Stereotactic Transperineal Prostate Biopsy

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KC9AOP
Regular Member


Date Joined Jun 2008
Total Posts : 85
   Posted 6/26/2008 2:01 PM (GMT -6)   
Hello Everyone,

Has anyone experienced a Stereotactic Transperineal Prostate Biopsy? I'm curious how the procedure went and your recovery.

I'm talking with a second doctor (the same doctor that treated my Father's cancer) to get an opinion and he suggested that since my Father had aggressive cancer and I don't have any overt signs of it except the PSA score, that it would be more effective to have the Stereotactic biopsy instead of a trans-rectal in a doctor's office.

Doctor said since my prostate is 40 grams that he would take 25 to 30 samples. This number shocked me! Sounds like a lot but he also said it was a transperineal approach guided by a rectal ultrasound so they can get many more accurate samples with less overall damage.

What do you think???? This is not a re-biopsy but my first one. Since Dad had obvious, aggressive cancer I do want to do the right thing but not too much of a right thing if you get my meaning. I could just have it removed, although after 35 samples I wonder if there is a measurable volume loss????

I'd love any feedback. Thanks so much.

KC9AOP
I am age 47 - Father, Paternal Uncle and Maternal Grandfather had/have Prostate Cancer. Father 72 years old, PSA = 10.6 Gleason = 5 + 5 = 10 (very aggressive) and high involvement in all cores. Seed therapy is the only option. Father died cancer free.
6/4/08 - At physical DRE normal, PSA test returns 4.4
6/20/08 - First Urologist visit. DRE and ultrasound finds nothing conclusive. Doctor says biopsy is the only safe way to go. Prostate volume is 40 grams.


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 6/26/2008 2:07 PM (GMT -6)   
From what I read about it after doing a web search, it appears to be a more comprehensive biopsy.....takes more samples and increases the likelihood of finding cancer if it is present.

Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 6/26/2008 6:59 PM (GMT -6)   

The more usual use of it is in instances where PC is suspected but previous biopsies had not revealed anything.

This was the case with a friend who had one last year, and why I'll probably have one next month. My last biopsy was all clear.

Transperineal has less risk of infection, but slightly more risk of urinary side issues.


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 6/26/2008 7:07 PM (GMT -6)   

You could obtain a "freePSA" test, but Considering your prostate size, your PSA figure and PSA density of .11 doesn't seem unusual.

Has there been an upward PSA trend?

 


KC9AOP
Regular Member


Date Joined Jun 2008
Total Posts : 85
   Posted 6/27/2008 9:20 AM (GMT -6)   
aus said...
You could obtain a "freePSA" test, but Considering your prostate size, your PSA figure and PSA density of .11 doesn't seem unusual.

Has there been an upward PSA trend?


Actually this is my initital round of tests and/or diagnostics. Only a few weeks ago I had the blood test and today I'm investigating diagnostic choices. My Father's doctor, Dr. Brian J. Moran at the Chicago Prostate Cancer Center, published a paper in the "Journal of Urology" in October 2006 regarding stereotactic biopsy. He is a proponent of using the procedure for early PCa detection. His recommendation is for me to have this procedure in light of my Father's cancer and the fact that my Uncle had a radical prostatectomy.

He suggested that he would take from 27 to 40 cores. Apparently the average is 1 sample per 1.44 grams of volume.

What is PSA density and how did you derrive the .11 number? It looks like its the PSA divided by the volume. What is the significance of the value? I'm new to this and am craving information.
I am age 47 - Father, Paternal Uncle and Maternal Grandfather had/have Prostate Cancer. Father 72 years old, PSA = 10.6 Gleason = 5 + 5 = 10 (very aggressive) and high involvement in all cores. Seed therapy is the only option. Father died cancer free.
6/4/08 - At physical DRE normal, PSA test returns 4.4
6/20/08 - First Urologist visit. DRE and ultrasound finds nothing conclusive. Doctor says biopsy is the only safe way to go. Prostate volume is 40 grams.


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 6/27/2008 6:05 PM (GMT -6)   

PSA numbers:

There is no "normal" PSA reading.  For example someone could have PC with a PSA under 3, or someone might not have it with a reading considerably higher.

The trend in PSA readings is more relevant than one individual number, and most look for any sudden trend rise defined as three higher peaks.

PSA Density: PSA readings are meaningless without factoring in prostate size. The prostate naturally produces PSA, and the larger it is the more PSA is produced:  "PSA Density" is one simple calculation of the ratio of PSA to prostate size which by some criteria should be less than .15.

A "free PSA" test will indicate the % of PSA being produced by normal means and provide a probability of PC. It's often used when the PSA is in the gray area between 4 and 10.

Very large proportion of PSA readings in the range of 4 to 10 are tracked down to benign causes.


KC9AOP
Regular Member


Date Joined Jun 2008
Total Posts : 85
   Posted 6/30/2008 11:45 AM (GMT -6)   
chas036 said...
Before you have the biospy, read this article

http://www.mrisusa.com/about-s_bx_mris.html

If I read this before I had mine, I would have thought twice about doing it.


This MRI method is quite an eye full!! It looks like it makes sense. I wonder what my Urologist would say?

I'll ask when I go for my next appointment. Since my PSA is only 4.4 I have the leisure of pursuit, although I'm not fooling myself either with the possibility of disease being high for me.
I am age 47 - Father, Paternal Uncle and Maternal Grandfather had/have Prostate Cancer. Father 72 years old, PSA = 10.6 Gleason = 5 + 5 = 10 (very aggressive) and high involvement in all cores. Seed therapy is the only option. Father died cancer free.
6/4/08 - At physical DRE normal, PSA test returns 4.4
6/20/08 - First Urologist visit. DRE and ultrasound finds nothing conclusive. Doctor says biopsy is the only safe way to go. Prostate volume is 40 grams.

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