Biopsy complication rates

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John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 2/5/2010 12:01 PM (GMT -6)   
http://prostatecancerinfolink.net/2010/02/05/complication-rates-after-trus-guided-biopsies-in-canada/

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 2/5/2010 12:34 PM (GMT -6)   

I am one of the people who got an infection from the biopsy.  It was an E-coli infection resistant to the first two antibiotics they tried.  I was hospitalized and finally had to have a PIC placed in my arm and IV antibiotic adminstered by my wife at home for 7-10 days.  Until they found the right antibiotic I was really sick.  Unfortunately, there doesn't seem to be any way around this.  The biopsy is necessary to confirm the PC and the number of men getting infections is small.  Perhaps in the future they will give a pre-biopsy antibiotic that the bacteria have not bult up a reistance to. Everybody has the E-coli in their digestive system and I guess it isn't hard for the biopsy needles to grab it and move it someplace where it shoudn't be.  Plus, I must be an infection magnet because part of my surgical incision got infected.  Bacteria seem to love me!! 


*Age 63, PSA July 2009 5.66
*Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
*MRI and Bone Scan Negative.
*Open Surgery October 22, 2009 
*Prostate, both nerve bundles, seminal vessels, and lymph nodes removed during surgery.
*Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
*Still slightly incontinant after 3 months - 1 pad per day (light). Dry at night. 1-2 trips to toilet.
*ED - Yes (will start Levitra possibly in January)
*30 day PSA (ultra-sensitive) .07
*90 day PSA (standard) <0.15
*01/10 - bladder neck stricture.  Opened during cysto exam.  Cath #2 in for 5 days.
*IMRT/IGRT delayed until April pending 180 day PSA result


Redman55
Regular Member


Date Joined Jan 2010
Total Posts : 87
   Posted 2/5/2010 1:02 PM (GMT -6)   
I was given an antibiotic prior to the biopsy so I'm surprised that that isn't routine. I continued on anti-biotics after the procedure for a period of time. No infection of any kind.
Age 54
PSA 8/2009 5.6 Gleason 8
DaVinci surgery 11/2009
Pathology - totally contained in margins -one bundle spared
PSA now undetectable at < .05
Continance: Night and morning fine and improving
Doing 3 P's and now using trimix


RickyD
Regular Member


Date Joined Dec 2009
Total Posts : 163
   Posted 2/5/2010 1:05 PM (GMT -6)   
What is the current thinking of the chances of the biopsy actually causes any cancer cells to escape the prostate?
Age 55,  PSA = 4.97 on 11/17/09, DRE negative,
Biopsy 12/2/09: 1 of 12 cores positive with less than 5% volume
Gleason 3 + 3 = 6
Prostate Size Estimate on 12/2/09 = 28 cc


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/5/2010 1:09 PM (GMT -6)   
Will just add one more tidbit to the equation.

TRUS biopsy can also create adhesions between the prostate and the rectal wall afterwards. This will somewhat complicate the surgery if it occurs. If I had one of those assembly line surgeons that was anxious to get to his next surgical patient, I would have ended up with part of the rectal wall removed and possibly a permenant coloscopy bag. Instead my surgeon spent the extra time (2 1/2 hours) being as careful as possible not to damage the rectal wall. Left me with a positive margin, but I will take that any day of the week.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


JerryB-UK
Regular Member


Date Joined Jul 2009
Total Posts : 39
   Posted 2/5/2010 1:23 PM (GMT -6)   
A template guided biopsy (taken though the perineum) is likely to be more accurate than a standard TRUS biopsy and incurs less risk of infection.
 
Jeremy

Age - 67
PSA – 7.8 ug/L. in February 2009
Gleason – 7 (4+3).  T stage – 2b.   Prostate size - 52 cc
July 2009 - ADT for 3 months to shrink prostate with a view to Brachytherapy but considering HIFU
September 2009 - prostate reduced in size but flow still to slow to allow brachytherapy.  Told that surgery is only option
September 2009 - decided on HIFU.  Scheduled for 30th October 2009


SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 2/5/2010 1:25 PM (GMT -6)   
I was given an antibiotic to take the day of the biopsy.  I think it was ciprofloxin.  The E-coli just ate it up, as it did with the second antibiotic I got.  I asked my Urologist specifically if the actual biopsy could result in the movement of cancer cells out of the prostate and he he stated "it is virtually impossible", "highly unlikely".  That seems to be the general concensus among the urologists. You would think that if the procedure can move bacteria from one place to another (rectum into the prostate), that it could move cells out and deposit them along the way.  I guess we have to take the word of the docs that the procedure is mostly safe.

