"AS" How often should one have biopsy?

I have posted here before when I was first diagnosed with Gleason score 6 prostate cancer. I see the urologist who did the biopsy tomorrow.

The reason I am seeing him after consulting with Columbia/Prespyterian Urologist and a radiological oncologist is about biopsy's. I am seeing him because they used "Profolol" and the procedure was not that horrible and I read from Columbia MD's that they do not use any sedative and that scares me. I know some choose not having sedation but I'm a bit of a coward when it comes to bearing my butt while in a extremely uncomfortable position. (I have severe back issues)
So I'm hoping he understands that I went to others for number one a second opinion and secondly, my wife resides full time in NYC while I split my time living about 80 miles North and would rather be by my wife after radiation treatments if I so choose to undergo radiation.
In a nutshell I want him to do the biopsy's and the other place to actually treat me if I choose to take the radiation Tx.

The second part is about the question I posed in my posting. I had my biopsy in the Summer and was not scheduled to see the urologist from Columbia doctors until January. Am I to assume he will want to do a biopsy soon after? As of now I am watching and waiting as per AS which means I'll have bloodwork for PSA and once in a while another biopsy-What "once in a while" is well, is kinda the question-how often does a person have a second, third etc biopsy?

Thank you all for the help

Glen

The normal AS protocol would be PSA every six months, a confirming biopsy 1 year after the first and then every 1-2 years after. I think that the follow up biopsy period is somewhat flexible and something you could discuss with your medical team.

No doctor should be offended that you chose to get a second opinion. If they are - get a new doctor. Given you're living situation, I think they'd understand in any case. If you want your biopsies under sedation, you have the right to use to use a URO who does that and owe no one an explanation.

Your URO likely doesn't care where you get RT (if you decide for that) and will follow up when you finish. ROs are only really involve while you're under going treatment - once your done, you go back to your URO for following PSAs and monitoring.

Andrew

I don't like blood tests, but there are worse medical procedures.

I do seem to spend a lot more of my time talking to doctors and waiting to talk to doctors.

Andrew

Glen, After the first year from diagnosis, which usually means that you have also had an MRI and confirmatory biopsy, and a genomics test, the schedule can be more flexible. It varies from AS program to program, but typically you may have psa/fpsa (or PHI or 4K) tests every six months, and a DRE every 12 months. Usually, they will want either an MRI or a biopsy every two years.

Because of my age and time under study, my doctors are letting me slide on the MRIs and biopsies. Maybe one or the other every three years...as long as the the blood tests remain stable.

GTO - welcome to HW.

feel free to start a new thread and tell us about yourself.

Andrew

I saw my primary doctor and my PSA settled down at 3.4 which is good. He still will not give me back my testosterone because he wants a urologist to approve it so I left him some research on testosterone given to grade 6 patients and also the studies that showed a marked improvement in more advanced cases. He tell me he has two patients in the same condition as me who have a urologist who will prescribe testosterone so it turns out the doctor is in the same group as my urologist. I see him December 21st and will ask him to talk to the other doctor or transfer my case.
I also told my doctor one way or the other I am getting testosterone prescribed. My first testosterone doctor was a pioneer Dr E. Barry Gordon and has written books on T Problem is he is retired but the Nurse practcioner who worked along side him is still practicing. I believe he has the same view as Dr Gordon and will prescribe it to me. So if my urologist refuse's to prescribe, I will go to the NP problem is and I kinda know the answer however as badly as I want the T prescribed I fear he may not share Dr Gordon's viewpoint on Pca and testosterone replacement so the though of lying came to mind-just tell him my doctor no longer wants to prescribe or some other story but anyway, I already know I'm going to be truthful.
I already feel kinda crappy with fatique and sadness as well as zero libido. The libido was not good to start but I did have moments and was able to function at least insofar as...well I do not want to go into details except to say the libido is gone..

Looking at the big picture, it's a moving target. The comment above said "Hopkins/Carter/Partin kinda wrote the book on AS," and that's kinda true, but the book keeps getting re-published with newer, better information and knowledge. (That's a good thing!)

Generally, the trend is towards FEWER prostate biopsies. Prostate biopsies have been over-used in the past, and give marginally good results...and they fairly commonly cause patients problems (and when problems occur, hospitalization is often needed). Generally, other tools—like the mp-MRI imaging technique—are displacing the need for so many biopsies; others are also rising into more common practice, too.

There's very good statistics that say after your 2nd, confirmatory prostate biopsy within about 12-months of the first, men who are still candidates for AS are indeed in a very safe program. But after that, expect fewer biopsies...and my crystal ball says those are trending downward in the future.

good luck!

In the year that I've been following an AS protocol, I've noticed that the guidelines seem to be getting more flexible. However, after my confirmatory biopsy, I may have contracted some prostatitis and my PSA has bumped up to a concerning level of 12.76 then down to the last reading of 9.88 in August. I'm due for another PSA in a few weeks, but this current frequency is due to the jump in PSA after the biopsy this past April. If not for that, I remember being told PSA maybe every 6 months, DRE annually, a followup biopsy in about 2 years and an MRI every 18-24 months. Something along those lines.

