Should I have a prostate biopsy?
Posted , 74 users are following.
Introduction
I’m 70 and have a PSA which was at 4.6 when I was 66, and while it has been regularly monitored over the past 18 months or so has been moving up and down between 6 and 7. My doctor thought that I should be referred and I have had two hpital appointments, but I have so far decided against having a prostate biopsy, though it is obvious that my local hospital’s oncology department would like me to have one. The health worker I saw at my first hospital appointment was happy to discuss the issue with me, but I suspect the consultant I just saw probably thought I should stop wasting his time and get booked in for a biopsy without further delay.
I have received information from those two appointments, but I have obtained much more information from online research. Based on studying a number of online medical reports over the period 2008 – 2014, it is evident that there is increasing prejudice, at least in the US and Australia, against the use of prostate biopsies. The primary reasons for this seem to be an increasing risk of serious infections from the most common type of biopsy, a growing recognition (though this may be controversial) that psa screening and biopsies are ineffective in reducing the incidence of terminal prostate cancer, and that screening and biopsies contribute to massive ‘over treatment’ of prostate cancers
Summary of Statistics (some of which may be controversial but all of which are based on (my interpretation of) studies published in urological journals, research reviews and conference speeches by leading urologists).
Of every 100 men who have a prostate biopsy:
· 97 didn’t need it (that is, they don’t have a prostate cancer requiring treatment)
· 6 will get a serious infection as a result (a figure which has doubled in recent years), which will cause them to be hospitalised, and from which a very occasional man will die, while others (we don’t know how many) will have persistent painful side effects
· between 17 and 22 will be offered treatment that they don’t need, as a result of which about 25% of men in their 70s will become incontinent or impotent.
The Perceived Indicators for Biopsy
Primarily a raised psa; a psa which has increased rapidly over a fairly short period, typically a year; smoking; family history of prostate cancer; age (considered with the other factors). I have a raised psa, but it’s not dramatically high – it’s been between 6 and 7 over the past 1 ½ years, and it has not increased dramatically – it was 4.6 five years ago. I do smoke, and I am 70, but I am generally in good health, and there is no history of prostate cancer in my family that I know of.
Statistics Based on Recent Urological Papers
Of every 100 men who have a biopsy, between 75 and 80 have no cancerous cells and didn’t need the procedure; 20 to 25 will have cancerous cells found on biopsy BUT a large percentage of these men will have a tumour which develops very slowly, will not be terminal and doesn’t really need any treatment. Only a small percentage will have an aggressive tumour requiring immediate intervention; the Harvard School of Public Health, in a 2014 paper, put this percentage at 10 – 15%, or 3 men out of the 100.
This means only 3 out of every 100 men who have a biopsy really needed it. And there are two other real concerns.
1. The one certainty with prostate biopsies is that 100% of the men who have them will have ‘side effects’. Some will be shortlived and not really a problem, but some will be painful and longer lasting, and some men, currently about 6 out of the 100, will be hospitalised with serious infections, and the very occasional one will die. There are no statistics for the number of men receiving treatment for post-biopsy infections at doctors’ surgeries. I don’t necessarily see this as a reason not to have a biopsy, because obviously if you really need a biopsy to diagnose a terminal cancer then it’s worth putting up with the side effects. But do you really need it?
2. Most worryingly, doctors apparently can’t tell from the biopsy result whether cancerous cells denote an aggressive tumour which requires immediate treatment, or a slow developing tumour which probably does not need any treatment. As a result, as I understand it, all patients with cancerous cells may generally be assumed to need immediate treatment, such as hormone replacement, radiotherapy, chemotherapy, even though 85-90% of them don’t need any treatment. Research papers suggest that in men in their 70s, 25% who have this treatment will become incontinent or impotent as a result. Many of these men will suffer these consequences despite the fact that they didn’t ever need the treatment they were subjected to.
It’s also worrying that at two hospital appointments the issue of what happens after the biopsy has not been raised, even though it was clear that both the people I saw thought I should have a biopsy. Maybe they would say that it would have been raised if and when I agreed to a biopsy, but given concerns about receiving unnecessary treatment, I feel it should have been raised at the time the issue of having a biopsy was raised. Would they have explained to me that if cancerous cells were found, they might not be able to tell whether I needed treatment or not? Would they have told me that there was a risk (if not a certainty?) that I would be ‘offered’ treatment that I might not need? Since they did not have that conversation with me I cannot answer those questions.
