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Biopsy question

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Posted 5/2/2017 3:01 PM (GMT 0)
Hello Everyone

We are at the beginning of all these tests now. PSA a 4.0, no nodules found on exam, received MRI results yesterday which is indeterminate. Prostate size normal, still no nodules found, no abnormalities other than mild reduction in ADC values of 950 and low T2 signals throughout the entire prostate. The doctor is recommending a baseline biopsy. Do you agree this should be done at this point? what are some questions I should ask about the biopsy and are there any side effects from this kind of biopsy? Incontinence or ED?

I appreciate any advice.
Thank you
Posted 5/2/2017 3:20 PM (GMT 0)
Welcome to HW.

Would you be willing to share you PSA history? That would tell us more than just one reading. High PSA can be caused by a number of things, PC is low on the list. You need to rule out BPH, infection, etc before going to a biopsy. A lot of unneeded biopsies are done. I suggest doing the PHI (prostate health index) test before getting needles shoved up your backside.

The SE of a biopsy aren't bad. The procedure is uncomfortable, annoying, and undignified. Post procedure you'll get bleeding, blood in your urine and seamen. There is the risk of infection so most give antibiotics as a precaution.

There are worse things than a biopsy and the risks are low to tolerable.

Andrew
Posted 5/2/2017 3:34 PM (GMT 0)
Thank you for the reply. The only PSA history he has was 7 years ago his reading was 0.26 now in March it was 4.0. He unfortunately did not follow up with his annual exams. Sorry to be naive but can you tell me what the PHI is and how we do it?
Posted 5/2/2017 3:55 PM (GMT 0)
Hello Butterfly67,

Welcome to the forum. Sorry you have worries. Hope we can help.

Was the 4.0 PSA your only datapoint or is there a history you could tell us about? A single reading is a poor indicator of cancer. What you look for is a continuous gradual rise in PSA. A single reading can be the result of a man having sex the day before the blood is drawn, or an infection, or a vigorous bicycle ride. Also, how old is he? A man's PSA tends to rise with age and a PSA of 4.0 will tend to mean one thing if you are 40 but quite another if you are 85.

You haven't mentioned a test of "free" PSA. fPSA is another blood test that can sometimes help find-tune decision making in cases like yours. PSA is a poor test for prostate cancer -- it has frequent false-positives and occasional false negatives -- but if you add a free PSA test at the same time, the combination is slightly less lousy. There is another blood test called a Prostate Health Inventory (PHI) that is better yet (but still only so-so accurate.) His insurance might not pay for the PHI (some companies do, some don't) but it isn't crushingly expensive even if you have to pay out of pocket.

If he and your doctor do decide to go ahead with the biopsy the side effects he can expect from a TRUS biopsy are blood in his first bowel movement after the procedure, small amounts of blood in his urine for a day or two, and blood in his semen for a month or two. This last seems to be the side effect that freaks guys out if they don't expect it. The day after the procedure his semen will be vampire-movie scarlet. This will gradually darken to chocolate syrup color then fade through various shades of mocha until things return to normal about six weeks out. Incontinence and erectile dysfunction are not common side effects. What is a bit too common is a problem with infections. Something like one guy in fifteen will develop an infection after the procedure and require further treatment.
Posted 5/2/2017 4:21 PM (GMT 0)
Hi, Butterfly,
You have been given the most important diagnostic questions to ask, but there are a couple of additional questions that will become important if your hubby chooses to go to biopsy:
1. Can the urologist do a rectal swab to identify if there are any bacteria present in the guy's rectum that would be resistant to the standard antibiotics given before the biopsy. Many uro's are willing to do this, and to administer additional preventive antibiotics if warranted.
2. If you/he choose biopsy, can the urologist use a prostatic nerve block? This takes the form of numbing medication injected into the prostate itself before the biopsy samples are taken. If this is used, then hubby will only feel two tiny injections into the prostate, instead of the dozen or so tissue samples they will take. Trust me, this one is worth asking for. Be sure it is actually a nerve block, not just lidocaine randomly administered. They use the ultrasound image to visualize the nerves before they inject it. I was terrified upon hearing friends' stories of biopsies that nearly caused them to pass out from pain, but when I asked my uro for the nerve block, he said "We always use that." And then the biopsy was as close to painless as I could imagine. A bit uncomfortable as they prepare, but if you've been a surgery patient anywhere before, it is just another procedure "down there."

All-in-all, the procedure isn't much of an issue, if done compassionately. Unfortunately, it is the waiting and the potential of what the results may bring that makes us crazy.
Posted 5/2/2017 4:36 PM (GMT 0)
OMG you guys are awesome I am so happy to have found you.

To answer PeterDisAbelard yes the PSA was the only datapoint. He is 49, well 50 next month. He went for physical 7 years ago PSA was 0.26 and now March of this year it was 4.0. So doctor sent us to Urologist who did rectal exam found no lumps, so sent him for MRI which came back indeterminate, so Urologist wants Biopsy.

He hasn't had any other blood work done.

Thank you Paxton for the response. His urologist said he was going to put him under for this biopsy because of his age. I don't exactly know what age has to do with it though.

One more question: You all have mentioned a free PSA and a PHI, can he just call his doctor to order these for him and we go to a lab to get them?

Again I am so happy for you all.
Posted 5/3/2017 2:26 AM (GMT 0)
Yes, he can just call his urologist and have him order PHI. In fact, just forward the following link to his urologist:

/www.accureference.com/phi/

Unlike several other tests, it is FDA-approved so insurance should cover it (I think the cost is around $125).
Posted 5/3/2017 3:25 AM (GMT 0)
Butterfly,

Given what you have told us it sounds like it would be sensible to schedule a PHI test later this month to see if the biopsy can't be avoided, at least for now. A biopsy is a surgical procedure and is not without some accompanying risk -- infection rates run around seven percent (and I've seen studies that give even worse numbers.) If a biopsy is necessary then it's necessary and the risk of infection is acceptable. But there is no reason not to do another round of blood tests to make sure it is needed.

Whatever he decides, keep us in the loop. We'll be here.
Posted 5/3/2017 3:07 PM (GMT 0)
Thank you again everyone, he will be calling his doctor now to request this PHI prior to biopsy. I will keep you posted.
Posted 5/3/2017 4:20 PM (GMT 0)
Sorry that you are here. I would recommend you get scans (CT/bone). The reason for that is to establish a baseline. I have a lot of arthritis and other issues with my bones from being stupid in my 20's. They could not readily distinguish between being cancer vs just being old. If you get scans at the start then they could use that as a comparison to see if (hopefully not!) the cancer ever spreads.
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