How to Detect Prostate Cancer without a Biopsy

My PSA has ranged from 13.2 to 8.1 over the past two years. I do have an enlarged prostate, 105 gl, and was told a normal PSA for me was about 8.2, based on prostate size. I have typical BHP symtoms.

I am afraid of biopsies for several reasons, including the fact they often miss finding any cancers, and reports show they can spread cancers by penetration of the prostate wall.

I have been studying non invasive detection of cancer, and I even visited Dr Wheeler's MRI institute in Florida. I was not happy with his presentation, felt very hustled, and he wanted to rush me to an offshore treatment center for $50,000. This was based on a MRI he performed, and every radiologist I showed that test to, said it was inconclusive.

Lately I have read about PHI test and PCA3 test.

Can anyone recommend a test that is currently the safest and most accurate? If so, where can I get this test...I am in Massachusetts.

Welcome to the forum Blackdog.
I think the issue to address here is whether a uro or RO guy would actually be prepared to offer any treatment without there having been a biopsy to confirm for them that a patient has cancer.
And sorry Blackdog, but I think you should be more afraid of cancer than of a biopsy and I'm saying that as a guy who had a really $%^&* time when I had my biopsy.
I have not seen any evidence that a prostate biopsy can spread prostate cancer.
Yes, a biopsy can miss cancer if you have a very tiny bit of cancer in a very big prostate. Otherwise a well aimed 12 needle biopsy should cover the bulk of the tissue, 18 needles even more so. But you could also see thst aspect in terms of the idea that if there is only a tiny bit of cancer to be found in the first place, then you have not got a very big problem.

My understanding is that clever MRIs are not used as an alternative to biopsies but to try and locate the suspicious looking areas of the prostate so that when you then do a biopsy you can aim at these suspect areas. ie you still end up having a biospy.

Seems to me that what you really need is a good uro or RO doc or oncologist to take you through all your concerns carefully

Alf

Thanks for the replies, but I have read to many articles claiming that biopsies can spread cancer and only have a 20% accuracy rate of finding the cancer. I would agree that a biopsy is the only foolproof way to confirm cancer, but I have read that PHI and PCA3 test, both FDA approved recently, are more reliable and accurate than a PSA test alone.

I would agree to a biopsy if, and only if, there was a very likely chance I had cancer. I would NOT get a biopsy simply based on a PSA test, which is the current practice now. Higher than 4.0 PSA, and they recommend a biopsy, is current practice.

There are also several studies that show that doing nothing, gives you the same life expectancy as any of the current procedures, which gives one pause?

These are just two reports on the dangers of Biopsy. I am not a Doctor, but they make some sense.



http://www.mrisusa.com/dangers_biopsies.htm
http://wn.com/prostate_please_avoid_prostate_biopsy

BlackDog,

You do know that those two "reports" are, in fact, advertisements for particular clinics. There's nothing wrong with that but it is wise to verify the things they say from other sources. The easiest way to do that is to find a doctor you trust and ask the doctor about your concerns.

Or, if you are a do-it-yourself type you can dig through the research yourself. Here's a link to a boatload:

http://www.ncbi.nlm.nih.gov/pmc/?term=prostate%20biopsy%20complications

In regard to non invasive testing, there is the PHI Prostate Health Index blood test which is new.www.health.harvard.edu/blog/harvard-expert-urges-caution-for-use-of-new-prostate-cancer-test-201207024990

PSA density can be informative, the PSA divided by the size of the prostate. PSA density under .12 is considered somewhat good, the lower the better.

Free PSA blood test: The higher the better if I remember.
Anyway, good luck.

I found this hook to get email updates at Beckman Coulter's website:

http://www.prostatehealthindex.org/us_phi/

I don't see any "where  they do this" sort of link. It may not yet be generally available?

It sounds like you would need to approach your insurance company to see if they cover it, and if an in-network lab does it.

The first report is dated in 1991...


http://mrisusa.com/documents/rectal%20wall%20recurrance.pdf
http://www.ncbi.nlm.nih.gov/pubmed/2016779

Hi: Personally, I would be scheduling a biopsy with your numbers. You may simply have BPH and that could be the reason for your high readings. I had a PSA of 3.3 and a 67 gram prostate which should have been safe, yet I was found to have 10% of my prostate full of cancer. I don't know you and forgive me for saying, but it seems as though you are finding excuses for not facing the one and only sure way of identifying PCa. Ask your Dr. to sedate you during the procudure. That is what mine did. It was a nice nap and I woke up with zero pain and had no issues of pain or side effects afterwards. I would never know it even happened except for reddish semen that lasted for about 2 weeks. That was it. A prostate biopsy is incredibly common for men in their 50's and 60's. I am amazed how many of my friends had one but never talked about it until I brought it up. Sooner or later you will have to go for one. Best to go now and if it is cancer, you caught it as early as possible.

Everyone of us on this forum has basically gone thru it. Under sedation it is a "piece of cake". Good luck.

Bill K. from NJ

DaVinci surgery July 2011, PSA's since surgery: <0.01 Gleason 6, No urinary issues ever, ED improving. 100% with Bimix

BillyMac,

I found one...

Local recurrence of prostate cancer in rectal submucosa after transrectal needle biopsy and radical prostatectomy.

One patient in Cleveland in 2005. So it does happen but, as the writeup says, it is extremely rare.

Peter - Thanks for link
The Cleveland guy who appears to have got some PCa in the lining of his rectum due to his biopsy was sure unlucky, but what I find more revealing about that case was that while his PSA was only 0.2 the lump was big enough to be detected by a DRE. That confirms for me the idea that a fairly large lump of tumour may only produce a small amount of PSA and that is why some guys with low or fairly low PSA can then have higher gleason than you might expect. I think this aspect may need to be taken into account by those advocating less screening and even by those opting for AS when they have a low PSA level.

Alf,

As you suggest, the inverse relation between Gleason score and PSA for PCa makes decision making based solely or mostly on PSA somewhat problematic. Since most PCa is low risk you can minimize the expense of treating a population (both in financial terms, and in sparing men unnecessary side effects) by simply assuming that all PCa is GS6 and that all men with low PSA scores have small tumor loads. This allows the higher risk man to progress and incur more expensive treatments later when their symptoms cannot be ignored, but because such men are much less common such a policy does minimize the costs, especially if you are stingy with PSA testing for younger men.

Being, myself, one of those statistically-few higher-risk men I cannot get behind such a program but I understand the math.

blackdog69:

That's what I have generally learned.   But even if the PSA rises slightly over time (at a low rate) there shouldn't be concern. For AS, I recommend using the ASURE PSA calculator to help manage AS over time.

Go to : http://sunnybrook.ca/content/?page=ASURE_Calc

To learn about the equation that the calculator is based on ( if you are science or engineering trained ) :

http://sunnybrook.ca/content/?page=ASURE_aboutApp

You can enter the two equations  based on your age at diagnosis, Gleason, and initial PSA  ( linear & exponential ) into a spreadsheet, and then gererate the two curves.  if you have time on your hands .....