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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2005question re: biopsy be newbie
Hi, I am new to this group and have a question. I am 48 year old male with psa of just over 2. Doctor wants to do biopsy because of my age and the fact that I am having some minor difficulty urinating. He says it shouldn't be over 1.6 - 1.8 at my age. He wouldn't do a free psa test since it wasn't over 4. My question is whether I should postpone the biopsy until I have had some subsequent psa tests that confirm the level. I would rather confirm the level with additional psa tests and free psa test before getting biopies taken. I am also concerned about "seeding" the cancer (if cancerous) by disturbing the prostate with needle biopsy. What is this groups' opinion? Lee Hello Lee, So far all I have read and heard is that a biopsy is safe. Your PSA seems very low. Other problems can make a PSA be above average. You can always consult another Dr. to get his opinion. I was diagnosed with Prostate cancer in 1999. I was 49 and my PSA was 6. I had a biopsy and it confirmed the suspicion.. I had RP in Nov. 99 and I am 55 now. I hope you find out and seeing another Dr. is really ok too! John Loomis > Hi, > I am new to this group and have a question. I am 48 year old male with [quoted text clipped - 12 lines] > > Lee Last year, I was 47 when I had a PSA reading of 4.9. Went for the biopsy and found 9 of 10 cores to be malignant. While a bit uncomfortable, it's not that bad - especially if they find cancer - that WILL be worse. Get the biopsy. Sandy K. > Hi, > I am new to this group and have a question. I am 48 year old male with [quoted text clipped - 12 lines] > > Lee Hard to say - I would take a second opinion from a Uro Reuben >Last year, I was 47 when I had a PSA reading of 4.9. Went for the biopsy >and found 9 of 10 cores to be malignant. While a bit uncomfortable, it's [quoted text clipped - 19 lines] >> >> Lee Hi Lee...I have added my comments within the body of your post...Best wishes and good health, Ron > Hi, > I am new to this group and have a question. I am 48 year old male with > psa of just over 2. Doctor wants to do biopsy because of my age and > the fact that I am having some minor difficulty urinating. He says it > shouldn't be over 1.6 - 1.8 at my age. Lee, is this your first PSA measurement? PSA is not an especially accurate marker for PCa. A trend seen in a number of consecutive readings would be much more informative than a single measurement. Also, anything that "massages" the prostate (like sex the night before the PSA blood draw, or if the doc does the DRE prior to the blood draw) can artificially increase the amount of PSA in the blood. So if this was your first PSA measurement it wouldn't hurt to get another measurement to confirm the accuracy of the first. > He wouldn't do a free psa test since it wasn't over 4. It has been shown that fPSA measurements are accurate and meaningful at least down to a total PSA of 2.6 (The Journal of Urology 2002; 168(3):922-925). I'd guess that it is probably meaningful at PSA ~ 2.0 as well. > My question is whether I should postpone the biopsy until I have had > some subsequent psa tests that confirm the level. I would rather > confirm the level with additional psa tests and free psa test before > getting biopies taken. There's no rush, PCa is very slow growing. The medical community says that taking a few more months to run tests, get educated and make a good decision should not cause problems. So get the tests you want. If your doc doesn't go along with this, fire him/her and get another one. > I am also concerned about "seeding" the cancer > (if cancerous) by disturbing the prostate with needle biopsy. Seeding along the needle tracks within the prostate has been reported in a very low percentage of prostate biopsies. However biopsy does not appear to spread the cancer outside of the prostate. Typically in early stage PCa, the cancerous cells have not yet developed the ability to live outside the prostate. If you do wind up having a biopsy, then you might see if color doppler TRUS imaging is available where you live. Color doppler provides enhanced images and makes targeted, rather than random, biopsies possible. > What is this groups' opinion? > > Lee My opinion is . . . you're asking the right questions. Too many men are more worried about a little possible discomfort than whether it's time for a biopsy. Tip: it doesn't hurt. Take a Tylenol afterwards and you'll forget about the whole thing within an hour . . . until you see blood in your fluids for a week or two and get a bit grossed out. I've sen no evidence that biopsies spread cancer. If I had an opinion on your timing, I'd offer it (no surprise there!). I.P. <Stevens_lee@hotmail.com> wrote > > What is this groups' opinion? > > Lee > Hi, > I am new to this group and have a question. I am 48 year old male with [quoted text clipped - 8 lines] > getting biopies taken. I am also concerned about "seeding" the cancer > (if cancerous) by disturbing the prostate with needle biopsy. Lee: I hear your concern! Is this your first PSA? What is "just over 2"? Can you be specific about your PSA score? Since you're having some trouble urinating has anything else been done for that? That is, have you taken any antibiotics like Cipro just in case you might have a prostate infection that is causing the urination problem and elevating your PSA? You are four years younger than I am and I can appreciate your worry about all of this. I might wait for a few weeks and do another PSA - a regular one - and then if it continues to be over 2 go ahead and get the biopsy. There is no evidence that a prostate biopsy "seeds" the cancer or that the disturbance of the prostate with a needle biopsy causes any health problems. The needle goes through the wall of the rectum right into the prostate gland that sits up against the other side of that wall. The cores are removed from one side, in a sense, of the prostate (the side that sits against the rectal wall). That is why even a needle biopsy can be somewhat inaccurate, in that it may not pick up on cancer on the anterior side of the prostate (the side that doesn't rest