Conclusions
My psa is raised but not highly raised and it didn’t move up fast, so I feel it is not at present a firm indicator of the need for a prostate biopsy – it’s inconclusive. The only additional risk factor I have is that I smoke, and I suspect that is often overplayed by the NHS. According to NHS statistics, I should be suffering the ill effects of smoking by the age of 70, in the form of early signs of lung cancer, but when I had a chest scan a year ago it was clear. In addition I have an enlarged prostate – which was determined at my first hospital visit not to feel cancerous – which means I would have a heightened psa anyway.
I have been offered another appointment by the hospital in six months, and I am going to take that up, but unless things change I think that has to be the last for the moment. It’s pointless me trooping up to the hospital every six months when I don’t want a biopsy – which is all they can do by way of diagnosis – and there could be people with aggressive tumours urgently needing those appointments. So I need to decide over the next six months finally, whether I am going to have a biopsy or not.
The hospital has asked me to have another psa blood test before I go for the 6 month appointment, but I have asked my GP for three-monthly psa tests, so that I can get more of a feel for movement on the results before I go for the hospital appointment. If my psa is suddenly moving up rapidly over the next six months, then, depending how fast and how far it is moving, I may agree to a biopsy. Otherwise it is unlikely that I will, in which case there is not much point in the hospital continuing to see me – though I will ask my local surgery to continue monitoring me with 4 or 6-monthly psa tests.
At the age of 70 I still work full-time (for myself), and having unnecessary treatment for prostate cancer would certainly have far more of an impact on my life than having a slow developing prostate cancer which would not affect my health or life expectancy, and might even have more of an impact in the short term than having an aggressive prostate tumour. So it’s a numbers game. None of us is going to live forever, and at my age quality of life is more important than lifespan. Younger doctors especially often don’t take account of this, and assume that keeping you breathing, no matter what state you are in, is some sort of medical triumph. Not surprisingly, there are lots of older people who don’t see it that way!
15 likes, 312 replies
skip79435 terryw
Posted
Accept my thanks and hats off to you, Terry, and all others on this forum, for insights and help offered to males having that suprise "high" PSA level. My story thus far has ended with a benign 3T MRI result but like many males on the PSA road, I went through a short time of unnecessary worry. Here's my take on the PSA controversy as it's been labeled. I'll avoid citing refereed authored medical studies--they're usually too dull but my thoughts on the subject come from medical literature.
But I must borrow from the late Dr. Thomas Stamey of Stanford for sound reasons. The PSA, with backing from biotech start-up Hybritech, was originally a prostate tissue antigen marker. In the seminal NEJM article 1987 by Stamey et al it was used to follow prostate treatment response, ( the buzz was its superiority over a phosphatase test) not developed as a cancer marker. It was later forced through the FDA as a "cancer screen" in the 1990's. The value cited of PSA 4.0 or lower as "normal was chosen "arbitrarily" as referenced in FDA transcripts.
More recent "contemporary" biopsy and PSA studies have shown the incidence of PC in PSA 2-4 similar to higher levels. Most prostate cancers are Gleason 6 or lower, ( indolent), and on autopsy ( as noted in these forums) about 80% of eighty year olds (without knowing it during their lives) will have clinically, non-significant, asymptomatic prostate ca.
Since then, Stamey, the author of "the NEJM paper" that started widespread PSA testing unintentionally to explode in 1987, has done an about face-- to paraphrase -- the mass PSA testing era is over.
