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Posted 6/17/2009 9:45 AM (GMT -8)
Just starting the search for advise. Last three PSA was 10, 9.8, 12. All three months apart. Free PSA 12%. PCA3 test positive. I do not want a needle biopsy so am looking at MRI color doppler to locate any cancer and then maybe a targeted biopsy. Live in south Florida, west coast. Any suggestions as to treatment and or doctors in area would be greatly appreciated. I will be 70 in November so am considering watchful waiting, maybe not.

Appreciate any and all help.

Posted 6/17/2009 10:22 AM (GMT -8)
Hello and welcome to Healing Well, dsdmike. Sorry you need to be here, but glad you found us on the web. We have a great group of men and women here, all will be eager to help you, give you hope and encouragement, and all the advice you can stand, lol.

Why do you not want a needle biopsy? Are you fearful of anticipated pain or perhaps the fact that its a somewhat humiliating procedure? Most of us didn't experience too much discomfort having biopsie performed, I had 3 of them along the way, 2 didnt hurt, 1 did mildly, some men here have been put under to have it done.

With your stated numbers, it would be normal at this point to have the biopsy done, my last one was a targeted one, and it wasn't bad at all.

At age 70, and no disrespect to your age, watchful waiting might make sense, once you know the extent of any possible PC. You would also want to factor in your other health issues, if you have them.

I am sure others here will give you their take on the biopsies, as a rule, its really not that bad, its one of those things, that thinking about it is worse then doing it.

Good luck to you, and again ,glad you found us here.

David in SC
Posted 6/17/2009 10:25 AM (GMT -8)
Welcome, although we hope for everyone in your circumstance who finds us that you don’t have prostate cancer and will soon go away.

I’m glad that you are thinking about options but I wonder if you will have enough information to make an informed choice without a biopsy. Color doppler might help in deciding if your high PSA was just inflammation rather than tumor but if tumor is suspected then I think that getting a Gleason score by biopsy will be important in thinking about watchful waiting versus more aggressive treatment.

Anyway, you have time to go step by step and learn along the way. Guys here report very different amounts of discomfort from biopsy, but all agree that being curled up on a table while a nurse, a doctor, and perhaps a couple of medical students do things to your bottom teaches you a lot about dignity or the lack thereof
Posted 6/17/2009 11:17 AM (GMT -8)

Dear DS:

As David said, watchful waiting (aka active surveillance) may be an option for you but you won't really know until after you get some pathology results.  FYI, here are the guidelines that Johns Hopkins uses for patients in their "expectant management" program:

1.  Age 60+.

2.  T1C, i.e. nothing felt on DRE.

3.  PSA density of .1 or less (this is PSA divided by size of prostate, e.g. PSA of 3 divided by prostate size of 35cc equals PSA density of .086 which is less than the .1 threshold.

4.  Gleason 6 or less.

5.  2 or fewer cores of cancer.

6.  No core with more than 50% cancer involvement.

There are many fine options for PCa treatment in SW Florida.  Specialists in Urology in Naples http://www.specialistsinurology.com/, has a lot of experience in robotic surgery and is expanding their treatments options into radiation as well.  I believe Dr. William M. Figlesthaler is their top gun.  I will warn you, however, that they have a strong bias toward robotic surgery, so you will want to keep that in mind should you visit them.  I would also suggest going to   Dattoli Cancer Center in Sarasota to get a good perspective on radiation as an option.   http://www.dattoli.com/

Good luck and let us know how you are doing.

Tudpock

Posted 6/17/2009 1:19 PM (GMT -8)
Hi dsdmike and welcome to this great site.

I was about your age when diagnosed with prostate cancer. I did a fair amount of reading on the subject and found that the needle biopsy, although not perfect, is still the best way of determining if cancer is present and how aggressive it probably is. Without knowing this you will be hard pressed to decide what kind of action you should consider and how quickly you should proceede. At 70 years of age, you should have many enjoyable years left and the needle biopsy is really not such a big deal; at least it wasn't for me. We are all a little different and whatever decision you make, it will be the right one for you.

All the best to you in the years to come.

