19.2 PSA and 93 core saturation biopsy

Just got the results of my saturation biopsy and they are all negative. I had another MRI early this year and the URO wanted to do another fusion biopsy. I was afraid that I'd end up with the exact same results as last time so I decided to find another doctor. I was able to get a referral to The James Cancer Center at The Ohio State University. I met with another URO there and he suggested that I have a saturation biopsy. They also read all my previous biopsy slides and were in agreement with those findings. I had the saturation biopsy on July 19 and was glad I was completely out. I woke up to find I had a catheter and was very sore. I had to leave the catheter in for 3 days and in the end it was the worst part of the experience.

After reviewing the biopsy results today I can completely understand why I was sore. He had thought he was going to take about 40 samples but after reading the biopsy results I see there were 93 cores taken! Yes, I said 93 this time and he took 10 samples in the area of the PIRAD-5 location. All 93 came back negative for cancer with 3 showing HGPIN all in the area of the PIRAD-5 lesion. At first he said see you back in 12 months for a repeat PSA but after questioning him he changed it to 6 months because of the high PSA value.

My prostate is large at 65grams but that's sure not enough to give me a PSA this high.

Good new is no cancer was found, bad news is I will have to have another someday.

93? Holy pin cushion, Batman! My saturation biopsy was 30 cores, a few of which struck oil. Even with a large prostate it must be difficult to find 93 different parts of the prostate to poke.

Most important, congrats on the negative 93 samples, although it certainly doesn't answer your PSA question. Good luck with the catheter and hope the soreness (and the bleeding--there would have to be a lot with all those samples) goes away quickly.

That is a rare finding and ouch!

Andrew

93 must be a world record.

I don't really know what else you can be doing, although I presume at some point anti-biotics have been prescribed to check for infection. That said, I have read here that infections are difficult to treat and can be stubborn. I'm not sure what your uro thinks about that.

FYI, the whole 93 samples has struck me so much that I did a bit of math probabilities on this. If 5% of your prostate was cancerous, 93 samples would have a 99% likelihood of finding cancer. If only 1% of your prostate had cancer, 93 samples would have still had a 61% chance of finding cancer. That's if all 93 samples were completely random. But in your case, 10 samples were from the PIRAD-5 location, so I would presume the chances of finding cancer--if it was there--would be even higher.

Hard to imagine anything working right after 93 cores. Good luck going forward.

My question is if you have a prostate left after that many cores were taken? ;)

Good calculations Blackjack. I actually joked with the Doctor in recovery and he said he removed between 1-2% of my prostate during the biopsy. Shortest core I see listed is 0.2cm and longest is 2.2cm in length with the shorter ones being in the "left lateral anterior" in general. Not sure why there is such variation but that's what is on the report.

I knew it has to be a small amount. When I had mine I asked to see what they looked liked and the cores are extremely small.

Thanks, Blackjack. Maybe there weren't 93 actual pokes, but I know there were a bunch. Now my only concern is my PSA will still be elevated from the biopsy in 6 months.

I just had my 6 month follow-up and my PSA is now at 23.8 so it's still going up. Nothing on the DRE again so the plan is to do an MRI at the next visit and see if there has been any change. The URO said he did 60 pokes and ended up with 93 core samples due to them splitting.

Your age and estimated prostate size would indicate PSA in the 4-8 range, or so. Add some BPH and prostatitis and it would go higher. Prostatitis can be tough as it is often not bacterial infection so antibiotics often have no effect. Another cause can be due to an abnormal parathyroid hormone. This helps regulate calcium and can cause elevated PSA. It is often accompanied by vitamin D deficiency.

Some thoughts and suggestions. Have your parathyroid hormone level assessed and level of Vitamin D. Consider using Avodart for a while. It is useful to reduce DHT and thus prostate size and resulting PSA, usually by 35-50% after several months. Then watch the PSA trend. This method has been useful in assessing PCa in difficult cases. Search for an urologist that specializes in BPH and other causes of enlargement. Another specialist may be valuable in addition to the one you have.

I remember a prior member of this forum had a steady PSA increase and suffered through 10 biopsies over the years, all negative until they located a tumor in the transition zone. I don't remember how they finally found it.