Another Biopsy

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Harryheart
Regular Member


Date Joined Apr 2009
Total Posts : 40
   Posted 10/2/2010 8:56 PM (GMT -6)   
Newbie here. 65 years old. 290 lbs. PSA increasing over the years. One year ago 7.3. Now 8.4. Annual DRE all neg. 2 biopsies neg. No history of prostatitis. Now the Dr wants to do another biopsy. I know the biopsy risks.
 
Question: What is the probability % of cancer in my case?  
 
Question: Can repeated biopsies cause problems?
 
Question: How many biopsies can a person reasonably have done? 
 
Thank you

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 10/2/2010 9:14 PM (GMT -6)   
I would ask the doctor - WHY? - if no enlargement of the prostate, no prior problems with DRE and previous biopsies - is he just concerned about the level of the PSA?
-when in doubt - ask - and ask again - until you get a satisfactory answer.

all the best
BRONSON
Age: 55 -gay with spouse, Steve - live in Peteborough, Ontario, Canada
PSA: 10/06/2009 - 3.86
Biopsy: 10/16/2009- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy: 11/18/2009
Pathology: pT3a- gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
Post Surgery-PSA: April 8, 2010 - 0.05 -I am in the ZERO CLUB
Sept 23, 2010 -0.05 - again -hoorah !

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 10/2/2010 9:16 PM (GMT -6)   
Read my history, I had 3..I believe the record on this board is 13..

You can ask for a saturation biopsy, 40 cores, usually performed under general anesthetic..You can travel to a center where they are equipped to do a Color Doppler Ultrasound, which is more accurate in scanning your prostate for cancer and can guide the biopsy needles with more precision..

You can wait a few months (not recommended) until the Four Gene Urine test becomes commercially available. This test can determine if you have PC or not without a biopsy..

But with a PSA of 8.4, SOMETHING is going on and I would not rest until you find out what it is.. The 290 pounds is another issue that hopefully you are dealing with..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
age 61: 5.2
age 64: 7.5, DRE "Abnormal"
age 65: 8.5, " normal", biopsy, 12 core, negative...
age 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
age 67 4.5 DRE "normal"
age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP performed Sept 3 2010, pos margin, one pos vesicle nodes neg

Post Edited (Fairwind) : 10/2/2010 9:22:11 PM (GMT-6)


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 10/2/2010 10:14 PM (GMT -6)   
In addition to Tatt2's good suggestions to consider a color doppler scan and/or a saturation biopsy, you might consider a PCA-3 test. 8.4 is not a "normal" psa, so I certainly would not "just drop it."
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 

Patches
Regular Member


Date Joined Jul 2010
Total Posts : 33
   Posted 10/3/2010 6:26 AM (GMT -6)   
You may have BPH which is causing the PSA levels to rise.
Age 49 years old with no family history of PCa. but had testicular cancer in 1985.

PSA on 3-8-2010 was a 5.6
PSA re-take on 3-17-2010 was a 4.4
Biopsy collected on 4-17-2010 showed 2 of 12 cores malignant with Gleason scores of 3+3 Stage T1C.
RALP surgery 7-21-2010 at Hopkins.
Pathology report revealed that the cancer was organ confined, all margins negative and a Gleason score of 6.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/3/2010 10:00 AM (GMT -6)   
took 3 to catch my pc. sounds like a saturation type might be in order next too. good luck
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 10/3/2010 3:01 PM (GMT -6)   
I would get color doppler if possible........Maybe JohnT will chime in w/some advise! I wouldn't continue to get biopsies without color doppler!!!!!!

Retire1965
Regular Member


Date Joined Jul 2010
Total Posts : 38
   Posted 10/3/2010 6:29 PM (GMT -6)   
Hi Harry,
 
You may want to consider getting a free psa test.  Many urologists use the percentage of free psa to assess the risk that you have prostate cancer.  If the percent psa is high, you might lean toward believing the high psa is from bph or other benign causes.  If it is low, urologists tend to get concerned and begin to believe even more stongly that cancer is an issue and it just has not yet been sampled.
 
Those results might help you decide on a saturation biopsy/12 core biopsy etc.
 
The odds do go down that the physican will find cancer as the number of negative biopsies go up.  However, biopsies take a very small tissue sample so it is quite easy for false negatives to occur.
 
Nothing about this disease is straightforward.  There is always a caveat or exception.
 
This is obviously a layman's opinion based on motivated research.  See what your urologist thinks.
 
Retire
 
45 Male, Prostatitus in Summer of 2009
PCA diagnosed in November 2009 due to elevated PSA level
12 core biopsy, 1 core positive 15% 3X3. T1c
PSA started around 10 at the end of last year escalated to 15 and is now around 5.0. RP done September 20th
Initial surgeon feedback is no extra prostatic extension. Waiting on full pathology report.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 10/4/2010 4:43 PM (GMT -6)   
Harry,
Pleawe read "Invasion of the Prostate Snatchers" by Dr Mark Scholz. There is an entire chapter devoted on when one should get a biopsy and how to eliminate unnessary biopsies. I wish I had known just 25% of what I know now having gone through 13 biopsies.
JohnT

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


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 10/5/2010 8:53 AM (GMT -6)   
I agree that Something has to be causing that much PSA so I think you and uro need to work out a plan to detect the cause, which means repeat biopsy at some point.
Have you been given any antibiotics etc at any stage to see if that can do anything about the high PSA?

Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
Tired
BMs weird
14 Sep 10 PSA <0.1
Erections OK
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