My father had his follow-up. Now I'm more worried.

Well my father had his follow up with his doctor.

If you recall he PSA jumped up to 10.5 since his negative biopsy last year.

The doctor told him he has three options:

1. repeat the biopsy to diagnose/rule out cancer (Doctor said he suspected this, but couldn't diagnose it without the biopsy)
2. remove the prostate all together or,
3. continue to take a wait and see approach using the PSA to determine when they should act

My father feels "the doctor is money hungry and just wants to repeat the biopsy for the money". So he's refused the biopsy and said he wants to get a second opinion.

The other things my father said to me was "I'm scared if I let them biopsy it and it is cancer that it will make it spread". Does anyone know if this is true or false and if there's literature I could print out to send to him (he doesn't own a computer). My father is very "old school" and, well, uneducated (he only has a 6th grade education). He also has cerebral palsy and this sometimes complicates his thinking process. If I had something to disprove this to him, maybe he'd be more open to doing the much needed repeat biopsy.

He says he's "talked to guys down at the VA" who warn him not to get biopsies due to side effects. I'm curious if anyone here shares this sentiment?

He told me today he's having trouble sleeping. He says he only sleeps about an hour or two in a 24 hour time span. I think he's probably more worried about it than I am and I feel this is why he's refusing the biopsy -- fear of spreading it and fear of a cancer diagnosis and because of things 'the guys down at the VA' have said to him.




I will be supportive of my father whatever his choices are for his treatment. I do feel he should get the repeat biopsy and trust his doctor who sounds like a capable doctor.

Post Edited (worrieddaughter14) : 1/28/2014 11:15:08 AM (GMT-7)

Worried,
There is no credible evidence that I know know that shows a biopsy causes cancer to spread. It's just a fear. The two biggest risks of the biopsy are: infection and actually finding PC. I'd think your father is at greater risk by not having the biopsy.

It could also be, that having had the unpleasant procedure once, he's resistant to having it done again.

Andrew

By the time the insurance payments are sorted out, I don't think a doctor is going to generate much revenue from a biopsy. That argument is not valid, as I see it.

There are those who will say that biopsies spread cancer. I personally think that is a myth. The biopsy is a valid tool.

I've had a 12 core biopsy. I got dressed and went home to rest a bit, then back to work. Not pleasant, but beats the devil out of getting a crown put in.

Worried,

Does your mother drive? If she does he can ask his doctor for some mild sedation for any future biopsies he might have. Somebody will have to drive him home. Prostate biopsies are uncomfortable and undignified but, mostly, they are just really, really annoying. I have had them with, and without, Valium and I can tell you that a bit of pharmaceutical detachment from the process helps a lot. Some guys' doctors knock them out to do biopsies but that is probably not necessary.

As for a biopsy spreading the cancer that is not a sensible concern. Yes, it has been demonstrated to happen but it is literally a one-in-a-million thing. More sensible is worrying about infections. Those do happen occasionally but that risk is acceptable if balanced against a significant chance of finding an aggressive cancer that needs treatment.

At his PSA level I would like to see him stay on top of things. Waiting and retesting could be an OK strategy if that is what he and his doctor are doing. If they are just kicking the can down the road, that's another matter.

There are a couple more tests he could ask his doctor about. A PCA3 test (a urine test after a the doctor presses on his prostate with his finger) is a good tool for deciding whether to do another biopsy and there is another PSA test (free PSA) that will tell him, and his doctor, more about what is going on.

I'm still not quite sure why they haven't given him antibiotics as part of monitoring his PSA but since I am talking to you and you are 1900 miles away from your dad and all you know is what he remembers his doctor saying there easily could be sensible reasons. I suspect that, sooner or later he'll need another biopsy.

Oh, and by the way, his doctor's list of three options should have had four or five more choices. Radiation (in various kinds) is often a good choice for men your dad's age who don't spring back from surgery as quickly as do men 25 years younger.

Keep us in the loop.

The cancer cell must acquire enough mutations that allow it to spread. If Gleason 3 cells would somehow be magically pumped into the bloodstream, nothing would happen. They would die. The cell does not have enough mutations in order to make it grow outside of prostate, remember those are prostate cells, not liver or brain or blood cells. If it were a higher-grade cancer, the benefits of a biopsy would outweigh its risks. One has to be able to judge the relative risk, and some people are just not good at it. Perhaps you can put things into perspective for your father.

My father was sedated during the biopsy, maybe the same could be done for your father.

worrieddaughter -

You commented about your dad:

"He says he's "talked to guys down at the VA" who warn him not to get biopsies due to side effects."

I certainly assume the "guys" he is referring to are not VA medical staff, but "buddies" he sits with while he is waiting for his appointments.

They would hardly seem to be making medically sound comments to your dad, and are more likely engaging in medical gossip. But is it possible he is putting too much faith in their comments?

Maybe it would be good if you had a talk with your dad about this and encourage him to put more trust in his doctor rather than waiting room acquaintances, who perhaps mean well but are not at all qualified to give him medical advice on such important matters.