Anybody have another biopsy after septicemia on an earlier one?

Not exactly what you asked but:

Some urologists now believe that it is wise to take a rectal swab from a patient some time prior to conducting a biopsy so as to ensure that the antibiotic prescribed to prevent infection will be appropriate for that specific patient.

From

prostatecancerinfolink.net/diagnosis/prostate-biopsy/

I will note that DR Polascik at Duke told me that since he had been doing a rectal swab prior to biopsy that he has had zero infections on prostate biopsies.

While that is not precisely what you asked it may help you in considering your path forward.

Welcome to HW.

I have to say that having that happen once is enough. Since you've had it once, I'd think the doctor would be extra careful next time. I have to say, I've not heard of anyone like you mention.

Hang in there,
Andrew

I have known quite a few guys that repeated TRUS biopsies after septicemia. Most did well, one didn't do as well. I have also sent guys down to Ventura California to get a color doppler guided biopsy after getting ill and that seemed to help as Duke Bahn will take less tissue sample with this method.

My understanding is that some people are prone to infection and in the 1 I know that double dipped the septicemia he was one of those. It is also my understanding that a change in antibiotics can help here. I also know of a guy that had a transperineal biopsy get an infection.

I guess the moral of the story is if you can get an image guided biopsy, that can reduce the cores taken, that's a best bet.

Allen,
Duke Bahn has been doing image guided biopsy for a long time. He is well respected for the ability to reduce the number of cores taken using color doppler. He is a regular presenter at PCRI because of this and his ability to better determine prostate size which could explain a higher PSA.

Also, MP MRI and other imaging techniques is typically recommended for patients these days considering AS. If there is no evidence of a spread this patient may consider AS but would still be facing a confirmatory biopsy a year later. Or later again. So by detecting adverse situations a patient would be directed to treatment and therefore again no more biopsies.

The whole reason for these imaging scans is brought forth as a method to reduce biopsy toxicity. When I am evaluating DoD grant applications, every new technique for imaging at the time of biopsies is clearly outlining this benefit.

I certainly do not dispute that TRUS needle biopsies have a more consistent pattern of causing infection for the reasons you named. But ANY form of surgical biopsy runs risk of infection. This is also well documented. We don't know who will suffer these toxicities. And we don't know for certain that they will again. But as I stated above, there are patients that have a propensity to infection and it certainly would be a misstatement that one would certainly not suffer them with another form of biopsy performed.

Post Edited (Tony Crispino) : 3/21/2016 10:33:45 PM (GMT-6)

Haha,
i love your post. Perineal biopsies are not new by any means. The papers you posted are consistent hypothesis. Not one single evidence based level 1 trial that stands the test of a phase III trial. All decent papers. Some wrought with bias and some just stating retrospective points of view ~ with bias. Conclusions that say "We believe" or "appears" or "we think" etc. These are not the best evidence I subscribe to.

The problem with evidence right now on targeted biopsy is that we need the paper. Without it I can load us both up with counter points:

MP-MRI can reduce biopsy core sampling?
www.ncbi.nlm.nih.gov/pmc/articles/PMC4122009/

www.europeanurology.com/article/S0302-2838(15)00036-6/fulltext/can-clinically-significant-prostate-cancer-be-detected-with-multiparametric-magnetic-resonance-imaging-a-systematic-review-of-the-literature


General Discussion
www.ncbi.nlm.nih.gov/pmc/articles/PMC4094966/

No Advantage with PB:
www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382014000100016

I think we should take this conversation offline. I'll tell you what is being discussed by the researchers. That in fact the trials for targeted biopsy are coming. Until we have them, we have multiple discussions from various angles.

Points we agree on,
1. Perineal is safer generally than TRUS in regards to Septicemia.
2. We need better data.

Points we don't,
1. Perineal is not 100% safe and the use of the term negligible only highlights sepsis and E-Coli. But disregards the use of a general anesthesia which can have variable tolerances among patients.
2. MP-MRI, and other targeted methods, Can in fact reduce biopsies sessions. Can also in certain advanced circumstances eliminate biopsy. And can reduce the number of needed biopsy cores especially in patients that had previous biopsies that were negative.
3. Not all patients that had a bad experience will experience it again, and that a change in antibiotics can affect this.
4. Perineal biopsies to not have a better track record of detecting prostate cancers than TRUS. There is no evidence to support such a claim at a level 1 criteria.

