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Do I really need a prostate biopsy?

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Posted 5/29/2019 12:26 PM (GMT 0)
I think the Urologist is just being cautious. It's possible his finger was off that day. Did your GP give the DRE exam?

I would ask GP if they would refer you for an Mri. Imaging companies offer a cash discount if you decide to go that route.
Posted 5/29/2019 1:07 PM (GMT 0)
... also as some others have suggested, get a more sophisticated PSA test done that gives you the free PSA score. In some places it’s called the PHI -prostrate health index
Posted 5/29/2019 1:19 PM (GMT 0)
Another DRE with different urologist and newer type of PSA test (above) would be prudent course of action in my humble opinion.

I have Medicare and the approved amounts actually paid for biopsies and MRI's last year are almost too low to believed (hundreds of $'s, not thousands) thus there is some wiggle room.
Posted 5/29/2019 9:35 PM (GMT 0)

markom3 said...
I think the Urologist is just being cautious. It's possible his finger was off that day. Did your GP give the DRE exam?

Yes, my GP gave the first DRE and referred me to the Urologist who did a DRE for about 5 seconds, before saying I had asymmetrical lobes and needed a biopsy. No discussion about it, just wrote me a script for antibiotic and tried to schedule an appointment.

Posted 5/29/2019 9:37 PM (GMT 0)

Mumbo said...
Another DRE with different urologist and newer type of PSA test (above) would be prudent course of action in my humble opinion.


Sounds good to me, but how difficult would it be to find a Urologist who agrees with that course?

Posted 5/30/2019 12:51 AM (GMT 0)
K Weiss: Sounds good to me, but how difficult would it be to find a Urologist who agrees with that course?
1. Ask your current urologist first. He may agree without hassle; otherwise, point out that YOU are the boss.
2. If that doesn't work, find another urologist.
Posted 5/30/2019 2:00 AM (GMT 0)
1. Ask your current urologist first. He may agree without hassle; otherwise, point out that YOU are the boss.
2. If that doesn't work, find another urologist.

Asking my current urologist first sounds like the most direct path, but I don't have a lot of confidence he'd be open, though he may be. He gave me a 5 second DRE and then told me that I needed a biopsy, with a 2 minute lecture about my situation first. He said the asymmetrical lobes were NOT a significant indicator of PC, but I needed the biopsy anyway. Basically no discussion, no options. Felt like a biopsy mill. I may be exaggerating but not by a lot.
Handed me a script for antibiotics and told me to come back in a month. No advanced PSA tests, no MRI, just a biopsy.
Posted 5/30/2019 2:06 AM (GMT 0)

KWeiss2000 said...
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?

I would suggest that you are thinking this through in a most unhealthy manner. You and your doctor should be in collaboration not in conflict. Your course of action here is clear.

You will seek a second opinion from another urologist. If the second urologist also recommends a biopsy you will have one.

You do not shop for an answer you want. You look for the most qualified urologist in your area for a second opinion.

If they feel a fPSA is needed, they will order it. If they feel an MRI is need, they will order it. If they think active surveillance is an option, they will give you that option.

Find another GP? Honest, and with all respect, this just is silly.
What you can do if you are dead set against a biopsy and both urologists recommend it is to simply refuse. You have that right. You can sign a document that relieves the doctors of liabilities in this regard.

It would be dumb of you but less dumb than running around shopping for the answers you want.

Post Edited (mentor5959) : 5/29/2019 8:30:57 PM (GMT-6)

Posted 5/30/2019 2:13 AM (GMT 0)
Kweiss - seems like you are answering your own questions. If you are not comfortable, move on. No reason to have a confidence problem with someone that you may have to rely on someday. This is just getting a second opinion, no one should be offended and if they are, screw them. Your situation appears to be stable, whatever it is, so just set up another appointment, maybe with a University Medical center where they can give you another look.
Posted 5/31/2019 4:14 AM (GMT 0)
I have a related situation. My cousin's husband, who is about 60, has a PSA of 9. This seems quite high to me. But he has already had two biopsies in the past few years, and both were negative. So his uro is telling him not to worry about a PSA of 9. Which is actually down from a previous high of 12!

Sounded strange to me. I'd never heard of a PSA of 9 to 12 that wasn't pretty serious.
Posted 6/1/2019 1:58 AM (GMT 0)
Ask for an MRI first. If something suspicious shows up, get an MRI guided biopsy.
Posted 6/1/2019 2:06 AM (GMT 0)
Looks like you are getting some good advise here. As for the biopsy, I'd heard horror stories but when I had mine the worse part was the anti-bioptic shot in the butt.
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