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How to Detect Prostate Cancer without a Biopsy

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Posted 12/4/2012 5:18 PM (GMT 0)
Blackdog,
You are correct. Overtime the measurement should be PSADT or psa doubling time. There are psa doubling time calculators you can use, but you need multiple readings over time. A doubling time > 3 years is associated with indolant or low risk PC whereas PSADT < 3 years should be treated. This is the cut off that many AS programs use.
Posted 12/4/2012 5:52 PM (GMT 0)
An exception can be if the cancer is high grade like a Gleason 8-10. As it will give off much less PSA there are times that the PSA will not be elevated enough or rising to indicate cancer. My brother's brother-in-law had a PSA of 1 and, because of symptoms, had a biopsy to find G9 cancer, followed by surgery, salvage radiation, and two rounds of hormone therapy..
Posted 12/4/2012 6:21 PM (GMT 0)
JNF,

In theory, as long as the tumors retain the same mix of cell types as they grow the doubling time calculations would still work. Less aggressive tumors would show a higher PSA value for the size of the tumor but that figure wouldn't grow very fast. More aggressive tumors would have low PSA values for the size of the tumor but since the tumor would be relatively fast growing that low PSA would show brisk exponential growth.

What diddles the pooch with PSA doubling time is progression -- when a patient with a mass of low risk tumor develops small, more aggressive spots that grow quickly. At that point you are trying to sort out the sum of two exponential growth curves. The higher levels of PSA produced by the low risk tumor tend to mask the contribution of the faster growing but small high risk areas.

The reason I characterized the tumors by aggression and/or risk instead of Gleason score is that the theme of this thread is what can be done without biopsies. Gleason scores come from microscopic examination of the tissues. To play by the rules for this thread you can't know Gleason scores.
Posted 12/4/2012 9:06 PM (GMT 0)
In reading various reports above, it seems that almiost everyone had several negative biopsy reports, followed by a positive report. I do not want to subject myself to even one biopsy, yet alone several thereafter. I understand that ultrasound targeted biopsys might be more accurate, but I am alarmed at the quantity of biopsy's needed to verify cancer. How can poking this number of holes through the prostatic membrane be anything but harmful?
Posted 12/31/2013 9:14 PM (GMT 0)
I noticed there was no mentioning of Trimprob (Tissue Resonance InterferoMeter Probe) that has been developed in Europe. It is very accurate on negative findings and accurate on positive findings (85%).
Hope it will help.

http://www.wired.com/medtech/health/news/2003/07/59434
Posted 12/31/2013 9:24 PM (GMT 0)
I am no doctor, but many doctors do agree biopsy's can spread cancer cells, or at the very least, irritate the prostate which can start cancers. I recently had a PSA of 16.4, so my chances of caner were very high. I just had an intensive MRI with an endorectal probe, and I was told by the Boston Medical radiologist I was good, no cancer.

Had I followed standard medical procedure, with a PSA of 16.4, they would have continued to stick me with needles until they found something.

We all need to do our own doctoring.
Posted 1/1/2014 1:26 AM (GMT 0)
You can wait till it metatazises and your psa is 4 figures. You will get treatment by an oncologist at that point. I am not being wise guy. Im totally serious, you wouldn't be the first who was his own doctor and lived a long life without be bothered by it. Don Imus treats with hot peepers only. Course I don't know he could have indolent cancer. Maybe you have, maybe you don't, the only way to tell is with a biopsy or my option. I won't bother you with a clint eastwood , quote as Im sure you know what it is. Goodluck blackdog. BTW, I still consider going the way of no psa test for my duration. I had an all clear a year ago, but am seriously considering that , cause for a few good reasons, I think Im cured. But then again pride goethe before the fall. I like the previous misspell, its like, you know…… me.
Posted 1/1/2014 2:45 AM (GMT 0)
There are many reasons not to have a biopsy, but inoculation of the cancer is not one of them. There has never been a research study that has shown that to be an adverse consequence of a biopsy.To understand why that is not a logical consequence as it may seem to you, you'd have to understand how a cancer cell becomes one that can thrive outside the prostate. It is certainly not possible for a Gleason 3 cell to survive on its own outside the prostate. Cancer cells are constantly being sloughed into the sera absent a biopsy, yet they seldom take root and grow. Prostate tissue closes up around the 18 gauge needle used in the biopsy and the cells do not get out. Even with full prostatectomy, where large cuts are made through prostate tissue, there have been only 3 documented cases of seeding of the tumor. It has never been documented from a prostate biopsy.

You have to understand that most of the "information" one reads on the net is misinformation. The only reliable sources are those published in prestigious peer-reviewed journals -- every thing else is just joe-shmo's opinion.