In effect, as he noted, prostate cancer is ubiquitous in males of a certain age, and urologists for any reasonable excuse, and enough biopsies, will find prostate ca. A high PSA level was that good excuse to biopsy. The urologists to their credit were practicing standard of care. Stamey later in his career stated far too many prostates had been removed unnecessarily. For values less than 10ug or probably less than 20ug, he and his team were convinced (carefully examining whole radical prostate sections) most often resulted from benign hyperplasia in the TZ. transition zone. ( His dept. study in 2004)
He was not stating that aggressive prostate ca ( for example--Gleason 7 or more) would not result in high PSA levels or that PSA be ignored And certainly, high levels of some PSA number, be it 20 or 50, indicates serious prostate issues. What's needed he believed is a specific and sensitive tumor marker, without high false postives and false negatives. Perhaps the 3 T MRI MP approaches this while we wait. As for PSA velocity, one can read that the Sloan Kettering epidemiology group has effectively cast cold water on this velocity parameter, which had initial appeal. Stamey has said he knew experts who no longer get their own PSA but, of course this is an individual decision for each patient, and the patient must weigh the harm to benefit ratio. I don't think he would fault a patient who insists on getting yearly a PSA, ---the trouble and the cascade start when it elevates. The PSA is an incredibly useful assay, the trouble is how it's used.
Clearly, we need something better and I hope it will happen soon.
thanks to this discussion group for sharing experiences. I welcome counter ideas to my thoughts and be shown where I've gone wrong.
skip
all the best,
skip
craig84609 skip79435
Posted
Very insightful, I think that doctors make a biopsy look so routine that most men don't really know how harmful they can be. To have a biopsy done blindly now without a 3T MRI, to me seems foolish. My current Uro still believes in this approach and I wasn't having it. She told me that if my PSA was elevated that she will want to do a biopsy. I said no, from what I have read I am in a low risk factor and if my PSA is high I would like a 3T MRI first to see if there is a problem at all. I think she was a bit suprised. Because of this I am a bit leary of the PSA test. I don't want to get stuck in this wait and watch situation, where I am biopsied every time there is an increase in PSA, because more than likely, at least in my case it would be casued by BPH. Funny thing though. My dad had BPH really bad, so bad he needed to have a turp done in his late 50's. The interesting part is his PSA was low, very low. Now I am nearing 50 and I have the same issue. I have BPH, but my PSA is only .24, go figure. PSA doesn't always show that one has an issue. So there needs to be a better test developed. I agree totally, until then I would always opt for a 3T MRI before ever having a biopsy done. It is time for the old time doctors to get with the times and give us better care than high PSA score blind biopsy. It was the standard, but not any more.
terryw skip79435
Posted
Hi Skip
Thanks for your detailed comments, which should be very helpful to any guys concerned about this issue. Here in the UK I keep reading about better diagnostics being developed which should be available on the NHS 'within a few years'. Hopefully before too long this debate will have been superseded by much improved non-invasive screening tests which can determine the presence of cancer, or not, and indicate whether it's aggressive - or not. Whether any of this will be available in time to benefit guys of my age (73) remains to be seen, but fingers crossed the scientists are getting there, and future generations of men shouldn't have to face the same dillemas over pca.
All the best Terry
andrew33992 terryw
Posted
Terry, I understand what you're saying and the uncertainty of it all. I'm 71 yrs in good health. That said 2010 I had first biopsy followed by 2012 both.12 cores each found to be negative. PSA then was 5. Annual physical 2014 found PSA 9, saturated biopsy of 25 cores 2 of which was low grade cancer assigned Gleason 3+3 placed on active survelliance. In 2015 a similar biopsy was performed following fusion MRI and PSA of 24.
Active survelliance was recommended and continues. April 3017 fusion MRI examination was done following a PSA level of 36.3. The conclusion if the MRI was weighed.. Equivocal. Doctors.recomend that I do another fusion saturation biopsy. The last MRI showed the Pelvis region is clear, but the enlarged prostrate with elevated PSA is cause for alarm and frankly frustrating since the medical institution is one of if not the highest rated in the USA. I'd appreciate any suggestions, comments . Thank you
terryw andrew33992
Posted
Hi Andrew
Thanks for getting in touch. I saw your separate thread and must admit I wondered why you started having biopsies when your psa was where it should be for your age and you had no specific problems. I was in a similar situation to you, but took a different route. I was referred and the hospital were very keen to do a biopsy, but I didn't consider there was good reason for having one. I was also aware that if they didn't find anything they would want to keep doing biopsies until they did, at which point we might start a whole new battle over treatment which I might or might not need.
I would stress, as I frequently have here, that the decisions I've made are mine alone for my circumstances, and others have to make their own decisions.
