prostate biopsy or not

I found biopsies were an OK experience - one was under local and then a saturation biopsy a few years later under general anaesthetic. The local felt as if I was being hit with a stapler!, and was very ungainly for me, with a crowd of staff standing around, but I reminded myself how women have to go through worse when pregnant and in childbirth and managed to endure it cheerfully with the hand-holding help of an understanding nurse. The general anaesthetic one was obviously easier but I reacted with urine retention, so had to be catheterised for a day. Hope you get a good experience, as it is worth it (in my view) to get more information. Good Luck!

Did you have the MRI performed by a facility that concentrates on prostate imaging? Or more correctly, was it reported upon by a someone highly experienced in prostate imaging reporting?

You are right. My point was that if one decides on having a MRI then it is best to go to a facility where the radiologist is an expert.

this is because even an expert can make a mistake and we should not forget that not everything that looks suspicious on a MRI is cancer.

Well the mri i went to was recommended by the specialist.  I have been advisws that there is a system where you can send a ueine specmin to th US and have the pca3 test done but decided to just go and have the biopsy

 

Interesting. I too am in Australia and was never toKe anything about the PCa3 test. Now, after reading your post, I understand why.

may I ask what type of biopsy are you going to have? And have you seen more than one urologist?

my dr id dr a cameron strange at pow who s supposed to br thr best so all i can do is trust his advice

The problem in Australia is that there is no guide as to who is ' the best'. Usually patients go where their GP sends them. And that is often a function of who they know socially or professionally.

I always see at least  two specialists in the same field when it comes to major procedures.

usually a biopsy is recommended when a patient has two out of the following three:

a supsicous DRE exam

a suspicious finding on the mri

A low of decreasing free to total PSA ratio

what is your free to total ration ( in %)?

 

It is my understanding that PCa can be present with a low or a high reading of PSA.

If a PSA is escalating quickly and a MRI is suspicious for a tumor then it 

Is crucial to have a biopsy so the grade and stage can be determined.

If it is indeed cancer.

Having a PSA fall to a "good" level and not having treatment indicates to me that the urologist thinks it is an insolent cancer which can be watched over time.

The generally accepted view is that RT is possible after surgery but surgery is not possible after RT. This is not strictly true - some surgeons will remove an irradiated prostate (although most are reluctant to do so) and RT after surgery is no simple task - without a prostate RT will cause more damage to surrounding tissue than would otherwise be expected.

​The most important thing for you to consider right now is your Gleason score. That should dictate whether you opt for treatment or not. With your PSA of only 13 it is exceedingly unlikely that there is any bone involvement but all doctors order a bone scan as routine.

​So, your GS is cirtical and will inform your treatment options.

​All the best 

Thanks David Gleeson score is 7

A bone scan will show if there is any metastasis. Has your doctor suggested a PET scan as well?

no Barney he didn't and he knows I am due to have a colonocopy in a couple of weeks I have an appt with my GP tomorrow so I will ask him about it

John, is that 4+3 or 3+4? - there is a world of difference. If 3+4 then I would seriously consider Active Surveillance. If 4+3 then perhaps brachytherapy, depending on the position of the tumour.

​At 68 I would be sorely tempted to review the situation - my dad had 4+3 for about 20 years and died of something completely unrelated.

​All the best

Forgot to say - he declined all treatment.

David.

Mine was 4+3 and 3+3. I will know if mine is aggressive....non agressive.. this Thursday. Also Results of MRI. I am hoping I can go active Survillanc. I am 75 .Your Dad went 20 years is hopfull. Thanks for sharing that.

Don't know where I got 68 from! Yes, my dad was diagnosed with 4+3 and refused all treatment. He died aged 84 from a heart attack with no symptoms of Prostate Cancer. At 75 I would not want invasive treatment but obviously your call.

​All the best

I agree. At 75 I not only would not want invasive treatment, I wouldn't bother checking my PSA. 

Asked my gp about thr 7 gleeson score but he couldn't me what the breakdown was, asked him about the pet scan but he said the bone scan is best to have first.  If its cancer when do we seek advice from an oncologist rather than a urologist?

You should be getting treated by a Urologist by now - not your GP. The Urologist will definitely be able to tell you whether it's a 4+3 or a 3+4. Getting back to my original comment though (and barney's), the simple fact is that 75% of men of your age will have Prostate Cancer (perhaps surprising but nevertheless true). All you have done is confirmed that you are in the 75% and that your cancer is not high risk (either low risk or intermediate risk depending on the Gleason grades). At age 75, Prostate cancer is extremely unlikely to play any part in your life and I would try to ignore it. Have regular PSA tests if you are concerned, although personally I would not even bother to do that. Your 4-a-day routine seems to be working just fine for you.

All the best

I agree with David.

the time for discussing this with your GP is long over.

the only physician you should talk to about this, regardless of whether you go for treatment or active surveillance, is your urologist, who If needed, will refer you to an oncologist.