PHI is not yet available in the US.

- Allen

Post Edited (Tall Allen) : 1/1/2014 2:11:20 AM (GMT-7)

Posted 1/1/2014 4:46 AM (GMT 0)
blackdog, Tall allens words are to be dwelt in. Comeback with some feedback to our feedback, when and if you have the time.
Posted 1/1/2014 1:51 PM (GMT 0)
Blackdog,

It sounds like no matter what we say, you will not be convinced that you should get a biopsy.
Posted 1/1/2014 2:06 PM (GMT 0)
I had a complete endo rectal MRI scan...no cancer detected. Why would I want to further abuse a prostate with sticking needles in it? And yes, I have read two reports of needle tracking in the Journal of Urology, and a study by the Univ of Caifornia medical school on increased risk of cancer proliferation from biopsys. Im sorry, but if you research european treatment of the prostate, it is not a stick it, remove it, or use hormones as a method of treatment. I recently read that some 40% of men who had their prostate surgically removed, have a reoccurence of prostate cancer cells, plus a life near impotence. Maybe cancel cellsare escaping during the removal process? We owe to ourselves to use every non evasive method to save ourselves, and not follow western science which is based on speed and economics.
Posted 1/1/2014 2:29 PM (GMT 0)
Blackdog69,

For what it's worth , PSA , free PSA , and biopsy allowed me to "catch" my cancer at Stage 3 disease and prevent me from developing Stage 4 PCa. James
Posted 1/1/2014 3:12 PM (GMT 0)
Blackdog,

There are risks with colonoscopies as well. Do you use the same logic for screening for colon cancer?
Posted 1/1/2014 4:47 PM (GMT 0)
Blackdog... I am going to be very candid here.

What are you trying to accomplish? There is no magic bullet on diagnosis of prostate cancer without a biopsy... period. If you don't want to do a biopsy, then don't... your call. Move on with your life and never worry about it again or just monitor you PSA for change. If you are old enough, this may be the right thing to do anyway (did you post your age?).

The question for you is, what would be the trigger for you to accept getting a biopsy? A positive bone scan?

Also, I did not catch as to whether you had a DRE and the results if you did?

I recommend you read the NCCN Prostate Cancer Early Detection Guidelines. They are the recommendations from 23 of the worlds best cancer centers and see what they recommend.

Good luck.
Posted 1/1/2014 5:23 PM (GMT 0)
Blackdog-
Thanks for giving me those references. I found a few cases in the literature as you describe, the last in 2002 and most reports well before that. I don't know why none since then, possibly because seeding is rarer with lower grade, and stage migration has led to detection at lower grades. Also, with the advent of PSA testing following RP, perhaps any seeded cells were destroyed by adjuvant/salvage radiation before any seeded tumor masses were ever detected.

Usually with mpMRI (using a 3T and endorectal coil), it is used to guide a biopsy, and to search other areas after a previous negative biopsy. They don't only biopsy suspicious areas, however, but also randomly sample from non-suspicious areas as well. Sometimes the tumor foci are too small to show up.

Are you satisfied that your PSA of 16.4 is fully explained? Have you been able to attribute that to BPH or prostatitis? Have you tried taking Proscar or Avodart to see if the PSA drops down to normal levels? A urine catch with prostate massage to attempt to ID pathogens in the prostate?
Posted 1/1/2014 8:20 PM (GMT 0)
@Allen--As a Gleason 6, I'm interested in reading the study that shows that a Gleason 3 cell cannot survive outside the prostate. Can you provide me with a link or direct me to the study please? Not that I can reverse my prostatectomy the way they do nowadays with vasectomies, but I've never heard or read anything about this before. I had a baseline PSA at age 40, then annual PSA testing. My PSA quadrupled in one year, hence the biopsy. The rest is history.
Posted 1/1/2014 9:15 PM (GMT 0)
Tim G-

A recent study of 1781 men from NYU demonstrated that there were no metastatic recurrences after RP for Gleason 6. All recurrences were local (e.g., tissue left behind or locally invasive).

Gleason 6 Prostate Cancers Diagnosed in the PSA Era Are Never Metastatic at the Time of Radical Prostatectomy

A similar study from Johns Hopkins of 14,123 cases from 4 academic centers also found that G4 or G5 is necessary for metastasis to occur:
Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes?

It is thought that G3 cells must evolve, or the progenitor cells that produced them must produce a higher grade lesion before it is able to survive outside the prostatic environment. Cells must undergo a process called epithelial-to-mesenchymal transition (EMT) before they can break free, and G3 cells cannot do that in their present state.

