Consultant not keen on 3T MRI route

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My partner is scheduled for prostate biopsy inapproximately6 weeks time to find out what is causing his high PSA level, 7.6 down from 9.5. From the information on these forums we decided to have a 3T scan done first to provide more detail and act as a map so to speak. The consultant is reluctant about this and does not seem to think it necessary. In his words if it is a high grade cancer it would be missed! We get the impression that he thinks it was being chosen instead of biopsy which it isn't. Surely it's best to have all the images etc possible before going in to take samples? We don't like his choice of words either. This could be BPH or prostatitis. He has burning in the middle section of urethra when urinating but apart from that no symptoms. He isn't even going to loo frequently any more. Confused and worried.

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  • Posted

    I would be reluctant to have a biopsy done unless I wa sure I needed it. There are many things which can trigger an increase in PSA results (digital examination, riding a bicycle, perhaps some medications. I guess I'm hesitant about having foreign objects stuck in my body unless I don't have a choice. What about a second opinion or a wait to see if thee PSA contnues to increase. It seems the last test revealed it decreased. I've been suffering from BPH for years and have decided against surgery unless  I have a serious blockage. BPH is certainly inconvenient but sometimes the cure is worse than the disease.

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  • Posted

    I agree with Reg. Prostate biopsies are not to be undertaken lightly; check out with Google. Of all biopsies, this is probbly the one with p;otentially the most serious side-effects, as well as being painful.

    I'm not sure having one would anyway shed light on why the PSA has dropped.

    The increasingly strong recommendation for such relatively low PSA is to adopt a wait and see how it develops (if at all). There is increasing evidence that even with a diagnosed prostate cancer, most such patients will die of something else than prostate cancer.

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    • Posted

      I'm really feeling sick at the thought of him going through this procedure Ian. I hope and pray it's conclusive but so many mixed reports. A lot of men say it's uncomfortable but not really painful. If it helps it will be worth it. Although the PSA is 7.6 it is considered high for a 50 year old and apparently should be lower than 4 I think.

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    • Posted

      I had a PSA of 8.8 aged 51 and got the prostate cancer scare too.  The uro did an MRI and it came back negative but he ordered 6 monthly PSA tests.   My PSA came right down since and hovers around 2.0-3.3.  So it may well not be prostate cancer, it's all too easy to get worked up about it.  Remember only 1 in 8 who get tested find they have it, 7 in 8 don't.

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  • Posted

    Because PSA's are so  unreliable a biopsy should not be done if it is less than10.

    A cystoscopy would be better.

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    • Posted

      I agree with that. I thought they would have done a cystoscopy anyway, this would surely show up any inflammation in the urethra and explain the burning sensation he is getting. It's beginning to feel like we are being pushed for biopsy and that's that! Ok, when it was 9.5 and the consultant suggested biopsy as only way forward we thought as it was near the level 10 cut-off point that was the best thing all round. We were surprised when this is still being done even though the level has fallen. The next PSA in January be interesting. If it has fallen again we will be adapting a wait and see approach.

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    • Posted

      My PSA was 9.5, and no PCa. In this instance, high PSA was most likely caused by large (98 cc) prostate.Google "PSA density" for more info about this. Do you know the size of his prostate?

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    • Posted

      No no-one has said how big it is, just that it is enlarged. They have felt it but nothing else. The bigger it is the more PSA it produces if I am correct. So how do they know the levels they are seeing don't correlate with the size of the gland? It's definitely not an exact science, too many other explainations aside from Pca and yet that is all they can talk about. Finding it, and please God it's not even there. Good to know you had the same level and were ok rich. I will google PSA density definitely.

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    • Posted

      You  nailed it. PSA is a very rough indicator. And even if PCa is discovered, most men will die WITH PCa and not FROM it. There's an excellent book about all of this: "Invasion of the Prostate Snatchers" by Dr Mark Scholz and Ralph Blum. The quote I love goes something like "If you're over 70 and don't have prostate cancer, chances are you're a woman."

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  • Posted

    What was his logic for "if it is a high grade cancer it would be missed"??? Never heard anything like that. The whole point of a 3T MRI is to see if there might be cancerous araes.I had  a 3T MRI before proceeding with a biopsy. The MRI showed a suspcious area, so I proceeded with a targeted biopsy which came back negative. Targeting the biopsy rather than or in addition to a random biopsy makes total sense to me.

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    • Posted

      Rich, I was with you right up to the random biopsy part. Randomly poking around after a 3T MRI that shows nothing is there makes little sense to me, particularly since any biopsy can cause injury and infection, e.g. prostititus.

      Neal

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    • Posted

      I agree with you Neal. Guess I wasn't clear. If the MRI doesn't show anything, then no biopsy at all. If it does show a suspicious area, then a do a targeted biopsy. While they're doing the targeted biopsy, my uro doc said that it's wise to do a a random at the same time. He had some statistics (don't remember them) that a random at the same time is advisable. I don't know if I agree with him as I haven't looked into the supporting studies at all.

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    • Posted

      I don't know what he meant by that. He seems to think that if it's a bulky mass it won't show up or something. Neither of us have a clue what he is on about and this is the man going in to take biopsy sad Nothing like instilling confidence in your patients. He has scared the daylights out of us with that comment. My partner is a worrier by nature and this has not helped.

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    • Posted

      Really does sound like at the very least you need a second opinion, or maybe just a new doc. In my urinary adventures, I have been given extraodinarily bad advice by more than one uro doc. I've learned that I need to take full responsibilty for my own care and simply consider docs as advisors, trusted and otherwise.

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