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Do I need a biopsy?

Posted , 12 users are following.

david53732
david53732

Today I visited an urologist recommended by my primary doctor because he found a hard spot on my enlarged prostate .  The urologist did an examination and confirmed there is a hard spot and that my prostate is enlarged. My PSA score is .40, a score that hasn't changed in 15 years (I'm 72 years old).  The urologist feels that it would be best to do a biopsy to make sure there is no cancer.  He did not mention any other tests like an MRI that several on another thread recommend.  I just wonder, given my constant PSA score, if I really need a biopsy.  Any thoughts would be greatly appreciated.  

0 likes, 49 replies

49 Replies

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  • terryw
    terryw david53732

    Posted

    Hi Geoff  I don't think they do MRI before biopsy on the NHS.  Great service, and free of course, but you do tend to get what you're given.

    • geoff90305
      geoff90305 terryw

      Posted

      Yes, the NHS is a good system, and as you say, unless you want to get it done private(read this as $$$$), then accept what you get
    • david41094
      david41094 terryw

      Posted

      They do, but you have to press very hard. Also, I discovered to my cost that they do not routinely do targetted biopsies, even if you explicitly request one. The Urologist performing my biopsy just went ahead with the scattergun approach despite me insisting that the instruction sent by my consultant clearly requested targetting in one area.
  • david41094
    david41094 david53732

    Posted

    I know that you have had a considerable response to your post but having reread it I would definitely not have a biopsy for the following reasons:

    1) Your age

    ​2) Your low PSA

    ​3) The constant nature of your PSA readings

    ​4) The very real risk of sepsis resulting from the biopsy

    Others will differ...........

  • miss_sue
    miss_sue david53732

    Posted

    I know different places in the States offer MRI guided biopsy. You have to remember because of the way the prostate is situated there is a side of it that is not visible ...Depending on where cores are removed can make a difference . A good urologist however should know what he his doing
    • david53732
      david53732 miss_sue

      Posted

      I'll look into the MRI guided biopsy.  Thank you for your help.

  • mark_fastco
    mark_fastco david53732

    Posted

    I don't know what the problem with having a biopsy is to me it was not a big deal basically painless. So just to make sure there's not a deadly life-threatening cancer in your prostate I think it is worth the inconvenience of a biopsy. I had to modify my diet the day before and the hours before and a home enema. That's the worst part of it

    • rolf61809
      rolf61809 mark_fastco

      Posted

      If I elect for the biopsy I want to get the best and safest one possible. The urologists I saw were recommending a blind transrectal biopsy. But I researched it, here and other places, and found that getting a 3t MRI first would enable me to get a far superior fusion biopsy where they would know in advance which suspicious areas to target, unlike the blind biopsy. And again, with advice from others here I found out that a transperineal biopsy was less likely to lead to infections and sepsis. And better access to some areas of the prostate. Something else my urologist wasn't going g to tell me. Sure, in the end you have to trust your doctor, but you're just one of hundreds of people he has to care for. In the end, it's up to you to learn all you can to make the best decisions. This is invasive surgery, not a brake job on your car where you can go to a different mechanic if the brakes still squeak. I may have to settle for transrectal if insurance dictates, or if transperineal just isn't available for some other reason.

    • david53732
      david53732 mark_fastco

      Posted

      Thank you for your response.  Every bit of information is helpful to me.
    • Supertractorman
      Supertractorman mark_fastco

      Posted

      It is when it goes wrong is the problem. I was an hour away from being a goner and had it not been a Nurse friend who said I had Sepsis 12 hours after the biopsy and got me straight to the Hospital ward and in 5 mins I was in the High Dependency Unit. Now 2 years on I still have urine infections and Prostatitis as a result. To me it is not a simple process.
    • miss_sue
      miss_sue Supertractorman

      Posted

      Sorry to hear you had such a bad experience with the biopsy .As with any medical procedure there alway will be the risk of infection .For thousands of men it is painless and free from problems and really is at this time a diagnosis necessity .They are exploring so much into PC and finding out more all the time . One day in the future maybe there will be a far better way but until that time 😯

    • barney34567
      barney34567 rolf61809

      Posted

      Your analysis of getting  PSA checked, then if need be, a 3T MRI  and then a transpernieal biopsy (for the reasons you mentioned) are spot on.

      That was what I had done after seeing my PSA climb.

      And cannot think of a better set of steps to take.

    • geoff90305
      geoff90305 Supertractorman

      Posted

      Yeah, every guys nightmare. Do the right thing and get a biopsy, only to find you are the one to develop sepsis. I guess the medicos said, yes, this is an issue for a very small part of the population, but cost and time wise, the transrectal is the prefered method for most men.

      I just saw a publication on medscape..PCa Diagnosis by MR/Ultrasound Fusion-Guided Biopsy. Says that if there is a lesion identified, the fusion guided targeted biopsy finds more PCa, as against blind biopsy. But it goes no to say people(like me) who have no lesions have no choice but to have the blind version. It also said though, a PIRAD score of less than 3 with no lesions may not warrant a biopsy.

      Geoff

    • Supertractorman
      Supertractorman geoff90305

      Posted

      After my experience with Sepsis I know when having a biopsy they point it out as a very, very rare risk and that we should not worry about it. I now make a point of reminding people who are having a biopsy to check they will ge given and have received A/B's as there can be mistakes made.  My other concern is many Medics are not fully aware of the signs of Sepsis and NHS out of hours numbers would have left me to die as I  they failed to check if I had the possibility of Sepsis especially after being told I had a Prostate Biopsy the day before, and that should have set alarm bells ringing.

      My symptoms were Sickness, Sweating, Blood from my Anus, Penis and Nose. Blurred vision, I could not read a number plate in front of me while being taken to hospital, splitting head ache and starting to talk rubbish. Everything in my body was shutting down and I did not remember the next 3 days in High Dependency unit.  Anybody with anything like this get to A&E fast.

      David

    • geoff90305
      geoff90305 Supertractorman

      Posted

      #$%^hell David, you were lucky to get to hospital and some one take you very seriously. 

      Geoff

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