Obviously your circumstances are now different, but if it was me I would want to ensure that I had eliminated all other possible causes for the elevated psa, including possible prostate infection which could be quite possible after several biopsies, before going any further with invasive procedures when the ones you have already had seem to suggest that you have slow growing pca which may not cause you any problems or need any treatment.
I don't know if that is helpful, but I wish you all the very best with this.
andrew33992 terryw
Posted
Thanks for your reply. Actually I was of the same opinion but the fear and pressure to do the first biopsy is what lead me down that path. I now realize there is confirmation bias among some if the doctors I've seen.
reginald30723 andrew33992
Posted
andrew,
you are fine. dont worry about repeat tests. get on with your life. you do not have PC! your psa can be caused by things other than cancer, so stop worrying and get on with living.
you are only lining the pockets of the doctors, and it is my guess, that you have good insurance that doctors like. that is why they keep putting you though all these tests.
if you did have PC, the biopsies would only have spread it...check article on seeding PC here;
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015162/
i hope this help.
reginald
reginald30723 terryw
Posted
I am a registered nurse, and will give you a case scenario. A patient is told that he has rising psa and a positive DRE. Therefore, assume you have prostate cancer, and do NOTHING. Why? Because a biopsy will only spread it *only 1 cell release is enough to make it spread...Also, after the biopsy comes back positive, the urologist, who is in it for the business, will enough you to either wait and see, *scareing you into wanting to do more...or, suggest that you go for a possible CURE by cutting it out.
This wont work, but, it WILL give you false hope and make him rich. After the surgery, you will have pain, some incontinence, and will have to go for psa readings every three months thereafter. What kind of life is that? You will always be on edge, waiting for the next test results.
Another scenario...rising psa, no positive DRE. Doctor recommends biopsy. Dont do it! Biopsy will spread it if you do have it, or you dont have it and dont need it.
It is my opinion that prostate biopsies presidspose the patient to harm (spread), and at this point, nothing will be a cure.
without biopsy, there is little chance of spread, or, the cancer may be a VERY slow growing type that shouldnt be treated anyway.
I have read extensively the medical journals on prostate cancer, as well, patient forum reports.
Do yourself a favor and put the whole notion of prostate cancer out of your head. There is NO cure if it spreads, and biopsy and RP surgery is NOT a cure. Those who say they were cured, had a Gleason 6 that were told they had a 7 or higher....If you have RP after a Gleason 6, you will never have a recurrance because 6 is NOT cancer. Therefore, do yourself a HUGE favor and forget about being tested.
I have two friends who have been treated for PC. Both are living terrible lives if just for the anticipation of their next PSA or chemo treatment, or incontinence or ED...
I hope this helps someone out there deciding whether or not to have a biopsy done.
Thanks for reading.
hank1953 reginald30723
Posted
terryw
Posted
All the best Terry
Davey22 terryw
Posted
You might want to look into getting a 3T Multi Parametric MRI scan. This will give a good image of the prostate and any tumors before needing a biopsy. And if you need a biopsy, make sure it's not a ultrasound guided biopsy.
A 3T Multi Parametric MRI guided biopsy is more accurate.
terryw Davey22
Posted
Hi Davey
Thanks for your input. Unfortunately with the NHS in the UK you pretty much get what you're given. NICE, the body which makes decisions on the NHS availability of drugs and treatments, said some months ago that doctors should ask for MRIs before considering biopsies, but cost and availability of resources will continue to be deciding factors for some time I suspect.
All the best Terry
Davey22 terryw
Posted
I didn't know you were in the UK. Do they have a nationwide insurance plan for everyone?
If that was me and my psa was under 10, I'd leave it alone, and no further testing
terryw Davey22
Posted
Hi Davey
The National Health Service is a nationwide 'free at the point of use' service for all UK citizens, and it's a fantastic service, but obviously it has cash limitations, and as I have said here before, if its a choice between providing better services for babies or for old guys I don't think there's much doubt where must of us would want to see the money going.
Totally agree with you about psa level. I was about 6.5 last time I checked, which is reasonable for a guy in his early 70s with bph from an enlarged prostate, but I have no idea what my current psa level is and don't much care. At the age of 73 I'm in reasonable shape, I'm not impotent or incontinent and don't want to be, so I'm happy to keep going as I am as long as I can.
