biopsies and scar tissue

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Regular Member

Date Joined Nov 2009
Total Posts : 43
   Posted 3/3/2010 11:39 PM (GMT -6)   
Do multiple biopsies create scar tissue that makes surgery difficult? I have had three biopsies in the last year.

Regular Member

Date Joined Jun 2008
Total Posts : 407
   Posted 3/3/2010 11:49 PM (GMT -6)   
My unprofessional opinion is, no, the biopsies wouldn't cause scar tissue enough (if any) to interfere with surgery.  However, your Urologist is the person to ask about this.  Are you contemplating surgery?

Age:  60 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0; 9/09: 0.0


Regular Member

Date Joined Nov 2009
Total Posts : 43
   Posted 3/4/2010 12:05 AM (GMT -6)   
I am not considering surgery yet, but weighing the risks of more biopsies.

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2217
   Posted 3/4/2010 2:39 AM (GMT -6)   

What are you stats, ie what is it that makes you want to have more biopsies?

I was told that what was important was that if you did choose to have surgery that it should not be too soon after a biopsy to give the prostate a chance to recover. (The biopsy makes the gland swell etc and especially at the point where the needle went through the wall of the rectum to get to the gland the swelling etc has to have gone away)

Also remember that PSA readings too soon after a biopsy can be higher due to the biopsy itself.


Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 3/4/2010 9:13 AM (GMT -6)   
I will have to diagree with Mavica. There can be adhesions to the rectal wall from biospy which can complicate surgery. I know, it happened to me. It added an additional 2 1/2 hours to the surgery to prevent damaging the rectal wall or a resection of the rectum. Now the chances of that occurring is extremely low and the benefits of the biopsy results certainly outweight the risks involved. Doctors normally won't tell you this except the standard statement that with all procedures there are certain risks. I would ask your uro on this and let him be your guide. Certainly don't base your decisions on my experience, because it isn't the norm.
You are beating back cancer, so hold your head up with dignity
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 

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 3/4/2010 10:09 AM (GMT -6)   
My last two biopsies were 6 weeks apart, then I had an uneventful open surgery 8 weeks after that. Safest bet is to ask your doctor, good question though.
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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 3/4/2010 10:21 AM (GMT -6)   
The needles go into your Prostate, even if it did create scar tissue, if you choose to remove the prostate the scars would also be removed as the glad is removed intact ( if possible)

Check with your Dr, they would know better
Age: 52, PSA (2008)=1.9
Biopsy on 01/09/09, Gleason Score = 3+3
One (1) out of twelve (12) cores was positive, plus external nodule found
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Post Op Path 3+3
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, <0.01 - 3 months post-op
PSA 1/10 undetectable, <0.01 - 9 months post-op
Trimix provides 100% erectile function

Regular Member

Date Joined Apr 2008
Total Posts : 140
   Posted 3/4/2010 10:53 AM (GMT -6)   
From Dr. Catalona's Urological Research Foundation,

Under the FAQ category, "Biopsy, Digital Rectal Exam, & Gleason Score, the following question was asked.

Q. TOO MANY BIOPSIES? Are there any negatives to having numerous prostate biopsy procedures?

A. Too many biopsy procedures can cause scarring around the prostate gland that can make nerve-sparing surgery more difficult.

I remember reading this a few months ago, and it caused me to think twice about active surveillance with repetitive prostate biopsies.
1996, Age 48, Stage III Colon Ca, Colon Resection followed by 18 chemo treatments.
2000, Colon Ca Metastasis to upper left lung lobe.  Lung lobe surgically removed.  24 chemo treatments scheduled.  Took 1, declined the rest.
9/08 PSA is 2.8, 12/08 PSA is 4.56??  Chalk it up to prostatitis due to urinary retention after Nissen Fundo Surgery.  VA docs prescribe 30 days of Septra.  Prostate feels normal.  PSA hovers around 4.1.  VA docs want prostate biopsy but can't seem to get me into the schedule.  Continue through Spring and Fall of 2009 thinking I have prostatitis.  Bacteria cultures are always neg.  PSA drops to 3.1 10/09.
12/09 Prostate Biopsy performed
3 of 10 cores positive, 5%, 25%, & 35%, 3 + 3= Gleason Six with perineural invasion.
Doc wants CT Scan due to prior Colon Ca. Findings: "The seminal vesicles are irregular & there is nodularity in the periprostatic fat such that local extension cannot be excluded.  Shotty lymph nodes in both groin measuring 2.3 cm."
Doc wants Endo-rectal MRI (OUCH!) Findings: Mild central zone BPH, no discrete focus of carcinoma is identified, no evidience of invasion into the periprostatic fat or seminal vesicles.  Normal size iliac chain lymph nodes.
2/08/10 Open RP surgery.  Findings: Gleason Six upgraded to Seven.  3 + 4, Stage pT2c, Bilateral w/perineural invasion, No pos lymph nodes,  margins uninvolved, no extraprostatic extension, no seminal vesicle extension,  39 grams, blood loss 1200 ml (didn't want a transfusion & didn't get one) nerve bundles spared bilaterally.  current age-61

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 3/4/2010 4:17 PM (GMT -6)   
Why not get a color doppler ultrasound instead of the repeat biopsies. With CDU a biopsy is only taken if something suspicious is seen and a biopsy is only of that suspicious area, usually less than 6 samples.

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.


Regular Member

Date Joined Nov 2009
Total Posts : 43
   Posted 3/4/2010 4:50 PM (GMT -6)   
Thanks, gentleman. That Catalona quote in particular gives me something to discuss with the uro.

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 3/4/2010 4:50 PM (GMT -6)   
I know we have men on here who have had some scarring issues, but if you consider the biopsy needle like talking a blood sample from your arm, not many of us have had any obvious signs of scarring from lab tests.

We are talking a small needle with a very sharp point. It would not seem logicsl that it would produce a very large scar unless your body has some kind of scarring disorder.

But, I am not a doctor, so I would say he would be the ultimate decider on this.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01

Regular Member

Date Joined Dec 2009
Total Posts : 130
   Posted 3/5/2010 1:37 PM (GMT -6)   
I asked my uro about this during our last visit. His response was that after a few biopsies there should be no real harm done, but made a point by saying that if I was even considering surgery, than why go through it.

I thought that was what AS was about.

I'm doing AS at this time, and will probably do one more biopsies around November 2010 or so just for the fun of it. sad

If you do get another biopsy, like the others have pointed out, it is best to wait at least a few months before considering surgery.

On another note, my latest PSA done Feb. 2010 increased to 7.9 from 6.7. Doc thinks maybe spike caused by biopsy, so he wants a re-do in a few months to see what that shows.

Either way, always go by what good physician recommends
Age: 54- good health, physical anyway. Tinkle alot at night- 4-6x's

DRE 11/08- no lumps, just enlarged prostate

1st PSA, total- 11/08= 6.1

2nd PSA, total- 8/09= 6.6 Referred to Dr. J. Hoeksema @ Rush Univ. Med. Center/Chicago

Needle Biopsy 11/09- 12 samples. 11 OK. Right Lateral Mid- Adenocarcinoma Gleason score 3+3=6 9 involving 5% of specimen. Prescribed Flomax for excessive peeing.
Second opinion 1/21/10 with Dr. Gregory Zagaja, Univ. of Chicago Med. Center

3rd PSA, 2/10= 7.9 Still on Flomax, but thinking of stopping as it's not doing much of anything.

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