As long as you are well informed and make a choice/balance that suits you and your situation, then it is the right answer for you Glen; and that is to be supported. I'm no MD, and certainly no psychiatrist but what you describe about your feelings and emotions also has many similarities to depression and given the diagnosis is a very common side-effect that probably 50% or more guys suffer from in reality. I certainly have that T-Shirt. I say this not to be 'depressing' but to flag it as a possibility, because help can be sought and like so many things, recognizing and facing it is in itself part of the battle and road to better times.

Post Edited (Lotusman) : 11/7/2018 7:34:41 AM (GMT-7)

Oh, I forgot to thank Lotusman

Yes depression certainly can be part of dealing with the Pca diagnosis. I was quite upset, scared and shocked to learn I had it. I am already suffering depression but it has been in remission, or at least remission from the "severe" state.
I suppose it is still there but the hallmark for me of my depression was not sadness as one may believe, but of no joy in things I used to enjoy and a sort of dullness of everything. For instance, I love to fish but even if I did go fishing, it was "going through the motions" with no enjoyment attached to it. Anxiety was also present.
What I am going through is unique to low testosterone-I know this because I went through it before. Back in 2006-7 I kept telling my wife-"something is wrong with me" I was timid and scared much of the time. I had low energy and no libido. Then it hit me! My doctor had me on androgel maybe two years ago and my insurance no longer paid for it. I could not afford it and went off. Tad da! I went to a Dr who specializes in testosterone, had a blood test and my T was 41 which was crazy low! Within a month or so the symptoms faded away. My wife sometimes jokes about how timid and scared I was-in a fun, good way.

I was able to find the doctor who took over my former testosterone doctors practice and started injections again. I was not upfront about my Pca diagnosis and am not sure it would have made a difference but my symptoms were so bad I felt I had no choice.
If the doctors who say testosterone is like throwing gas on a fire in the case of Pca then I suppose I'll find out upon a biopsy down the road. The important thing is my PSA (which was 3.4 yea) will be monitored each 6 months and biopsy will be scheduled as required and changes will be considered. My quality of life is of importance. An example I can think of is my brother's case. He had non Hodgkins lymphoma in 1992 and through surgery and chemo and radiation he beat it until 3 years ago when he had lung cancer. He beat that for about 3 years and we were all grateful. Toward the end of his battle he had a possible choice of a new remarkable drug that would add 3 to maybe 6 months to his life. I, my wife and most all wanted him to take the new drug but Alan had enough. He said "no more"
In hindsight I agree with him (did not say at the time I disagreed I just felt that way) We spent time together and he had quality hospice time at home with his wife and many children and grandchildren including two new additions. His last three days were painful but it could have been worse. Maybe we'd be blessed to have him another 3 months but at what cost to his quality of life?
I went on Amazon and got him a memory foam mattress topper so he'd sleep better and offered to pay for a vacation to Atlantic City or whatever but as much as he enjoyed these things it was too much for him to travel. For once in my life I had a bit of disposable cash and wanted so bad to do something for my brother but that was not to be-However, 4 days before he died he shook my hand and thanked me for spending so much time with him. We spoke and played with the grandkids and I thought to myself we will have at least a month or so more together but then the call came....I rubbed his feet as he drifted off and felt such sorrow but at the same time was sure I did all I could.
Sorry for going on but maybe I had to write this for me.
3+3 gleason left side Pca last PSA was 3.4 on AS next biopsy will be Janurary 2019

Glen

Thank you for understanding the depth of what we all went through. We are human and will all face disease or injury and of course death so there is a common thread of compassion we all feel to some extent; Some more then others.
I have to say I was blown away by the care, understanding and even humor all in this extended family shown. We all hoped for more time but understood his decision as hard as it was and stood by him to the end.

After my brothers passing and my dad's a couple of years before that, I was in awe and total respect for my 3 nieces who spend overnights at the hospital with my dad (their grand dad) and the same at my brother's home. In other words, I knew they were good kids but had no idea how much love they had inside until then.

Glen

Hi Glen,

Back to the biopsy for a moment - I had a MRI TRUS guided biopsy with 14 needle samples in August. This first pain I had was the nerve block injection which was tolerable and I was warned. The next 3 samples were extremely painful and the doctor apologized profusely saying that these MRI guided samples were in an area (extreme end of prostate?) where the pain killer does not work well. However, the remainder of the samples (11) were virtually painless compared to the initial samples. Based on my one experience, the nerve block and any other pain killers should be mandatory as the needle biopsy discomfort was real and I would have never made 14 samples that way unless my first three targeted biopsies were unusually painful compared to standard sampling locations, others may know the answer to this.

BTW - I think I am pretty tough and did not use any opiates after my recent RALP surgery but those first three needle biopsies brought tears to my eyes along with some loud verbal protests that made it clear I was not happy.

Craig