Posted 4/21/2013 11:15 PM (GMT -7)
You might be in a similar situation to mine before I opted for a da Vinci prostatectomy.
Do you have any urination problems such as slow to start, weak stream, starting/stopping, never completely emptying, etc? If so, you are suffering from BPH -- a benign growth of the prostate. It can both increase the PSA count AND also, as a result, hide the presence of a tumor, which is why a biopsy is often recommended in such cases.
With your PSA number, however, and being positive in several cores, I see no NEED for any subsequent biopsy because you have ALREADY been diagnosed with PC. However, I also see a DEFINITE need for some sort of treatment.
If you are having the urination problems as I was (my prostate was 98 grams -- the normal is about 25 grams), you would really want to have the surgery ..... but ONLY if you can get a surgeon (da Vinci OR open) who has performed at least 300 of them. Don't go with a less experienced surgeon because s/he is still learning how to use it.
The problem with a very large prostate, as my surgeon explained to me, is that they sometimes tend to twist and deform and sometimes tend to encroach into the bladder.
In my case, external beam radiation could have cured me, as explained by the radiation oncologist I visited. But he also noted that the radiation would NOT solve my urination problems -- so the radiation oncologist actually recommended that I have surgery instead. Due to the huge size of my prostate, he also had mentioned that I was not a good candidate for radioactive seeding because they would not be able to angle the seeding needle to all the areas of the huge prostate that would be needed.
So, if your situation is anything like mine, my experience would suggest that you strongly go with surgery -- but ONLY with a highly experienced surgeon, even if it is the open procedure instead of robotic.
Without alarming you, it is also important for you to realize that a biopsy does not always reveal the true extent, or aggression of a case of PC. I believe the stat is that about 28% of post-operative pathology reports show the Gleason grade and tumor volume were GREATER than suggested by the biopsy.
Lots of stuff for you to consider. But with 3 positive cores and a high PSA, I would forget about another biopsy and begin thinking of treatment as soon as possible.
Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & slowly getting a bit stronger.