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Posted 12/7/2012 1:40 AM (GMT 0)

I've been lurking for several months trying to learn as much as possible about PCa because my PSA numbers have been rising for several years. Now its time to see what the future holds for me.

Tomorrow I will be seeing the Urologist to see what we will do next. I'm sure he will be recommending a biopsy and I think it is time to do one.

My numbers are as follows:

Current age 55

11/07 PSA 1.0

12/10 PSA 3.9

12/12/11 PSA 4.2 Slightly enlarged prostate

12/30/11 Free PSA 17%. PSA 5.4

4/12/12 PSA 4.3

11/12/12 PSA 5.49  mad  

All DREs and ultrasounds normal so far.

The one thing that bothers me about doing a biopsy is the random nature of it, like a shot in the dark. I have read about the Color doppler ultrasound and MRI guided biopsies but they seem to be something that people do after several negative biopsies. Should I go with a normal biopsy first and see what it shows then take it from there or should I be looking at doing something else?

Any thing I should be looking for or asking him before we make the decision.

Thanks

Edit 12/7 edited PSA results based on new info.

Post Edited (Steve57) : 12/7/2012 5:52:16 PM (GMT-7)

Posted 12/7/2012 2:15 AM (GMT 0)
Get a normal biopsy first, the more cores, the better. With your PSA track record, looks valid to do so.

I had 3 biopsies to find my cancer, and 7 years worth of "negative" DRE's to boot. Nothing every seemed wrong with me, other than a fast rising PSA number.

Better safe than sorry.

david in sc
Posted 12/7/2012 2:16 AM (GMT 0)
55 years old, 5.49, just do it......If you have PC, 90% of the time the first biopsy will find it..If your test is negative (good for you!) but your PSA continues to rise, for your second biopsy you might insist on a more accurate procedure like the color Doppler or a saturation 40 core biopsy....

Backstage, your insurance company is directing traffic... They have to okay this stuff...
Posted 12/7/2012 3:56 AM (GMT 0)
If color doppler is available then it should be your first choice, if not, traditional Bx is ok. I went with the CDUL because it was available, your insurance may not pay for the CD part, that part was only about $550. One of the advantages is the mapping and recording of the locations of the samples, kind of like baseline info in case you need to go back to the same locations, or avoiding the same locations.

Also, my CDUL did not show suspicious blood flows despite 3 out of 14 cores were positive.

Mp
Posted 12/7/2012 4:22 AM (GMT 0)
I'm not a medical professional, but a biopsy could be wise based on what you've said. It's not pleasant, but it's also not terrible and it will be good to get more info.

My first biopsy of 12 cores was negative and my second was a "saturation" biopsy of 30 cores. If you ever did get into a second biopsy situation like I did, the suggestions here would be very helpful and could help you avoid the extra samples I had.

But most important...IF you make the call to have a biopsy I wish you good luck and if it's negative, I wish you declining PSA scores!

Michael
Posted 12/7/2012 5:15 AM (GMT 0)
Welcome, sorry you need to be here but it's a good place to be if you need it.

Get the standard biopsy. One thing to consider is what will your insurance pay for and what procedures can your Uro do.

Not everybody needed more than one biopsy to find the PC and a negative test could mean that you really don't have PC. I was told that there was only a 25% chance they find any in me and what do you know, first test, G7.

But the other thing to ask about is what else could be causing the PSA to rise. BHP, infection are possibilities too. Check out everything.

All the best,
Andrew
Posted 12/7/2012 10:18 AM (GMT 0)
If you can swing it I would go with the CDU and saturation biopsy right from the start. I understand where guys are coming from when they say just do the standard biopsy. It is much easier and you can have it done " right down the street in the uro's office". On the flip side of that though it is just not conclusive enough and it has the potential to cause a nasty infection. But while the CDU offers much better imaging and the guided sat biopsy is much more through it is more expensive and available in only a few facilities.

One question you may want to ask your uro is if his biopsy comes back negative how certain would he be that there is no PCa in your prostate and what's next?
Posted 12/7/2012 1:21 PM (GMT 0)
Steve57:
I would go with the standard 12 core biopsy at this time. They sample most areas of the prostate. Make sure your uro. puts each core is a separtate marked container - my bozo uro. didn't. That was one reason why I dumped him.

There is a chance to miss some CaP, it's a sample ( if you have any ) , but the chance is very small. CDUL is used mainly for AS , after being diagnosed.