All the best to you and all of us
Terry
anne05147 terryw
Posted
All best wishes
Anne
Davey22 anne05147
Posted
Anne,
I just read your last comment. I don't know your husbands stats to comment on. If you could mention his current condition, I'll comment. As far as a biopsy, I'll be needing another one soon. Only after getting a 3T Multi Parametric MRI scan. This will give a good image of the prostate and any tumors before needing a biopsy. And if you need a biopsy, make sure it's not a ultrasound guided biopsy.
anne05147 Davey22
Posted
Thanks Dave, well, over a year ago I suggested my husband have his psa done with his 60 year old check up. It came back as 11+. He was then referred to urology who did an MRI which was suspicious, level 3 but also showed an enlarged prostate. He was offered a transrectal biopsy but wasn't confident about the hospital as it is voted the 2nd worst in the UK. We went to another hospital and his psa's were monitored and fluctuating between 7 and latest was 11+ so up, then down and then back up again, The doctors there said there was nothing exciting on the MRI but are going to include him in their study, since then he has had a ultrsound showing an enlarged biopsy, and was booked for another MP MRI and transperineal biopsy. This has all been delayed the past month as inbetween he had an open surgery for acute appendicitis. He is due to go back for the MP MRI in september and afterwards will have the biopsy. I feel anxious for all that he is undergoing as it was me who suggested he have the psa test and wonder if perhaps it is just the fact that he has a large prostate that is causing the raised psa. He is only just recovered from having his appendix out and then we'll be to hospital for another procedure.
Just unsure about it all really. My husband seems relaxed about it all but obviously it is worrying. Anne.
anne05147
Posted
anne05147 Davey22
Posted
p.s. also his prostate examination they said felt normal and his only symptoms of anything are urinating more often but this isn't a big problem, he has good rate and flow etc., he doesn't have any other problems. The doctors said it would reassure them if he had the biopsy as at the time were were going for regular psa testing instead of any intervention unless really needed.
I hope all goes well for you too with your next biopsy, how many have you had?
Davey22 anne05147
Posted
Anne,
I've had only 1 about 3 1/2 years ago. It was the old ultrasound guided biopsy, not the kind that I would recommend today, and painful. Probably not the best choice in doctors. Well, 9 out of 12 samples were cancerous and they were graded a Gleason 7 & 8.
I opted for HIFU. That also was guided by ultrasound. Now, 2.5 years later, my psa went up to 5.5. It appears that some was missed in the procedure. I'll have another blood test in a month and then see the urologist and talk about another biopsy. But this time, having a 3T multi-parametric MRI of the prostate, then the urologist could fuse this with the biopsy.
You probably read about the good and bad of biopsies. This is the only way to tell just how severe the cancer is. Then that could determine what is the proper treatment.
If he needs a biopsy, do some research and find a doctor with a lot of experience, don't just go to any urologist.
Davey22 anne05147
Posted
Anne,
Read what this doctor says about testing before a biopsy.
I'm not promoting anything here, just FYI.
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anne05147 Davey22
Posted
Thanks Davey. So hope all goes well for you.
Yes the only way is a biopsy to know for definite. Just wonder sometimes if men are being overtreated since our GP said that if they look hard enough they'll find cancer of the prostate in all men of any age as it is so slow growing, but also sadly there is also the chance that it might be an aggressive cancer, so it's about better to be safe than sorry.
My husband's consultant is a Professor in urology, so hopefully knows his stuff.
I've read so much about the prostate now and the various treatments and what to do and what not to do that I am mostly totally confused
All best wishes for a good outcome for us all. Anne.
terryw anne05147
Posted
Hi Anne
Apologies for the delay in getting back to you. I posted this thread three years ago and I'm doing fine. I posted again about 18 months ago after making a decision on a biopsy, and probably the best thing I can do is repeat that below. I hope it helps.
All the best Terry
Hi and thanks to everyone who has posted on this thread. Well, with your help I have answered my own question, 'Should I have a Prostate Biopsy?', and very much along the lines that many people have suggested. I have cancelled my next consultant's appointment and taken myself off the pc rollercoaster.