*Age 63, PSA July 2009 5.66
*Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
*MRI and Bone Scan Negative.
*Open Surgery October 22, 2009 
*Prostate, both nerve bundles, seminal vessels, and lymph nodes removed during surgery.
*Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
*Still slightly incontinant after 3 months - 1 pad per day (light). Dry at night. 1-2 trips to toilet.
*ED - Yes (will start Levitra possibly in January)
*30 day PSA (ultra-sensitive) .07
*90 day PSA (standard) <0.15
*01/10 - bladder neck stricture.  Opened during cysto exam.  Cath #2 in for 5 days.
*IMRT/IGRT delayed until April pending 180 day PSA result


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/5/2010 1:45 PM (GMT -6)   
Prostate Biopsy complications and/or infections are rare in the US. Can they happen? Of course, even the simplest medical procedure has standard risks associated with it. But I would hope this information would never stop a man from getting a biopsy if warranted. Also, the pain issue has been discussed in depth here, but for the new guys, if your uro won't work with you on the pain factor in a way that is favorable to your wishes, you already have the wrong doctor in my opinion. Once you have a positive DRE or suspicious and/or rising PSA numbers, then a prostate biopsy (or more than one if needed over time) is imperative. Early detection between PSA screening, DRE's on a regular basis, and biopsies if needed, is still the best way to save lives concerning Prostate Cancer in my opinion.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 2/5/2010 2:02 PM (GMT -6)   
I agree that the prostate biopsy is necessary. Without mine, I would not have had confirmation on the cancer. The procedure was basically painless for me and the fact that I got an infection is just a rare fluke that almost nobody else has to worry about.
*Age 63, PSA July 2009 5.66
*Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
*MRI and Bone Scan Negative.
*Open Surgery October 22, 2009 
*Prostate, both nerve bundles, seminal vessels, and lymph nodes removed during surgery.
*Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
*Still slightly incontinant after 3 months - 1 pad per day (light). Dry at night. 1-2 trips to toilet.
*ED - Yes (will start Levitra possibly in January)
*30 day PSA (ultra-sensitive) .07
*90 day PSA (standard) <0.15
*01/10 - bladder neck stricture.  Opened during cysto exam.  Cath #2 in for 5 days.
*IMRT/IGRT delayed until April pending 180 day PSA result


Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 2/5/2010 4:24 PM (GMT -6)   
LV-TX ...

Yikes .. 2.5 hours for BIOPSY?

Was he playing chess with you while he did it ("Your Move Doc " --- KATCHACK .. "OK your move LV" ... etc ...)

Mine was in and out in 5-10 minutes --- one of those assembly line guys --

KATCHACK KATCHACK KATCHACK KATCHACK KATCHACK KATCHACK KATCHACK KATCHACK KATCHACK KATCHACK KATCHACK KATCHACK

... like that ...
Age 58, 57 at DX, PSA Aug2008 7 4 ... June2007 4.7 (BPH + LUTS)
11/2008 Biopsy: 1 of 12 cores 5%, Gleason 3+3 - Sona showed size 140+ cc (110 grams post op).
02/03/09 open RRP surgery , Nerve sparing both sides, 1 day in hospital, Day 4 first BM,
Pathology Report: All margins clear - No Invasive spread - no change in Gleason score.
02/18/09 Cath out, passed a 1cm oblong STONE within hours.
03/06/09 Started Levitra@20mg / Viagra@100mg / (04/01) Cialis@20mg -- no real effect (thru 02/2010).
04/01/09, 07/07/09, 10/01/09, 01/15/10 PSA <0.1
08/09 MUSE@1000mcg +pump&plump - (80-90%) (alpro ache).
09/09 MUSE@500mcg +pump&plump + 2 advil - (80-90%) - (less Alpro ache).
10/09 TrimixGel@(500/300/100mcg): 1st:60%, 2nd:(pump&plump) 60%, 3rd(added 500mcg muse):70-80% --
12/09 MUSE@500mcg+Cialis@20 working well (>90%) and useful erection.
02/10 TrimixGel@1000/300/100mcg - first squirt -- 80-90% - just barely @ useful level. Needs Cialis I think.


TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 2/5/2010 5:49 PM (GMT -6)   
I was one of the rare cases to get a septicemia infection from a biopsy. From all sources I've read, a strong oral antibiotic should be administered for a day or so leading up to the biopsy. I did not get one. It was a mix up in communication between the doctor and the hospital. I had my biopsy done at the hospital under anesthesia for two reasons: 1) I'm a wimp and 2) I had a flexible cystoscopy done at the same time to check for bladder cancer, which, fortunately, came back negative. The symptoms of the infection came on approximately 30 hours after the biopsy but once they hit, they literally had me floored within one hour. I called 911, was rushed to an emergency clinic where they had to insert a catheter due to swelling from the biopsy and not being able to urinate. I spent four days in the hospital (2 of those in ICU). I was told I had a gram-negative organism. They said I dodged a bullet. Then, on the day I was released from the hospital, I was told my biopsy was positive.
Age at dx 49, 6/2005
PSA tests 3/05: 3.8 ng/ml, 4/05: 4.1 ng/ml, Stage: T1c
TRUS biopsy: 2/10 cores positive, Gleason 6 (3+3), bone scan: neg.
daVinci Robotic Prostatectomy 8/2/2005
Post-surgical Path report: upgraded to Gleason 7 (3+4), pT2c, NX, MX.
neg. surgical margins, neg. seminal vesicles, neg. vasa deferentia
Perineural invasion: present
prostate capsule: tumor focally invaded into, but not beyond prostatic capsule.
Post-surgery PSA tests, all <0.1 ng/ml for about 4 yrs.
Then on 7/23/09: 0.1, 10/16/09: 0.2, retested 10/23/09: 0.1, latest test on 1/22/10: 0.2.


BigG
New Member


Date Joined Oct 2009
Total Posts : 4
   Posted 2/6/2010 11:04 PM (GMT -6)   
I am also one of those unlucky enough to get a 5 day stay in the hospital as a result of a biopsy.  I did have the antibiotics, two different ones, before and after the procedure.  about 30 hours after I went to bed not feeling well, my wife called the doctors office, she woke me up and we were on the way to the hospital ER.  There were times I thought I was going to die.  I had had 3 other biopsies during the year before that without incident.
 
From what I have read the incident of infection from biopsy is about 1%.  Quite small but not insignificant.  I am in an AS study and am supposed to have an annual biopsy.  I am now rethinking the need to have it done annually.
DX 11/2008
Age @ DX 59  
2 of 12 cores positive
5% each core 
Gleason (3+3) 6 for each
Last PSA 2.87   (Hybritech access assay)
PCA3 9.8
Currently in Active Surviellance study


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 2/7/2010 1:04 PM (GMT -6)   
BigG,
To avoid annual biopsies look into getting a color doppler. Once a base line is established a biopsy is only give if a change is seen. It is an excellent method to monitor AS without the risk of biopsy complications.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Reinardo
Regular Member


Date Joined Jan 2010
Total Posts : 23
   Posted 2/7/2010 4:00 PM (GMT -6)   
The most common side effect of ordinary biopsies is bleeding.
Cancer cells will surely leave the prostate gland getting into  the blood stream, but chances for metastasies are considered negligable.
Occasionally infections will occur  which  is very serious and  life-threatening.
 
I had my ordinary biopsy in 2001,  for side effect just bleeding. I am now on AS. No way I will agree to have another such biopsy.
Instead of the ordinary biopsy I had two fine-needle aspiration biopsies, their complication rate being just 0.9%.
 
Ordinary biopsies have a complication rate of 19.8%.
Ordinary biopsies extract tissue that is examined for cancer, establiishing gleason.
 
Fine-needle aspiration biopsies scan the whole prostate for cancer cells.
From cancer cells you can get a DNA-Analysis showing  cancer yes or no and malignancy.
 
Unfortunately I had to travel a long way to get this done as urologists are not trained in the technique.
 
Reinardo
 
 
Diagnosed  in 2001, PSA = 8.9  Gleason 2+3 = 5
In 2001/2002 triple hormone therapy  protocol Leibowitz.
Watchful waiting thereafter.
Actual PSA = 10.6
Change of lifestyle and diet, food additives,  homoeopathy
In 2009 palliative TUR


caring wife
Regular Member


Date Joined May 2008
Total Posts : 20
   Posted 2/7/2010 6:11 PM (GMT -6)   
My husband was treated with oral anitbiotic before his biopsy and also after the biopsy.   He had the biopsy at 11:00 on a Thursday and awakened on Sunday morning with raging fever.  He was septic and spent nearly a week in the hospital on IV antibioics.  Our urologist told us that there was a 1% chance of this type of infection.     He is spinal cord injured resulting in para plegia which always complicates things.   He had his surgery 6 weeks later....his surgery was on a Monday and he didn't " wake up" from the surgery until Thursday.   He likes to keep me on my toes!!!!

My husband is 60 years old.
RRP surgery April 14 2008
Gleason score 3 +4
PSA 6.8
Free PSA 6.5
Father and Grandfather had prostate cancer
Father is still alive..diagnosed with lymph node involement in 1993...He has received hormone therapy since then....just this year has bone mets.
Path report for my husband showed negative margins but extra prostatic extension.
First PSA done one month post surgery  results .04
PSA July 08 .04  Oct 08 .04  Jan 09  .04  April 09 .04

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