repeated biopsy questions Was No Subject

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New Member

Date Joined Mar 2010
Total Posts : 7
   Posted 4/27/2010 8:50 PM (GMT -6)   
hello Folks,

Does anyone have information as to whether or not subsequent biopsies are wise (second opinion) or necessary? Are they damaging to surrounding area ( damaging to nerves, urinary tube, etc?)

Will brachytherapy needles also cause damage?

what are side effects ??

What is the chance that identified perineural invasion may indicate cancer outside of prostate?


65 years

3+4+7 gleason

6.2 psa

biopsy: 1 positive of 10 in one lobe 0 positive of 10 in other lobe.

Post Edited By Moderator (James C.) : 4/28/2010 8:15:36 AM (GMT-6)

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 4/27/2010 9:53 PM (GMT -6)   
A subsequent biopsy isn't necessary. You have a G7 and a 2nd opinion of your biopsy slides would be very worthwile if they are sent to Epstien at Hopkins or Botwich labs.
some think that perineural invasion is significant, but many other doctors think it is of no value.
I know of no cases where the Brachytherapy needles have caused any damage or any case where biopsy needles have caused damage. the biggest risk from an additional biopsy is infection and may take additional time to heal before a surgery, about 6 weeks.
The side affects of Brachy are:
Slight risk of incontinence, about 1%
Slight risk of bowel issues, about 5%
Urinary constriction in about 10% of cases that is usually resolved in months.
ED in about 40% of patients that is resolved with viagra.
Urinary frequency and urgency for about 4 to 6 weeks that is tolorable and won't affect daily activities.
In general the side affects are much less than surgery or conventional radiation, with a large number of patients having no permanent side affects.

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 Apr 2010
Total Posts : 83
   Posted 4/28/2010 6:19 AM (GMT -6)   
Biopsies are way too invasive, in my opinion. Odds are it's accurate. I chose the surgery, and I am glad I did as the pathology report was worse than the biopsy report - which I would never have known if I had not done the surgery. Of course, everyone is different and you just need to gather all the facts - and make a well educated decision - keep us posted
Dx age 62 - March 2009 - Gleason 7
Surgery - da-vinci RP on April 29, 2009 Gleason upgraded to 9
Started VEGAN diet June 2009
3 month PSA - <.04
6 month PSA <.04
9 month PSA .05
12 Month PSA  .16

New Member

Date Joined Mar 2010
Total Posts : 7
   Posted 4/28/2010 7:08 AM (GMT -6)   
thanks loads Your info is extremely helpful.
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