Use of Doppler vs. Biopsy?

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coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 2/24/2009 4:29 PM (GMT -6)   
A buddy of mine has an elevated PSA (the doctor did not say what it was) and his PCP also sated his prostate was enlarged per the DRE.  The PCP suggested he use Doppler as his next test.  Anyone experience this?  Would doppler be used instead of a biopsy?
Age 51, (50 at DX)
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
ED, need a little help from Levitra
First post op PSA 11/11/08, 0.00
Second post op PSA 2/10/09, 0.00


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/24/2009 6:35 PM (GMT -6)   
What Ohio says makes a lot of sense to me. At the very least, rather than being a random sampling, the biopsy would be better targeted.
Ohio, what is "DDed"?
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/24/2009 6:59 PM (GMT -6)   
Billy, think you are on it too, if a good dopler image could stop a lot of painful and wasted biopsies that keep missing the hot spots, or no spots at all.

David
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 2/24/2009 7:13 PM (GMT -6)   
I had two color dopplers, one with a targeted biopsy and one without. Both spoted a suspious area that turned out to be a tumor. 13 other biopsies and an MRIS had missed this. Needless to say I'm sold on the color coppler technology, but it depends a lot on the skill of the operator. The two best color doppler guys are Fred Lee in Mi as Ohio mentioned and Duke Bahn in Ventura Ca.
A usual biopsy is at least 12 sample cores and as much as 16 or 18. There is rarely more than 6 taken with a color doppler biopsy and future biopsies can be avoided because a base picture is taken and if nothing changes, no biopsy. It cost a little more than a standard biopsy, about $2200 vs about $1200.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 2/24/2009 8:15 PM (GMT -6)   
Thanks for the feedback. So the Doppler is used to identify where to take the biopsy?
Age 51, (50 at DX)
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
ED, need a little help from Levitra
First post op PSA 11/11/08, 0.00
Second post op PSA 2/10/09, 0.00


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/24/2009 10:03 PM (GMT -6)   
Tumour cells have a higher blood flow pattern than normal tissue and I believe this what the colour ultrasound picks up.............it identifies the "possible" tumour areas and give better target areas for the biopsy needles.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01


cvc
Regular Member


Date Joined Jun 2008
Total Posts : 440
   Posted 2/25/2009 10:02 PM (GMT -6)   
So...If the ultrasound is the better choice why wouldn't everyone use it ??  How is it done ?? Painfull ??

will be 50 years old this year ( 2009 )
 
Uro said enlarged prostate 
 
DRE Negitive
 
Psa  2003- .55
 
     2007 - .99
 
     2008 -  1.01
 
watchfull worrier , lol

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