Since I put up the post I had a psa test about 6 months ago, which came out 6.5, the same as 6 months or so earlier. Its gone there from 4.6 6 years ago, and the last 2 or 3 years its been between 6 and 7. The doctor I was seeing recommended I be referred to a consultant, but I know other GPs in the same practice would not have thought any action necessary. And I think they are right - I know I have had BPH for some years, which is pretty common and is probably why my psa is up. Bigger prostate = higher psa. In any event, if my psa of 4.6 from 6 years ago had been an indicator of an aggressive tumour - which a consultant suggested it could be - I should be dead by now.
I have no symptoms - no getting up in the night, no blood in my wee - I have no family history of prostate or breast cancer, and I have no interest in running up to 6% risk of Sepsis from a biopsy, or the possibility of receiving treatment I may not need, which is nevertheless likely to leave me impotent and incontinent. At 73 I want to carry on being as I am as long as possible, and I think my best chance of achieving that is to steer clear of procedures I don't want and probably don't need.
I've been intrigued by some of the stuff that is available in the US, and maybe in the UK in private medicine, but not from the NHS. PSA may be unreliable, but it's cheap so the NHS will keep using it, and the same is true of the random biopsy through the rectum. The NHS is fantastic, but it's never going to offer all the latest testing, because there must always be hard choices about how the money is spent, for example, should it be spent on better prostate testing for old guys, or specialist services for sick babies? Not really any contest is there?
I'm not necessarily assuming that I don't have a tumour. I may well have. But if I have, it seems likely to be slow growing, and if it's not going to kill me or cause me any problems I don't give a damn about it. It can carry on doing what its doing and I'll do the same.
I wouldn't say there's no risk. I have read patient postings elsewhere saying they had no symptoms and by the time they were tested it had spread into their bones and nothing could be done. Obviously they were urging everyone to get a psa and a biopsy as soon as possible. And I'm not doing that, so I could be putting myself at serious risk. But that risk is at most 2 - 3%, which is half of my risk of becoming seriously ill from a biopsy!
I really don't believe that most NHS staff would deliberately put me at risk, or give me treatment that they knew I didn't need, but inevitably they have a different viewpoint from me. In most cases I suspect they think 'better safe than sorry' . That's probably what the GP thought who referred me to a consultant, that's no doubt what the consultant thought when he wanted to give me a biopsy, and would probably be his attitude to treatment also, after which it's very likely that I would be impotent and incontinent. 'But,' my consultant would be likely to say then, 'you're alive!' To which I would be likely to reply 'That's a matter of opinion!' I hate to disagree with the medical professionals, but that's not my idea of being alive. Of course, if I really faced a choice between biopsy and treatment, with all the side effects, and death, I would be foolish to make the decision I have, but my assessment is that I'm not in that position, and since it's my life I'm going to back my assessment.
Anyway, that's the decision I've made, and my reasons for it. It's not the right decision for everyone, and I would never try to persuade anyone to do what I'm doing. We all have to weigh up our own personal circumstances and make our own decisions.Good luck to all of us.
Davey22 terryw
Posted
Terry,
I believe you made a very wise decision. Your psa has risen very little in the past years so there's no reason to be alarmed and listed to doctor who tells you to get a biopsy. They should take into consideration your age, your present health, and the slow rise in the psa numbers. That alone would tell me no further testing except psa monitoring. I've been reading about the negative effects of a biopsy, which is not good.
All cells are surrounded by interstitial fluid. This fluid drains into the lymph system through lymph channels, to the upper left chest, where the major lymphatic channel drains directly into a blood vessel. When a scalpel or needle invades tissue with cancer cells, there will be some bleeding, spilling cancer cells into the blood vessels or the lymph system via the interstitial fluid. Once a few of the billions of cancer cells break away and enter the bloodstream, they travel to distant organs and start to grow. This process is called 'seeding'. The dangerously high amount of radiation in PET and CT scans damages normal cells, which produce abnormal cells when they divide, and those abnormal cells can become malignant.
