Prostrate Biopsy - Can I avoid it after MRI scan showed suspicious nodules
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Should I have a biopsy? I was sick after holiday in Thailand (with my wife). First PSA test was 4.2. Second test a few weeks later was 4.8. Ultrasound showed prostrate was clear. But then third PSA test was 6.8 (1-2 months after holiday) so had MRI scan a month ago on new Ultra High Field 3T MRI scanner. This showed three nodules 6x6x6mm to 8x8x8 mm. MRI doctor reported nodules were at PRIADS stage 4 and highly suspicious. Urologist advised having sonar-guided trans-rectal biopsy. I hesitated after seeing online reports against biopsies (infection, spreading cancer etc.). Also USA doctor friends advised against biopsy at this stage. Too early they said. High PSA levels probably caused by infection. Another friend said nodules could be caused by infection.
Urologist said no rush, finish current antibiotics and retest in one month (that was two weeks ago). This fourth PSA test (using free and total PSA) was lower at 5.5. Urologist said take further course of antibiotics and retest in 2 months (in another one month from now).
I rang Prostrate Cancer UK last week. Specialist nurse (who was excellent) advised having biopsy and noted that NHS performs 100,000s biopsies each year. She said I won't know if cancerous without biopsy. She indicted that trans-perineal biopsy had lower risk of infection, compared with trans-rectal.
I was taking Nebido hormone replacement therapy by three monthly injection (for 1-2 years) but doctors stopped these. I have no other health issues and no family history of prostrate cancer.
I have enlarged prostrate but it always showed clear on ultrasounds and PSA tests were normal (below 4) until now. I am 62 years old. I want to avoid biopsy but am fearful of delay and leaving it too late. Urologists say let current holiday infection pass but I should want to know if it is cancer and if it is malignant.
Prostrate Cancer UK nurse said something that sticks with me - PSA levels can go up and down but the detailed MRI scan will not change.
I currently work in Middle East so cannot access NHS quickly but will visit UK in 3 months. I am new to all this having been blissfully ignorant. All comments welcomed.
0 likes, 14 replies
anne05147 MikeTango
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Hi Mike. My husband has a PSA of 11, no other symptoms, but I suggested he have a PSA test at age 60. A little knowledge can sometimes be dangerous, but I'd heard about the PSA test. Came back at 11. So off to urologist and offered rectal biopsy which my husband declined and we requested an MRI which were told was suspicious. Then heard about a 3T MRI which we would pay to have done privately, but then also asked for a referral to a different hospital and not confident in the first Saw another consultant who said could participate in in research study, who did a rectal ultrasound, and had another 3 T MRI, all showed a large prostate but said the MRI showed no evidence of cancer, it was clear and not suspicious, just as the rectal ultrasound showed an enlarged prostate. Husband declined the transperineal biopsy which was part of the research study. He was at this point in time recovering from having his appendix removed. I wondered if the transrectal ultrasound may have introduced infection into the colon which caused the appendix infection, but don't know, obviously.
Long story short, in the end my husband said he would just like regular PSA testing and the consultant agreed, and that's where we are now, and any spikes in PSA test will result in going back to see consultant.
Our GP at the time said if you look hard enough you will find cancer in all prostates, even that of a 25 year old.
My husband is very reluctant to have any biopsy unless things change significantly and appears able to live with taking his chances.
All best wishes.
MikeTango anne05147
Posted
It’s heartening too that a relatively high PSA score of 11 (if that is high) was obtained on a clear MRI prostrate scan - again good for you both.
I too read the books and reports about all men having prostrate cancer if we live long enough. The issue is when to do a biopsy to receive confirmation that its either not cancerous or not aggressive (benign not malignant). I like your husband’s choice because it is based on doing nothing more than PSA testing which I now consider as a walk in the park compared to biopsy or at the end of the line, removal of the prostrate. I am starting my research on the options in between.
But being a pessimist and a cautious person, I cant help returning to having a biopsy. I’m working overseas so would need to visit UK. I almost had a biopsy here after the MRI scan but my doctor friends dissuaded me - they say watch and wait even for a year as that is how long it might take for infection to clear. I’d test regularly though and have an updated MRI scan.
