Is Color Doppler Ultrasound used IN PLACE of biopsy of the prostate?

Hi all-

I hope my PSA history shows in my signature now.

I have a rapidly rising PSA (up to 8.3 on the last test) and a fPSA of 6.1%; these are both alarming numbers. My first urologist, at my request, did a PCA-3 test and results came back at 13 indicating low chance of aggressive cancer to be found in a biopsy. So he recommended we wait 6 months and then re-test PSA. He's attributing my PSA and fPSA numbers to BPH. But I know fPSA typically does not got this low due to BPH.

So, I went to a 2nd urologist several days ago. They're doing this new test called a 4KScore test; a composite of 4 prostate antigens/proteins commonly associated with PC. It supposedly has a high accuracy rate for determining PCa.

Regardless of what the results are, is it sensible to press for a color doppler ultrasound of my prostate? I've read this can be used to identify aggressive cancer tumors and is sometimes used in place of biopsy. I know it can also be used for a more guided biopsy of the prostate and so less than 12 cores are required (since it's less random).

Last question: if I have to choose between MRI of the prostate or color doppler ultrasound; which is best?

I so wanted to just give full credence to my first urologist and just forget about all this for 6 months, pinning all my hopes on that PCA-3 test. But that feels irresponsible.

Grateful for your thoughts. -Brad

I had a CD ultrasound before I had a biopsy. The scan showed some suspicious areas, I then had a CDU guided targeted biopsy. Since the biopsy was targeted to the suspicious areas, I only had 4 cores taken versus the traditional 12 core random biopsy. Later on, right before treatment, I had a 3T MRI, the results of which were in line with the CDU. Vascularity (amount of blood flow to a suspicious area) can also be determined from a CDU, as well as from MRIs.

CDU scans are faster and less expensive than MRIs, but MRIs have a reputation of being more accurate. I believe that the number of doctors with enough training and experience to reliably interpret what they see during the CDU is limited. On the west coast, Duke Bahn, Richard Lam (who did my CDU and biopsy) and Mark Scholtz are very experienced at using CDU technology for PCa work. A CDU done by an inexperienced doctor could be pretty much worthless for tumor evaluation IMO.

Brad, welcome and hello..I get the feeling you are terrified of having a biopsy performed and you have spent way too much time on the internet scaring yourself silly..I think the Urologists in Albuquerque may surprise you with their level of expertise....They most certainly can perform a biopsy which is still the ONLY way you will know for sure...It's not the most pleasant half-hour you will spend but it's by no means the worst...You can spend all kinds of money dancing around trying to avoid the 12-core TRUS biopsy but I think you will find all roads eventually lead to this point...Before you sign up for any tests, scans or treatments, or travel out of state be sure the provider gets pre-approval from your insurance company..

Best of luck to you...

Thank you Fairwind and John T for your responses. Fairwind: I'm not so scared of a biopsy (certainly not looking forward to it!). I'm more scared of going through what John T has endured: TWELVE biopsies and MRIs all negative. In his case, it seems CDU biopsy was what finally found the PC. I know every case is different. I also have understood a biopsy is a shot in the dark and that there's a better chance of it being more-informed when it's guided by CDU or an MRI. In John's case, it seems the MRI wasn't all that helpful--so I will now investigate multi parametric or fusion MRIs.

I'm pretty much resigned now to bx. But, I'm going to endure it, I'm going to do everything possible to ensure it's guided and productive. And, oh yes! I'm checking with my insurance for pre-approval on everything.

So--I'm hoping to solicit feedback on the most effective way to go about the biopsy now.

I agree with Allen...Also known as a saturation biopsy, usually performed in a hospital under general anesthesia, much more expensive than a TRUS biopsy (expect some resistance from your insurance company) but IF you have prostate cancer, it is 99.5% effective at finding it....

I had an elevated PSA back when I was 45. Follow up over about two years included 3 biopsies, the final one being color Doppler ultrasound guided, done by no less than Dr. Fred Lee himself. Turned out he was right here in Michigan, so quite close by.

The CDU showed a rather vascular area, pulsing pretty blue and red on the screen. It raised his eyebrows and he poked that area a couple of times in addition to others. All they found was inflammation, nothing suspicious. So I went on low dose aspirin for chronic inflammation, and over the next couple of years the PSA dropped until it was even under 2.0 for a couple of years. So, cool, got it taken care of, and even stopped PSA tests since it was so good. Check again when I'm like 55, says I, the PSA is over-rated anyway, says the docs.

At 55, I had the PSA checked. It was elevated, and this time unfortunately a rather ugly positive biopsy. Interestingly, my aggressive G9 case was found in exactly the same area Dr. Lee had targeted 8 years earlier with CDU. Not sure what to make of that, exactly. The MRI showed it pretty clearly after it had occupied about 2/3 of the left side of my prostate.

You can usually see the tumor area on a multiparametric MRI, like I had. The mpMRI is important to distinguish PCa from other junk that happens in the prostate. They do MRI-guided biopsies now, as well. I'm not sure any scan is sufficient yet to definitively diagnose prostate cancer.

Brad,

According to this list, Dr. Tamburri in Phoenix uses CDUS for prostate diagnostics:

/www.inspire.com/groups/us-too-prostate-cancer/discussion/list-of-locations-for-color-doppler-ultrasound/

I would research him a bit before making the drive over to Phoenix though to make sure he has a good track record of CDUS expertise.

You may wish to proceed with a CDUS, if any suspicious areas show up, get a CDUS guided biopsy. If no suspicious areas show up on the scan, consider getting a 3T MRI scan or a 12 core random biopsy.

Hopefully as you go forward, one path will feel "more right" for you than all of the other options. I wish you best of luck and keep us posted.