Should I seek a second opinion or

I was just scheduled for a biopsy. My PSA has been rising here are the numbers:

10/22/12 1.6
6/27/16 5.8
4/4/18 6.1
8/1/18 7.5

Problem with the numbers is that they are from different testing methodologies. For example the 6.1 result done under the WHO standard while the 5.8 and 1.6 were done with the chemiluminescent immunoassay methodology. The 7.5 I don't know what method was used. Point is, the 6.1 is really a 7.3 (23% difference between tests)

Would this make a difference as my PSA is rising only .1 in 4 months?

Or at 7.5 should I just have it done?

Second, I will be having the random biopsy. Is it worth the $2,000 to have the MRI guided biopsy done?

And most important, should I get a second opinion about having the biopsy done or is moving from 5.8 to 7.5 in two years enough evidence that a biopsy is needed?

As I understand no one here is a doctor I was just wondering what can be shared in these regards as far as experiences,

Thanks

Post Edited (mentor5959) : 8/3/2018 7:53:11 AM (GMT-6)

142 said...
A second opinion on any major intervention, be it surgery, radiation, or the like, is always called for. My insurance paid for 8 different opinions on the various treatments.

As to a biopsy being justified?
I will say that my highest PSA was 7.x (don't recall the decimal this morning), and after surgery some months later, my prostate was heavily involved. You'll find that PSA level is often not an indicator of severity as much as presence. Doubling time is very important.

You may want to ask for some additional blood work, such as a Free PSA test, to look for additional information.

Welcome to HealingWell!!

thanks very much for the reply... so for a biopsy, seek a second opinion is prudent? ??? or just for surgery, chemo..... (next stage )??

Maybe a second opinion with a PHI rather than PSA test.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3943368/

Mentor,

Welcome to the Forum! Sorry you find yourself needing to look for us but glad you found us. Hope we can help.

Different test/labs/etc. can explain small PSA differences but not usually differences of the sort you're talking about.

There are lots of amazing urologists in NYC. There's no reason you shouldn't talk to a different one if you'd like to trade up but if you like your current doctor and are just looking for another uro in hopes of avoiding that biopsy I think that's a pretty forlorn hope at this point.

Looks like biopsy is indicated based on PSA and Free PSA. I assume that you must have checked on the MRI guided biopsy and your insurance wont cover it. I would prefer that to a random biopsy myself but not sure I'd pay $2000 out of pocket for it.

hrpufnstuf said...
Looks like biopsy is indicated based on PSA and Free PSA. I assume that you must have checked on the MRI guided biopsy and your insurance wont cover it. I would prefer that to a random biopsy myself but not sure I'd pay $2000 out of pocket for it.

Yes, I asked my doctor about it, he said it was absolutely preferable and in the future will always be used. Insurance's just does not want to pay.

You might try a T-3 MRI as a substitute for prostate biopsy. You will probably need a biopsy down the road but this might avoid it for a while and you will want a T3 later too. Of course, a deep pressure digital rectal exam would useful. A biopsy can cause infections, but rarely. I had one in Feb. -no pain , no shame. Results were used for genetic testing TPen and Prolaris also for second opinions. You'll want a second opinion. A lot of this is subjective, lots of debate about everything from diagnosis to treatment. Some of it is almost religious, but I digress. My results revealed Gleason 3+4=7 adenocarcinoma of the prostate involving 15% of the right apex and 15% of the right mid with additional Gleason 3+3=6 prostate cancer involving 5% of the left base with a PSA of 13.7. The pathology results were reviewed and confirmed at the University of New Mexico and John Hopkins Path lab. However, MD Anderson upped it to 4+3=7. Feedback on this site indicated that was because it 30% was 4, but I still don't buy that since it is supposed to be >50%. Also, they do a transrectal ultrasound of the prostate with the biopsy, my gland was about 24 grams. This was because of a prior TURP. Generally, most folks will have a 60 or 70 grams prostate> A biopsy might miss some cancer, especially in larger glands. If you can get a T-3 MRI it should pick up a tumor or other events. My lesion was rather large 1.8 left side. Good Luck!

68 years marathon runner on Lupron since May 21, 2018 6 months. PSA 12.7 Finateride since 2003. TURP 2002

Post Edited (SantaZia) : 8/4/2018 9:53:31 AM (GMT-6)

I would save the $2000 just in case the biopsy doesn't find any causes for the rising PSA and the PSA rise continues in spite of a negative result (and negative for inflammation). How big is your prostate?

Certainly the MRI guided biopsy goes a long way to reduce the risks of false negatives often found in the random biopsies. I opted for that earlier this year and I was glad I did. In fact, I had to have one that lasted an hour, with almost no anaesthetic (except for Swedish Death Metal music on my iPod, full blast) and 17 samples taken, and I am still glad I had it done. Came back a G8, then the pathology after the RP found it G9. I was glad we didn't miss this.

In the event, my insurance paid for it but only because it was ordered by the urologist after my PSA had suddenly jumped from 8 to 16 and my percentage free down to 7%. I would have paid it out of pocket, though. I have heard some say that a key thing to watch with the PSA is the velocity of change. Certainly that is what we followed in my case and it sadly turned out to be completely justified. But in the long run this might give me an edge.

great support, thanks all

now my question is about doctors

My urologist is doing the biopsy. I know nothing about him, I met him 2 days ago for 10 minutes. (first appointment) He had someone in the office call me to tell me the PSA results and tell me to schedule a biopsy. I bumped into the fee PSA results on line. I did not even know he had also ordered that test.

Is there anything for me to check out or just let him do it?

If it comes back positive for cancer do I then look for another doctor? Does the same doctor do surgery? Is it at this point I look for a second opinion? I really am not comfortable having anything more done locally, I'd rather drive into the city, NYC, Columbia Presbyterian if it comes back positive.

I am very confused on how to proceed....

Mentor:

Let me answer your last question first: If your biopsy comes back positive do you look for another doctor? No. You look for several more doctors. Depending on what sort of result you get the mix of doctors may change a bit but you will always want to get several opinions from doctors who treat or manage prostate cancer in different ways. Urologists are surgeons and, since they perform the biopsies, they are the doctors who are there when the patient learns he has cancer. This tends to result in too many men deciding on surgery without looking at other options first. Sometimes surgery is the best option, sometimes not, but most urologists lack the expertise in other disciplines to counsel the patient over the whole range of available treatments.

There are a number of really good cancer centers in NYC. It's certainly worth driving into the city to consult with the doctors there. Memorial Sloan Kettering comes to mind but there are others. If you biopsy comes back positive come back here and we'll help you fill out your dance card.

An ultrasound-guided sextant biopsy is a fairly standard procedure that most urologists perform frequently and insurance happily reimburses. There are more advanced biopsies that might require specialists to perform but they may be overkill for a first biopsy. That's kind of up to you. Make sure your urologist prescribes antibiotics before and after the procedure. There is significant chance of infection and anything that can be done to minimize it is a good idea.

The U.S. News World Report is a good resource for various hospital rankings in many specialties,

https://health.usnews.com/best-hospitals/rankings

This link may have to be copied and pasted in address bar.

I hope your biopsy comes back negative. If it doesn't, you just take a deep breath and *Take Your Time* to figure out what to do. First off, many types of PCa don't even need to be treated. Secondly, there are many options if you do need to be treated. The last thing you want to do is make a decision when you're not calm and well informed. PCa--even the aggressive types--gives you time to do that.

But most important...my best wishes for a negative biopsy. BTW, did you know most biopsies are negative?