It is important to have your slides read at a known top-rated lab. Your uro. probably won't send the samples to one of these, but maybe he will if asked. That might give you some insight into him. You can get your slides and mail them to another lab for a second opinion, however ( if positive)

Go to the PCRI website to see a list of the known top-rated labs.
Good luck.
Posted 12/7/2012 1:27 PM (GMT 0)
Welcome Steve57 - sorry you had to find us but I think you'll be very glad you did. I would agree, based on the stats you provided it is time to get a biopsy. The traditional transrectal approach is the most common, but I would also encourage you to look into Stereotactic Transperineal Prostate Biopsy (STPB) as another option as there are significant advantages to this approach, as well as less risk for infection.

Best of luck to you - stay with us and we'll help you on your journey.
Posted 12/7/2012 2:59 PM (GMT 0)

JAVGuzzi said...
There is a chance to miss some CaP, it's a sample ( if you have any ) , but the chance is very small.

Errrr, um... small... -ish. An ultrasound guided transrectal extended pattern (12 core) prostate biopsy catches PCa approximately 7 out of 8 times. It is quite reliable on the positive side but negative results are never dispositive.
Posted 12/7/2012 5:58 PM (GMT 0)
I would go with a standard, but ask for more cores if posssible. You can do the color later if necessary.

Joe
Posted 12/7/2012 6:51 PM (GMT 0)

JAVGuzzi said...
... You can get your slides and mail them to another lab for a second opinion, however ( if positive).

I would consider getting a second opinion even if they are negative. I had to get three biopsies and I always wonder if someone missed something. Particularly on the second one where there were atypical cells.

Posted 12/8/2012 12:48 AM (GMT 0)

Well went to the doc this afternoon and learned some more about my situation.

The doc did a free PSA test last December and I didn't know they had the PSA also listed on that lab. It was at 5.4 then which isn't much different than the latest test which was at 5.49. Interestingly enough I also had a PSA test done just a few weeks before the free PSA test last December and it came back at 4.3

So I have PSA numbers wandering between 4-5.5 right now. Doc did a GOOD smhair DRE and an ultrasound today and everything seemed normal so the decision was to check back in 6 months. So I guess I'm on some what of an active surveillance program right now.

I told him I was anxious but willing to wait and see based on what we know right now. He has no problem doing a biopsy if I want to do one so I will think it over for a few weeks and see how I feel.

In the meantime I'm going to get copies of all my bloodwork so I have them to look at. I see my primary care doctor for my annual physical in a few weeks and we will talk it over also.

I appreciate all of the feedback and suggestions. I will take some time to let all this information soak in and see where it takes me.

Steve

Posted 12/8/2012 5:51 PM (GMT 0)
Steve - sounds like a reasonable plan to me. My older brother is doing a similar thing. He has an enlarged prostate and his first ever PSA came back a 8. Six months later it's still 8 so his Uro and PCP both agreed that checking every six months was the best plan and no need to do the biopsy.

Before you do a biopsy they usually want to see a clear pattern of rising PSA - bouncing around could just be your normal level. But it is interesting to me that you seemed to have a steady rise and then it fell - no idea what that means.

But, it is your body and if it would put your mind at rest it's up to you to ask for the biopsy.

For now, I'd suggest enjoying the holiday season and take a fresh look at the whole thing again in the new year.

All the best,
Andrew
Posted 12/8/2012 8:05 PM (GMT 0)
Steve,
That is a very reasonable recommendation. you should also ask for a PCA3 test at your next appointment.
Posted 12/15/2012 3:42 AM (GMT 0)
I went and got copies of all my lab work today and have a clear picture now.

Here are my numbers with dates and types of analysis:

12/14/11 4.24 using COBAS E analysis
12/30/11 5.4 with free PSA of 17% using Beckman Coulter analysis
4/12 4.31 using COBAS E
11/12 5.49 using COBAS E

So my most recent test which showed a 5.49 is up from my last test in April whic was a 4.31. He is looking at last Decembers test at 5.4 and comparing it to the most recent number of 5.49 and saying everything looks stable. I don't think he is comparing apples to apples??

I think the problem is that I had orders for bloodwork from my primary care doctor and from my Uro and the docs only see their tests unless you alert them that there are other results on line in the hospitals system.

So after sorting it all out I am going to make an appointment to see the doc and get this straightened out and tell him I don't want to wait any longer, lets do the biposy.

