To biopsy or not to biopsy

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Regular Member

Date Joined Apr 2011
Total Posts : 50
   Posted 6/15/2011 7:55 PM (GMT -6)   
Hi from NW USA.

Age 53. Normal DRE.
2008: 2.0
2009: 2.8
2011: 3.4
Repeat PSA 2011: 2.7

Urologist wants to biopsy anyway. Understand there is a continuum of risk with PSA levels.

<.5 ~7% have PCa at biopsy (12% of those cancers high grade)
.6-1.0 ~10% have PCa at biopsy,10% of those cancers high grade
1.1-2.0 ~17% have Pca at biopsy, 12 % high grade
2.1 to 3.0 ~24% have PCa at biopsy, 20 % of those high grade
3.1 to 4.0 ~26.9% have PCa at biopsy, 25% of those high grade

I fear high grade disease but also fear complications of treatment of "clinically insignificant" cancer. Decided to check PSA in 6 months.

Regular Member

Date Joined Apr 2006
Total Posts : 347
   Posted 6/15/2011 8:03 PM (GMT -6)   
I don't know much, and not a doc, butblooks like your doc could be jumping the gun especially since psa dropped 2.7

Veteran Member

Date Joined Jan 2011
Total Posts : 735
   Posted 6/15/2011 8:15 PM (GMT -6)   
Hi Starr,
Ask for a pca3 urine test and instead of a total PSA test request a free-PSA test. Both these tests might provide information about the presence of prostate cancer before undergoing a biopsy.

Phoenix, Arizona
Disclaimer: I am a long-term prostate cancer survivor. My comments are not intended as medical advice. The intent is to provide information. Seek direct recommendations from your medical team.
Surviving prostate cancer since 1992 at age 58. RP; Orchiectomy; GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA September, 2010: <0.1 ng/m

Veteran Member

Date Joined Jul 2010
Total Posts : 3596
   Posted 6/15/2011 10:43 PM (GMT -6)   
Also, there ARE genetically based urine tests out there that can tell with great accuracy if you have PC or not...One I know about, called "The Four Gene Signature Urine Test" has been approved and is ready to go but the two labs licensed to perform the test (Abbott and Quest) are both sitting on it and the test is not generally available..The PSA test by itself can not be used to diagnose prostate cancer...It should only be used as an alarm bell when performed on healthy men...You might wish to look into a color Doppler ultrasound examination as a way to more accurately diagnose any prostate problems. You may have to travel to find an expert practitioner who performs these exams and if needed, biopsies...

None of us here are doctors and none of us offer medical advise, only information which others might find useful...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Regular Member

Date Joined Sep 2009
Total Posts : 462
   Posted 6/16/2011 5:34 AM (GMT -6)   
I would get the biopsy, you have nothing to loose and all to gain.  The biopsy is a cake walk, if you ask to be knocked out.  I would not have it with out being asleep.
 I was the same situation as you.  My psa went from 2.9 when I had my first test done at age 50, to 4.5 when I was 56.  My Gp suggested a biopsy just to be safe. I  had my biopsy exactly 4  years ago this month and was diagnosed with PCa Gleason 6  <5% cancer in two samples out of 12. 
I am glad I had the biopsy when I did because I caught it early.  I had robotic surgery 9/2007 and am now I am cured.  If I had waited a few more years to have the biopsy (which I almost did) , there would have been a very good chance that it would have escaped the prostate because the pathology report showed the cancer only a few mm from the margin. 
With the biopsy report I had, <5%,   today most people would recommend "watch and wait", and I almost did that too, but something in me wanted that cancer out , so I had the surgery.  The pathology report came back with more cancer than the biopsyhad showed, which is usually the case.   When I look back, I am glad I had the biopsy and surgey when I did, because I am completely cured now.

Post Edited (NY-Sooner) : 6/16/2011 5:51:22 AM (GMT-6)

Regular Member

Date Joined Apr 2006
Total Posts : 347
   Posted 6/16/2011 5:57 AM (GMT -6)   
I would get a free psa test before biopsy if those numbers look okay, do what urologist then suggest

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 6/16/2011 6:22 AM (GMT -6)   

Hi Starr from NW USA, and welcome.

The decision to move forward with a biopsy or not is a bit cloudy with the information you have so far.  Indeed, a positive biopsy is the only way to really confirm that you do have some degree of prostate cancer, but on the other hand if you only have a tiny bit of PC (which may or may not need to be aggressively treated), then you should also be aware that the biopsy is simply a "sampling" process which may miss PC cells.  PC cells tend to grow in clumps, around a focal point rather than be homogeneous like cream in coffee.

You've gotten some good inputs already.  Here's one to consider from the American Urological Association (LINK):

"...the decision to proceed to prostate biopsy should be based primarily on PSA and Digital Rectal Examination (DRE) results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and comorbidities."

The "free PSA" (PSA-f or FPSA) test measures the proportion (%) of free PSA to bound PSA in the total PSA in your blood sample...the test you alread had is called the "total PSA" test.  The "free PSA" test is called this because PSA-f circulates in the bloodstream "unbound," without a carrier protein.  That might be more info than you need for now, but know that high free PSA -- above 25% -- usually indicates BPH (benign prostate hyperplasia) which is a benign prostate issue which increases PSA.  On the other hand, low free PSA likely signals prostate cancer. Most men with prostate cancer almost always have a free PSA below 15%.
Your urologist can administer this's done with the same blood draw as a "total PSA" test.
Also, you surely are having some infection issues which cloud your total PSA result, as evidenced in your decline in the follow-up 2011 test.  Did the doc prescribe antibiotics?
For your age, your PSA is a bit high...but please do keep in mind (with regard to your comment about treating clinicially insignificant PC...which is a very astute comment) that just because you might find out that you have a prostate cancer doesn't automatically mean that you need to jump into an aggressive treatment.  A good doctor might tell you to "wait, and lets see what's going on" before aggressively treating.  Make sure your diet is focused on not eating things that promote cancer, and eating things that help fight cancer; and, make sure to also fight cancers with a good exercise program.  If you do proceed with biopsy and you do find a very small amount of low-grade cancer (a common finding), some men (participants in scientific studies) are able to keep it from progressing through diet and exercise...and have improved their quality of life by doing so!
best wishes...

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