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Do I really need a prostate biopsy?

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Posted 5/27/2019 8:21 PM (GMT 0)
My PCP referred me to a Urologist after the DRE, with a normal PSA score. The Urologist performed the DRE and announced that I had "asymmetrical lobes," one side was slightly larger than the other. He then told me I needed a biopsy and wrote me a script for an antibiotic, and asked to schedule the biopsy for a month away. Based on the normal PSA, do you feel a biopsy is called for and is worth the risk... He indicated that asymmetry was not a strong indicator of PC, and that it could be cause by various things. He didn't mention other options like MRI, or the wait and see approach. What is the feeling of the forum on this instance? To biopsy or not? Is it even a choice?
Posted 5/27/2019 8:30 PM (GMT 0)
It would help to understand your age and your PSA number.

Asymmetrical lobes are not as alarming as when they feel firmness or nodular during DRE.
Posted 5/27/2019 8:34 PM (GMT 0)
what are you calling "a normal PSA score"?
Posted 5/27/2019 8:35 PM (GMT 0)
Don't remember the exact PSA score, but the Urologist said it was "good" -- I've been having good, normal scores and tested every year for at least 10 years. I'm 65 soon. Thanks for the reply
Posted 5/27/2019 8:35 PM (GMT 0)
Same question as F8.

What’s your PSA and age. More important, what has been your PSA trend.
With that we could probably collectively give you an intelligent answer.
Posted 5/27/2019 8:36 PM (GMT 0)
PSA is around 2.5.
Posted 5/27/2019 8:41 PM (GMT 0)
Age is 65, PSA is 2.5
Posted 5/27/2019 8:51 PM (GMT 0)
Your actual PSA history would help if you could obtain it. Do not want it to be typically 0.50 and jump to 2.5 in the last year's test.

For your reference from a quick internet search:
RESULTS: On comparing groups with suspicious and normal DREs, and abnormal with normal PSA levels both, as expected, were associated with a statistically significant increase in cancer detection. However, an asymmetric prostate did not carry an increased risk of detecting prostate cancer when compared with a normal prostate, regardless of PSA level.

CONCLUSIONS: An asymmetric prostate does not appear to be an independent risk factor for detecting prostate cancer. Therefore, an asymmetric prostate with no abnormality in PSA level should not mandate prostatic biopsy, or even an increase in monitoring frequency above the presently recommended annual interval.

Keep in mind that if you searched farther, you probably could find a study with the opposite conclusion, just the way it is with PCa. I would study further before doing anything rash.
Posted 5/27/2019 8:53 PM (GMT 0)
some of the higher grades of prostate cancer give off low PSA, and i'm not saying you have a high grade of cancer. it's very possible to have prostate cancer with that low of a PSA or an infection or nothing. but then there's also the DRE findings. I think those two things alone would warrant a biopsy if infection has been ruled out.

when I was in your position I freaked out and after the biopsy I felt pretty embarrassed. sure it was unpleasant but nowhere near as bad as my mind made it out to be.
Posted 5/27/2019 10:31 PM (GMT 0)
My PSA has been consistently around 2.5 over the past 10 years or so. No real change there.
Posted 5/27/2019 10:46 PM (GMT 0)
You probably don’t have anything to worry about - if you have to absolutely get something done - it should be a MP MRI.
Posted 5/27/2019 10:59 PM (GMT 0)
That's really the crux of my original question -- do I absolutely have to get something, some testing done. What if my GP insists on the biopsy, based on the Urologists orders. Find another Urologist who will recommend an MRI instead? Will the insurance cover it? Find another GP if he insists on following orders?
Posted 5/27/2019 11:08 PM (GMT 0)
Thanks. F8 points out the problem with trying to jump to any conclusions with simple index tests since all things are possible with PCa and there are exceptions to every rule of thumb. Any PCa in your family? Dad, brother, etc?

I might suggest a 2nd urologist opinion from a respected group or center (comes with free DRE) and discuss options such as different types of PSA tests and MRI prior to biopsy. You could always ask the first Uro more questions before the next step also.