Great to hear your story and comments and to “talk it through” with another person - I think it through as I write. Many thanks again.
anne05147 MikeTango
Posted
If you do have a biopsy, as my husband may decide to eventually, he would prefer a transperineal one as it takes more core samples, is more definitive and offer less risk of infection.
It always helps if you can discuss all options with a consultant who is prepared to consider all the options that are best for each individual and their individual signs and symptoms.
I've posted a link which might help offer you some more information below, but it might need to be moderated first but is from cancer research.
http://scienceblog.cancerresearchuk.org/2018/03/06/why-a-one-off-psa-test-for-prostate-cancer-is-doing-men-more-harm-than-good/
Best wishes.
Triplets MikeTango
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Have it done
cheers Keith
MikeTango Triplets
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thanks again Keith. I appreciate your reply and frankness and directness.
Pepasan MikeTango
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craig84609 MikeTango
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If they are telling you to wait that is what I would do. There is probably a good reason for it. For me getting a biopsy can do a lot of harm and I would be happy if they said hold up a bit. Then if it turns out that one is needed I would have it done through the Perineum as the chance for sepsis is nearly zero. I wouldn't go for the traditional way through the rectum. Just my 2 cents on it, ultimately you have to do what you feel is right for you regardless of what me or anyone else thinks. But, I figure if they tell you to hold off a bit there is some validity to it. I hope it all works out for the better.
MikeTango craig84609
Posted
This has certainly made me more fatalistic about life generally. But above all i would take any risk and have the treatment in order to stay alive for as long as possible, including having removal of prostrate if it came to it. After all I want to live for my impending retirement as well as enjoy it.
i noted other posts on this forum about people with cancer who let it get ahead of them. They said they couldn’t;catch it back up. I’m grateful to have had this wake call so will not delay too long. Getting on a plane and paying what it costs are straightforward actions that now need no decision.
Great to hear that risk of infection with perineal biopsy is near zero. That is what i would or will have. Urologist here said he’d do a trans rectum biopsy so I’m glad i held off for a while. I hear that our UK doctors (and in USA and Germany) are considered the leaders in the world for prostrate treatment.
I am starting to feel that knowing is important for my state of mind. So I would either have to see a clear MRI scan (a second MRI scan in a few months if that is how long it would take) or a clear biopsy. If it is possible to obtain such a result.
If the biopsy was not clear then i would go for the next treatment. But i haven’t read up on that yet or discussed it with more experienced people on this forum.
I hope my meanderings are interesting or possibly helpful for other newcomers to this forum. What a wonderful resource it is. I keep thinking of questions that i forgot or couldn’t ask the urologists.The doctors here do not have English as their mother tongue so communications are difficult.
Thank you very much for your reply and thoughts Craig.
Pepasan MikeTango
Posted
MikeTango Pepasan
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richard98806 MikeTango
Posted
There is always a risk of infection with either biopsies. I believe the statistics of occurrence are equal with both.........very low. I also believe that you won't know if you have cancer until a biopsy is performed. Seek second opinions to see if necessary. As far as general anesthesia, I certainly didn't need it. It was a bit uncomfortable and of course the location is unnerving but in reality it was a piece of cake and I'm no superman.
I was also given an oral antibiotic the day prior and took it for a few days
MikeTango richard98806
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dennis63948 MikeTango
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Hi Mike, the more people you ask, the more differing replies you may get based on personal experience. I had just read an article in the Independent querying the need for occasional PSA tests as it can vary when, 2 weeks later, I had a routine blood test. (I am in the UK) Everything was fine except the PSA had jumped from 4.2 a year ago to ^.4. The Doc suggested another PSA test and it was very similar. A biopsy was recommended and I asked to see a consultant to query the need. I was told that the only way to know wether it was "just a lump' or a cancerous one was to have a biopsy and that the jump may be an indicator. He also said that there was a 70% chance of a cancer case. Many lumps can be benign and so slow growing that you can watch and wait.
I had the biopsy and it was a cancer, known as Gleeson grade 7 which is moderate but treatment advised. My lesson was that the only way know was the biopsy and, if I was you I would do so too. You may have no worry then, or will know what you face.
I have spent several weeks finding out the best treatment options and am about to go ahead with my own preference now.
Good luck!
MikeTango dennis63948
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