For a deeper discussion of why G3 cells are not malignant, you may be interested in the following article (you have to log in to read it):
Do low-grade and low-volume prostate cancers bear the hallmarks of malignancy?

This does NOT mean that GS3+3 does not need watching or treatment: G4 cells may not always show up in random biopsies, and low grade cancer may over time progress to higher, more invasive grades.

- Allen
Posted 1/1/2014 9:19 PM (GMT 0)
Blackdog,
You remind me an awful lot of my husband. For the last 3 years, he has found every reason not to do a biopsy, even though 3 different doctors recommended one because of his slowly climbing PSA numbers. He would cherry-pick his information, looking for evidence to support his stance of resisting a biopsy. When he finally gave in to my nagging, cancer was found in all 12 cores of his 12-core biopsy. And the cancer had made its way out of the prostate (EPE). He would give anything to go back to 3 years ago and have the darn biopsy earlier.
Posted 1/1/2014 9:42 PM (GMT 0)
Blackdog69,

My path is somewhat similar in that I am having an MRI before I have a biopsy. If the MRI indicates a likelihood of cancer I will have the biopsy the next day. One major difference in going this route is that the biopsy will need fewer samples. The center I am going to usually needs about 5 samples instead of the typical 12.

My free psa and PCA3 both indicate a low probability of cancer even though my psa has risen to 6. DRE did show a hard spot on prostate, so I am expecting I will need the biopsy.

I do agree that a biopsy and surgery are so 1990's and doctors need to catch up with the latest technology and treatments.
Posted 1/1/2014 9:56 PM (GMT 0)
No need for anyone to get upset. I have my own beliefs, and that is that needle picking or a biopsy a prostate is a last resort. I found a radiologist at Boston Medical, a top rated hospital, who specializes in prostates, and he is confident his MRI screen will determine if cancer is present without a biopsy. I just had his MRI scan, and it was revealing. I have had a high PSA because of the size of my prostate and typical prostititus. I also suggest many of you slammers read Dr Ronald Wheeler's book all about what I am discussing here. I have met Dr Wheeler, and though I am no fan of his, he does bring to light much of what I believe. Needle tracking is understood and widely published in other organs, why not the prostate? There is a reason why Asian men rarely get prostate cancer....diet and medical practice.
Posted 1/1/2014 10:02 PM (GMT 0)
One other thing...not just any MRI is satisfactory. Dye is always used, an endo rectal probe, etc....one doctor uses spectrosophy....with his mri.

I suggest everyone look into how much of Germany treats prostate cancers, with hypatheraphy.....a very benign method.
Posted 1/1/2014 10:29 PM (GMT 0)
@Allen--Thanks a lot for posting those links; I look forward to reading further about G6 prostate cancers.  Much of my research prior to prostatectomy in 2006 was reading Johns Hopkins

studies--also Catalona, Scardino and Grimm. You provide a wealth of good information, avoiding junk science and goofball Internet articles, for newcomers and oldtimers alike.

Posted 1/1/2014 10:35 PM (GMT 0)
To be perfectly fair Tall allen, the statement you used in your post that triggered Tim G request does not match your answer. Your evidence is to strengthen non-metatastic spread/systemic versus local spread. Will you make the same claim that Gl 6cells can not survive outside the prostate, as the local area is outside the prostate. can you claim they,a gl6 tumor cannot grow locally, such as in the pros tate bed or near the rectum. Lets make it simple, is it your claim that GL6 cells can only survive and spread within the the prostate and hence once escaped do no harm in the local area. That any harm would come from a Gl 4or higher cell that was in there. Thats a pretty convenient hypothesis{unproven} and would not want to be in the dock for my life, at that trial with that kind of evidence.
Posted 1/1/2014 10:40 PM (GMT 0)
Blackdog, question!. Why did you wait so long in this thread to tell us the results of your MRI from Boston?? This is not a rhetorical question!!
Posted 1/1/2014 11:12 PM (GMT 0)
Blackdog,

We really are not trying to pick on you...it's just that for most of us...we have seen countless guys cured, or find out that they had low grade cancer that didn't need treated, all because they had a biopsy.

On the contrary, we're trying to watch out for you...this forum has been around the block a few times and have seen it all...and the members here have built a knowledgebase 2nd to none.

If you ultimately decide not to get it done...please keep getting your psa periodically and keep track of it.

- You may have already answered this, but have you been on antibiotics for prostitus....and what about avodart, etc.... for bph.?


Richh - are you saying there is a more accurate method of diagnosing pc then a biopsy?

Thanks,
Jerry
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