My biopsy was not a lot fun and the effects lasted for a while after others told me it would be no problem so I know where your concerns might come from. It is, however, the only way to actually determine if you have cancer cells by looking at them. No magic test for that.
Posted 5/27/2019 11:12 PM (GMT 0)
Yes, agreed, a second urologist opinion would be smart, but what are the odds he'll say "go for the MRI instead?" Do they all want to do expensive, fast biopsies?
Posted 5/28/2019 1:03 AM (GMT 0)
K, the deal is, at 65, you probably have detectable PC, never mind what your PSA is. It's just the way it is. Beyond that, it's all statistics--and stats don't mean much to the individual.

Now, typically, with a PSA of 2.5 at age 65--particularly if it's been about the same for years in a row--they wouldn't recommend a biopsy. If your PSA had been climbing steadily over the last 2-4 years--then a biopsy would be logical next step.

I would for sure consult with another Uro--and make sure you have your PSA history when you go. After that--it's going to be based on what the second Uro says---and your comfort level and how worried you might be.
Posted 5/28/2019 2:49 AM (GMT 0)
Based on all the data you presented, I would not get a biopsy. (Not that I'm a doctor, of course.) But I probably would want to get more information over the next 6-12 months. If anything, an MRI first to see if there's any suspicious areas. And yes, PSA history would be very important.

Let us know how we can help!
Posted 5/28/2019 3:58 AM (GMT 0)
Welcome to HW.

I have to say: Not enough info to decide. However, an abnormal DRE does make a case for moving ahead with more testing. It's possible that some imaging might be recommended. An MRI is a good choice. Many insurance plans would cover it.

I would get a second opinion, but there are worse things than a biopsy. Many tolerate it with minimum issues.
Andrew
Posted 5/28/2019 4:52 AM (GMT 0)
Watch Dr Mulhall on U-tube. Optomizing sexual function. And other literature about the prostate snatchers. See if you even want to go down this slippery slope.
Posted 5/28/2019 10:01 AM (GMT 0)

KWeiss2000 said...
Yes, agreed, a second urologist opinion would be smart, but what are the odds he'll say "go for the MRI instead?" Do they all want to do expensive, fast biopsies?

Personally, I'd go for the mri first as it's less intrusive. Then if zero suspicions, I'd watch and wait. I went this path ... but something did show up so the biopsy followed almost immediately.
Posted 5/28/2019 7:37 PM (GMT 0)
Are you worried about the biopsy? So was I. Nevertheless, I wanted to know for sure. My worry showed and they knocked me out. Woke up with very little discomfort and less than two weeks of colored sauce. Point being the knowing defeated the worry and the ultimate lack of SEs. Two things to keep in mind, (1) everyone is different (2) I am not a professional.

I simply had to know.
Posted 5/28/2019 8:49 PM (GMT 0)
Thanks for all the replies, especially to those that recommended going with the MRI as a first testing strategy. Question is whether insurance company will pay for it in my situation. I imagine the MRI is more expensive, and therefore less desirable from the insurance point of view. Second, will the urologist agree with this course, or will I need to do some doctor shopping to find one who will agree?
Posted 5/28/2019 9:40 PM (GMT 0)

KWeiss2000 said...
Thanks for all the replies, especially to those that recommended going with the MRI as a first testing strategy. Question is whether insurance company will pay for it in my situation. I imagine the MRI is more expensive, and therefore less desirable from the insurance point of view. Second, will the urologist agree with this course, or will I need to do some doctor shopping to find one who will agree?

if you look around i'm sure you can find a doctor who'll tell you what you want to hear. good luck!
Posted 5/28/2019 11:53 PM (GMT 0)
If you wind up doing a Biopsy, Take a pair of depends with ya just in case you bleed like I did....
Posted 5/29/2019 12:02 AM (GMT 0)
My advice is to watch your PSA carefully (e.g., every six months), and not to get a biopsy or an MRI. As already stated above, an MRI probably won't be covered by insurance and is never definitive with respect to prostate cancer.
Posted 5/29/2019 4:08 AM (GMT 0)
Phone around and get quotes for mri and biopsy. MRI's are way cheaper than biopsies where I am, but I'm not in the US.
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