Our friend John T is a great example of 100+ biopsy samples both TRUS and perineal that was missing a core element that Duke Bahn detected with one core taken. I know that is anecdotal but it is true. I have a couple guys that also had a similar experience.

I think we've probably confused this particular patient enough. I would be more than happy to entertain a one-on-one in a new thread. We can always learn from each other. But if we regulate that this new thread must contain Level 1 Phase III trial data and no study hypothesis?

You'll hear a pin drop.

Always love ya, Allen. I'll be down there again soon. We need to close the gap.

AUA2016 is in San Diego May 6-10. I'll be there discussing detection and well I cannot say.

Just Wondering,

If you find you are up for another biopsy, see if you can find someone in your area trained on MRI-TRUS fusion biopsies. I had one at the NIH back in May of last year and it really helped me to determine the extent of my PCa.

TA and Tony are obviously MUCH more knowledgeable than I will ever be on these subjects, but during my research that led me to the NIH I discovered that, at least 1-2 years ago, fusion biopsies were rare. Most docs used MRI guided biopsies using cognitive registration technique as opposed to MRI-TRUS fusion computerized software mapping that eliminates the manual element inherent in cognitive registration. MRI-TRUS fusion is much more accurate as a result:

www.ncbi.nlm.nih.gov/m/pubmed/25539241/

I'm not sure if MRI-TP fusion biopsies are even possible or available at this time. TA or Tony may know better.

EDIT: It does appear that MRI-TP US-guided fusion biopsies are also available:

www.ncbi.nlm.nih.gov/m/pubmed/25523210/

That might be your best option to avoid problems with sepsis, assuming you are ok with the anesthesia route and risks of course.

Lastly, bigger picture from an AS perspective it is my general understanding that at JH they are now using MPMRI scans as an integral part of their AS protocol. I know one guy there on AS protocol in his mid 60's who was diagnosed with low risk PCa five years ago and now five years out on AS, his last annual biopsy came back with no cancer cores, stable PSA, etc. JH scanned him with MPMRI and told him that he would have annual PSA and MPMRI scans and provided his stats remained stable and his MPMRI scans year to year didn't indicate any changes going on in his prostate that biopsies would not be necessary every year - perhaps one every few years as opposed to annually. This is obviously anecdotal given it is one mans experience, but I've heard similar stories from other men on JH's AS protocol that have low risk PCa so figured it was worth sharing.

Just a reminder...

89% of level III reported data has incorrect conclusions drawn once level 1 trials test them. As compelling as they are, the drawn conclusions are typically heavily flawed.

Are you available for that cup of coffee in SD? It would put a huge smile on my face. I know thats a drive for you. I'll meet you in the middle on my way home.

Edit: This would add 100 miles on my return trip but I plan on taking my wife's Camaro SS convertible from Vegas. Along Pacific Coast highway the level III data is quite compelling - it will be rewarding on the way back.



Tony

Post Edited (Tony Crispino) : 3/23/2016 12:37:07 AM (GMT-6)

Explorer59 said...
I got to experience septicemia as a result of a first biopsy...That infection was the most serious illness I ever experience......It all ended well, but I still drop in here occasionally to give a little back to newcomers asking questions.

Interesting and appropriate post.

I sometimes think that people forget or don't think about the fact that 7% infection rate can be life threatening if you are one of the 7%.

Which is why I have yet to be biopsied. Although, would have had a targeted biopsy at Duke if there had been anything to target.

Update.

I (the original poster) want to thank the guys and gals on this site who provide so much invaluable support.

Maybe the toughest thing about this disease is that in spite of considerable progress, the research results necessary to nail down the prevention and effective/predictable treatment of PC is still frustratingly elusive.

As I said to my urologist yesterday, the 1st anniversary of my Dx, it’s just a matter of playing the odds and hoping for the best.
Anyhow, as you can see from my updated signature, the results yesterday were not as one might have hoped. My PSA jumped and my Free PSA dropped. I have to hope that the changes can be explained bu the continuing enlargement of my prostate.

Needless to say, the recommendation was for another biopsy. I’m still studying the options mentioned above in your various posts, but it seems clear that some form of “tissue sampling” will be necessary.

Carl