When performing prostate biopsies, doctors often aspirate cells from 30 different samples. Thirty chances for cancer to spread. While needle aspirations are safer than surgical biopsy, there are still dangers. Patients having prostate needle biopsies are seeing an increasing number of antibiotic resistant infections, such as E. coli. Two of every 100 men undergoing prostate biopsy will develop sepsis, a potentially lethal blood infection. Another study showed that 9 of 100,000 men who tested negative for cancer died within a month of their biopsy.
Remember the saying: Most men when they get older will have prostate cancer, but very few will die from it.
craig84609 Davey22
Posted
I couldn't agree more about the dangers of a biopsy. They stopped doing needle biopsy's on women that were suspect of having breast cancer, because it was proven to spread the cancer and make a bad situation worse. I believe this can also happen in men with PC, so not sure why they have not studied this more.
anne05147 terryw
Posted
I got the impression from one doctor my husband saw that having a psa level done causes more problems than it sometimes solves.
Stay well. All best wishes. Anne.
anne05147 Davey22
Posted
very interesting post, anything I find out here I pass on to my husband and he agrees it is not definite that he will opt for the biospy. Just awaitng the outcome of his next MRI which is booked for september.
Can you just say after having it all done MRI, Psa levels, etc., that you wish to only be monitored for psa levels for the future and review at intervals whether or not to proceed further? Does optionn remain open for further treatment if you decide at a later date?
Davey22 anne05147
Posted
Anne,
Well, not in my case. My biopsy showed cancer in 9 out of 12 samples with Gleason's 7 and one being an 8. I don't want PCa to spread outside the prostate. The urologists that I seen here all said that I should have it removed. Unfortunately, the HIFU didn't kill it all. I think I did choose the wrong treatment. Now I have to deal with this again. I'm trying to get the point across to all the men out there that has PCa with a Gleason of 8 that HIFU might not work for you. I just hope my next psa will be low enough that I don't have to get another biopsy. I hoping for the best, but the end result might just tell me that another biopsy is needed. Then I'll out for the latest in biopsy testing.
The result just may be that I need further treatment, and at this time, I don't know what it will be.
Davey22 anne05147
Posted
ES28567 Davey22
Posted
Hi Davey,
I had HIFU exactly one year ago. My cancer was 3+3. I also had severe BPH symptoms. Based on my last 3T MRI, the HIFU destroyed the cancer but I will continue to get checked and do follow up testing. The HIFU also helped my BPH symptoms to the point I did not need a TURP or any other procedures so far.
I'm sorry HIFU did not work for you. Is it possible another HIFU procedure would take care of the rest of the cancer for you? Also, just wondering who did your procedure, if you don't mind me asking.
Davey22 ES28567
Posted
How many biopsy samples were cancerous?
ES28567 Davey22
Posted
anne05147 Davey22
Posted
sorry to hear that, if you chose the wrong treatment you didn't know that at the time, and it's a hard lesson to learn but I hope whatever treatment you get for the future will resolve this for you once and for all.
What is the latest in biopsy testing you mention? Do you mean the transperineal biopsy?
Davey22 anne05147
Posted
Davey22 anne05147
Posted
A real-time prostate biopsy done in the bore (tunnel) of a magnet excels over all other biopsy methods. Standard 12 needle TRUS biopsies miss 30-40% of tumors. In-bore biopsy with fewer needles is twice as accurate. Also, “fusion” is called “MRI-guided biopsy” because it fuses previous MRI images with real-time ultrasound, but this process compromises accuracy.
3t Multi-Parametric MRI – BlueLaserTM empowers patients by providing accurate knowledge about what’s going on in their bodies. You should consider BlueLaserTM 3T mpMRI for early detection before other testing
anne05147 Davey22
Posted
sallie84 anne05147
Posted
anne05147 sallie84
Posted
Thanks Sallie. You are correct about the vague reports given by nhs reporting. I think we need better diagnostics and reporting so we were also going to get one done ourselves and pay for it ourselves but needed a referral from a doctor, when I asked for this the professor of urology asked to see us and said they would do this for us on a MP MRI scanner as part of a research trial. My concern is that men are being put through unnecessary biopsies because of inadequate diagnostics, so sometimes, if you can afford to, I would rather we pay ourselves if these resources aren't available on the nhs, to get a much better picture of what might be going on.