Thanks for all the input here and on several other posts concerning the different types of analysis and the need to get copies of all your paperwork so you can be on top of things.

Steve
Posted 12/30/2012 4:33 PM (GMT 0)
Well had the biopsy done last Saturday, 12 cores and the doc called today (yes on a Sunday) and said it was negative :).

Going to see him on Wednesday to get the report and go over it and also figure out where we go from here. I am thinking I should check PSA in three months and see what it is doing. It was 5.5 last test and had gone up 1.2 points in 8 months, that why I opted to do the biopsy.

Is this just a short reprieve until another biopsy? Seems like eventually you will get a positive biopsy with elevated numbers like mine so I want to keep on top of it. Maybe look into a PCA3 test and targeted biopsy if the trend continues.
Posted 12/30/2012 5:48 PM (GMT 0)
Yes, great your first biopsy was negative, yes unfortunately that's not the end of it. My first biopsy showed ASAP (atypical cells) and I had to go back 4 months later for another biopsy that found the cancer. Those other tests you mentioned should be done but a saturation biopsy or the kind John T had may be in your future. Hopefully he'll chime in and give you his story because he had a tumor in a region of prostate not picked up by routine biopsies. You're in the right place here for advice.
Posted 12/30/2012 7:05 PM (GMT 0)
Steve:
It might be worth it to ask the Uro. to put you on cipro for a month and then repeat the PSA. You might have a low level infection or inflammation causing your elevated PSA. Cipro is cheap and this could rule out that cause. If you were me, I would insist on it.
Posted 12/30/2012 8:35 PM (GMT 0)
In your place I'd be thinking about getting the targeted biopsy or a saturation biopsy in six months or so (let things heal from this biopsy). The problem is that it could be a false negative as easily as a true negative. Really hard to say.

But, for now I'd just go with the negative and revisit the PSA in a few months.

Andrew
Posted 12/31/2012 4:08 AM (GMT 0)
Steve57 - CONGRATS on the biopsy results, great to hear some good news out here!!!!  Be sure to get a copy of the report and have your Uro go over it in detail with you.

Yes, you will need to stay on top of this situation based on your PSA history, including future biopsies.  Earlier in your thread I had mentioned the option of transperineal biopsy, and would again simply suggest you do some research into this approach as you move on down the road.

The following link does a good job presenting this approach and its associated benefits:

http://www.prostateimplant.com/STPB-stereotactic-biopsy.html

UroToday reported that "the transperineal approach was associated with an overall cancer detection rate of 50%. Notably, 94.1% of these cancers were located in the anterior or apical regions of the gland, areas that are not adequately sampled by the transrectal approach." 

There is a fair amount of information out there if you decide to look into this - and I'm not suggesting that your recent great news is flawed in any way, I'm only providing something you may want to look into.

Best of luck in your future and hoping for continued negative results!

Posted 1/3/2013 4:15 PM (GMT 0)
Saw the uro yesterday and got the report. It shows all 14 samples benign, no abnormal anything. yeah Doc says that is as good as it gets and not to worry just keep an eye on things for now.

I asked him about cipro and checking in 3 months but he said with the biopsy results he thought that was not necessary and he would be comfortable seeing me in two years if I wanted to go that long:) So we compromised and set up another PSA in 6 months to see what it is doing. My butt is still a little sore a week and a half later but I am much less stressed out now with the biopsy behind me. :-)

Posted 1/3/2013 8:35 PM (GMT 0)
Glad to hear you got the results. A PSA in six months sounds reasonable.

It took me a good two weeks before I felt like I was completely healed from the biopsy.

Now, go enjoy life and call us in six months when the new number is in.

All the best,
Andrew
Posted 4/21/2015 2:16 AM (GMT 0)
Haven't posted in a while, but still lurking, watching, waiting, and learning.

It has been over two years since my last update. We have been doing PSA checks about every 6 months and it has been fairly steady. DRE's have all been unremarkable and so we are continuing to monitor. I am very comfortable, but cautious as the years go by. A little anxious every time the checkup comes up but so far so good. It looks like just a case of BPH. Every day that goes by is a day closer to a cure or a day closer to some new treatment that will make all the difference if it ever turns into something more!
Posted 4/21/2015 3:45 AM (GMT 0)
You have been missed.
To hear you've not crossed the PC line
is joy for us to hear.

Update us on your progress as you can,
Andrew
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