsies and one 25 core biopsy at that clinic - all with the outcome of no cancer found. The "saturation" or 25 core biopsy that I had was done under conscious sedation - felt pretty much aware of the entire procedure but could remember little of it. The saturation biopsy was no more difficult from which to recover than were the previous two 12 core biopsies - absolutely no recovery difficulties with any of them. I can tell you that I felt better about this entire prostate roller coaster when the 25 core biopsy came back as all benign tissue. Since that time, I've been better able to relax about PSAs, etc., and just watch it every six months. Good luck with whatever you decide.
Posted 12/13/2013 1:19 AM (GMT 0)
I think John T has got this one covered. His is the most specific to your stats as depicted in your post. Okie Hick, 2 years ago you went from "normal" to 5.1 Had a minor biopsy, 12 core, negative, went on with your life happy as a clam, tho shaken. Then the story ends. Fast forward 2 years and you had an "annual" psa test and it came back 23.{ what was the psa level the year between the 5.1 and 23} Uro does the proper thing , gives a dose of cipro, waits 3 weeks and now its down to an abnormally high 18. Im 90% sure you have Pca, I bet your uro is sure you have Pca. He wants to do the the saturation as it has the best chance to find you Pca and go to treatment. He is not try ing to get rich off you. I am as cynical of the cash machine a jade medico can milk, but my classmate, your story is simple. Everything about your case says a tumor that is hard to detect. Avoiding an issue such as the probability of Pca, looking for reasons to say it ain't so, will not change the facts. I totally disagree with casey59 next to last paragraph as it pertains to you be cause , it does not pertain to you. Going from 5.1 to 18 in a month or so might fit that paragraph, but going from 5.1 to 23 in 2 years and then only going down to 18 after a 3week dose of cipro , does not. Casey I only am referring to that specific portion and how it could be received from a man who, IMO is looking for a reason not to have it , against ,imo , tremendous odds he does. You need to follow your uro's advice period and should help him and you, by having trust in him or by getting a uro you have trust in. Also help your Uro and yourself by seriously looking at John t's advice on finding the tumor. I say all of this and listen close. In 3 to 5 years I want to see a post from you reporting continuous undetectable Psa's, not a cry for help with a stage 4 bout of advanced cancer and riddled with mets. Good luck, and don't let it ruin the holidays ,be thankful you are still at a point that will in all likelihood provide life well into the 90's.
Posted 12/13/2013 3:30 AM (GMT 0)
Y'all are using acronyms that are foreign to me. Keep in mind that I have been able to avoid doctors for most of my life. This whole scenario is really strange to me. What is "PCA"?

LOGOSLDIT: I really appreciate your post. It's invaluable!...
Posted 12/13/2013 3:44 AM (GMT 0)
When I saw my urologist for my first visit, he said that he was very happy that I had not had a saturation biopsy because in his experience there can be significant scarring around the gland making the delicate dissection of the nerves off the gland much more difficult. He thought it was due to some of the saturation cores being obtained at the very periphery of the gland, and even some from just outside of the gland, resulting in more bleeding around the gland, and thus more scarring. Has anyone else heard this concern?
Posted 12/13/2013 5:32 AM (GMT 0)
Peaty malts I haven't and I assume the urologist was also a surgeon, not always the case. I think it makes a lot of sense. Im glad he said much more difficult and not impossible.Successful nerve sparing is at best a difficult procedure. Having said that it must be remembered that pca treatments first priority is cancer control{total removal}, maintaining continence, or regaining it asap, and returning to potency at the earliest time. Perhaps a person on the verge of this procedure should discuss this with his Uro and possibly get fewer pokes, Idon't know that one is beyond my pay grade.
Posted 12/13/2013 6:18 AM (GMT 0)
OkieHicks, I appreciate your comment it was heart warming. Here are a few more tips. At the top of the list of pca {prostate cancer} threads[ different subjects that deal with pca, you started a thread called saturation biopsy}. Any way at the top of that list there are two "locked threads indicated, by pad locks. The first is the most important one and will be better understood by referring to the second one as needed,i.e abbreviation or acronym meanings as they relate to Pca. Read them and study them if needed.
Also buy Dr Patric Walshes book on PCA, [google}, read the parts that apply to you. Advance Cancer does not apply to you. I can not say that definitively, but am 90% sure.This is why they need to find the cancer so as to stage it 1, 2, 3' or 4. I have to remind you, there is a possibility that you do not not have pca. I gave you my odds for that. My odds do not negate that it could be a very stubborn, deep seated, case pf prostatitus, resistant to anti biopics. I hope and pray it is, not because you are going to die, if it is in fact, Pca. But who needs the grief, right, specially at our age …. But it is beatable and at an older age , more so, simply because we only have to beat pca to the reaper and croak from something else and we have less time ,presumedly than some of these whippersnappers, , a lot of whom have very difficult cases they are living, fighting and surviving with. Another tip browse thru the posts at will and whim, you will meet us, and tho we scrap with the best of em. we are a band of brothers and sistahs. you know the women who are supporting their loved ones.
Also you will find other options for treatment, that might be more suitable than surgery with equal results. Im hop
ing and confident others will join in from these different options with there advice. right now tho the main thing you have to find out is do you have pca and to what extant. The treatment options are really useless un till the info is known. Ok keep us in the loop, ask questions of us. But lets agree, you will do your home work as well, so as to help us help you.

I love oklahoma, I went to the FAA Acadamy back in 69 at will rogers airport in training for a career as an air traffic controller. I went many times for additional training during the years. Capped it all off with, after retirement in 05, a year as an instructor for the young " power rangers" with OU who held the contract at the time. So I am some what of an a adopted hick myself. Man they sure got some great places to grind{ eat} in OKC. Did,t much like the 3.2 beer much…. OK OkieHicks, have a great Christmas and New years. Regards, Logo
Posted 12/13/2013 6:26 AM (GMT 0)
PCA, or PC, simply prostate cancer. Sometimes written as PCa, but means all the same thing
Posted 12/13/2013 1:21 PM (GMT 0)
OkieHick - if there's anyway you and our brother Logo could hook up for a beer I think you should, seems like a good connection developing there.

Logo - Kudos to you for your last couple of posts, some of the very best I've seen and IMHO invaluable to our new friend here!
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