Magaboo

Posted 6/17/2009 2:19 PM (GMT -8)
Sorry you have to be here. The biopsy is really not bad at all. All of us here have had one or more biopsy and most of us had very little pain if any. I personally had absolutely no pain. The biopsy will tell your doctor if you have PCa and how aggressive it is. Good luck
Posted 6/17/2009 3:08 PM (GMT -8)
A color doppler targeted biopsy is the best, but it is still a biopsy. The benefits are that the tumor can be seen and location and volume can be measured. A good color doppler guy can also tell the agressiveness of the tumor. Also it is usually no more than 6 samples vs the 12 in a normal biopsy.
The best color doppler guys are Fred Lee in Rochester MI and Duke Bahn in Ventura CA. It is well worth the money to travel to see these guys.
In Fla Danotolli has a color doppler and will probably do biopsies, but you have to realize that he is pushing radiation and you may not get an unbiased opinion as your would with Lee or Bahn.
I have had 12 regular biopsies and one color doppler biopsy; The color doppler gave me more info than all 12 put together and was the least painful.
JohnT
Posted 6/17/2009 3:09 PM (GMT -8)
DS: I'm going to chime in along with a few others and assure you that my biopsy experience was not traumatic or painful at all. As stated in earlier posts, I took a Hydrocodone an hour before the procedure and a 5 mg. Valium as I walked through the door. The injections of lidocaine were painless and the twelve cores were taken in less than 5 minutes with no discomfort at all. The worst part of the procedure was the thorough DRE at the beginning. I'm not especially pain tolerant (so my wife says). Wishing you the best.
Posted 6/17/2009 3:45 PM (GMT -8)
Hi dsdmike,

Every urologist you are likely to see will want to do a biopsy since it is an easy procedure and it usually reveals PC if it is there. That was not my experience however since I did several over about a 10 year period with PSA much higher than you. It finally showed itself as fairly aggressive and I have went through the surgery.

The biopsy(ies) was uncomfortable but not intolerable. The samples feel like a rubber band that someone stretched and released against your prostate. They get your attention but just keep counting them and you will see that 12 happens before you know it and you are out of there in only a few minutes. You will see a little blood in your urine for a while which is also a little surprising but that also passes soon.

The problem with the biopsy is they sometimes miss the cancer. In my case, I probably had cancer for some time before the final biopsy but it was not detected. On the 2006 biopsy, my urologist was sure I had cancer and seemed disappointed that the pathology didn't show it but he told me that the biopsy was the only tool to confirm cancer - the PSA meant nothing without the confirmation of the biopsy.

John
Posted 6/17/2009 4:20 PM (GMT -8)
Hello dsdmike,

The biopsy was a non event for me. A mild sedative and pain block similar to novacaine and I never felt a thing. I do not know if the doppler methods can determine gleason grade or not but I would personally prefer a tissue sample for pathology if it were me.

Good luck.

Don
Posted 6/17/2009 6:11 PM (GMT -8)
Hi dsdmike,

I believe the doctor John T is referring to is the Dattoli Cancer Clinic in Sarasota. They have a color flow doppler. They usually treat patients already diagnosed with PCa. I know the 2 doctors there are radiation oncologists not urologists.

I'm not sure how far south you are, but the Moffitt Cancer Center in Tampa has a excellent rep. MD Anderson in Orlando is another one.

I've had a biopsy twice and had no problems with either.


Mike
Posted 6/17/2009 7:13 PM (GMT -8)
Hi DSMike,

I encourage you to get the biopsy and find out just where you stand. I also recommend sedation, which makes the process comfortable for the patient. See my signature for more details. The seed implants failed for me so I am on Lupron. There are much worse things that could have happened. I'm still glad to be able to write this to you. All the best, whatever you decide. This is one thing that is very personal. Gene
Posted 6/18/2009 5:51 AM (GMT -8)

Greetings, DSMike.  I'll agree with most of my brothers here who say a biopsy is important to know your diagnosis.  Even if it were the worst thing in the world - which it isn't - you need to find out if you have cancer and how agressive it is by getting your Gleason score.  My biopsy was more uncomfortable than really painful.  I could feel the 12 shots (the rubber band analogy used earlier is very appropriate). 

Just get used to not having much modesty or dignity.  The treatment is more important and to get the treatment you need, people - lots of them - are going to need to do things to your most private body parts.   

I did not have the blood in my urine after the biopsy but I did have a lot of blood in my semen so watch out for that as well.  The most important thing is to find out what your situation is to the best of medical knowledge and then you can make good decisions.  There should be lots of good treatment options there in South Florida.  Please keep us posted.  Trust that everything will work out just fine.  David

Posted 6/18/2009 12:27 PM (GMT -8)
I suspect not wanting a needle biopsy is more emotional than logical.
Even so, write down the pros and cons and at least tell you logical side what you should do.
Cons as I see them are discomfort (pain) and embarrassment.
Get used to both. Particularly the latter. This is not a disease for the prideful.
More embarrassing would be the hand print you wear through eternity if this kills you.
You know the one from your mother's head slap when she finds out you didn't take care of business and ended up seeing her early because of it. We won't even go into that limp and hitch in your backside from your father's reaction. smilewinkgrin

The Pros have been well expressed by others.
However, no one mentioned that you'll be able to urge others to do the same after the fact.
Also blood red semen has to be seen to be believed and there is no other way to get that experience.
Sorta cool in a weird kind of way.
I feel sorry for those who have to waffle on the biopsy decision.
I wasn't even asked. It was more, "let's go in the other room and do a biopsy." Oh, okay.
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