against the rectal wall). The biopsy plucks out a core of tissue and the chances of that process dropping or releasing cancer cells that can continue to live in that environment is very very slim. Any that might come out of the prostate and enter into the space outside the gland would find that to be a fairly hostile environment. The same is true for any that spills into the rectum. The "spread" of the cancer doesn't happen that way, it happens as cancer cells move through the seminal vesicles or through the blood or lymph or along the nerve bundles that infiltrate the prostate. But, as I understand it, if a cancer cell "erupts" from the prostate somehow and floats in that space around the prostate without being attached to tissue then it will die. If you do have cancer, wouldn't you want to know that sooner than later? OCL Lee, PSA testing only tells you you might have cancer. If the biopsy finds no cancer you may be ok, or the needles may have missed it. Then you can watch the PSA a while longer and maybe have another biopsy if your PSA continues to climb. If the biopsy finds cancer then you know you have to take some action. The biopsy does not preclude having seed thearpy. The earlier you find it the better off you will be. You didn't mention a DRE. Is your prostate enlarged? An enlarged prostate is an additional reason to have a biopsy. The biopsy is a simple procedure, mine was done in the uro's office. Have it done. Pete PSA just over 2 is not a warning sign on its own at your age. The difficulty urinating is obviously a significant concern, but cancer is not the most common cause of that with such low PSA, though you are young to have symptoms of BPH (benign prostate hypertrophy). How is your DRE - does the doctor feel anything unusual when they put their finger up your butt? Did they say whether your prostate seems enlarged at all? Have you had any infections lately? Have those been treated (if so, how)? As you have obviously found out, PSA/free PSA would help to suggest whether you are high risk for cancer, high risk for BPH, or somewhere in between. Ask your doctor why they believe a PSA around 2 would invalidate PSA/fPSA. Also ask what region of the prostate they want to biopsy. The normal region that is biopsied for PCa is not the region that usually causes urinary symptoms. Buy Peter Scardino's "The Prostate Book" for some good diagrams and lots of information about possible causes of your symptoms - it will put you on more of a level footing with your doctor when discussing all of this. Whatever you do, don't delay doing it. If the DRE is normal, there is only a small chance you have something very nasty going on in there on the evidence you have given us so far, but this is not a smart time to be taking chances. I'd be tempted to find a second opinion (and not within the same practice, obviously). Finally, IF your doctor gets mad at you, tries to brush you off when you start asking lots of questions and demonstrate that you have done some study on the subject, or tries to railroad you along with inadequate explanations, FIND A NEW DOCTOR, period. This is your life, you get to make the decisions. Hi, Thanks for all the replies so far, My actual PSA was 2.08. DRE showed nothing unusual and no mention from the doctor as to why the trouble urinating. I have not taken any antibiotics. PSA test was in January, Doctor visit was in May when he said he wanted to do the biopsy. I am thinking another PSA should probably be done. This time, i will make sure there was no sex recent before the test and I will stop the saw palmetto, pygeum bark, and stinging nettle extract i am taking prior to the test. Lee Lee, the folks here have given you great advice as they always do. Another test...a second opinion...all correct. The only thing that I can add is that if you DO have a biopsy...don't worry. It won't hurt as they usually use lidocaine injections these days. You can walk right out...drive...and do whatever you want. Blood in urine for a few days...in semen for maybe 2 weeks. No other problem. Good health, which is likely, Ron B. Chicago > Hi, > Thanks for all the replies so far, My actual PSA was 2.08. DRE showed [quoted text clipped - 6 lines] > saw palmetto, pygeum bark, and stinging nettle extract i am taking > prior to the test. Lee: Aha! :-) I'd do another PSA then since this one was in January. I am really interested though in the difficulty urinating and you're taking saw palmetto. So there's some chance that the saw palmetto has shrunk your prostate or reduced some swelling. You sure could have a low grade prostate infection or inflammation. Prostatistis can be tough to treat sometimes. But a PSA of 2.08 and difficulty urinating with no signs of swelling on a DRE isn't unheard of for infection or inflammation. A biopsy if your PSA is still higher would at least rule cancer in or out. How much saw palmetto are you taking? It works really well for some men. It did for me at 48 when I had difficulty urinating. But, then four years later I was diagnosed with PCa. I suspect that I had an infection or inflammation back then four years ago that I self-medicated with saw palmetto and it went away, but that it meant that some of my prostate cells began their journey to cancer. OCL > > Hi, > > Thanks for all the replies so far, My actual PSA was 2.08. DRE showed [quoted text clipped - 26 lines] > > OCL OCL, I am taking 160 mg saw palmetto, 50 mg pygeum bark and 120 mg stinging nettle. The urinating difficulty is not really a difficulty, it is just a weak stream and have to get up one to two times a night. What happened in your case? What grade cancer did you have and how was it treated? Lee >> How much saw palmetto are you taking? It works really well for >> some men. It did for me at 48 when I had difficulty urinating. [quoted text clipped - 3 lines] >> that it meant that some of my prostate cells began their journey >> to cancer. > I am taking 160 mg saw palmetto, 50 mg pygeum bark and 120 mg > stinging nettle. The urinating difficulty is not really a difficulty, > it is just a weak stream and have to get up one to two times a night. > What happened in your case? What grade cancer did you have and how was > it treated? Lee: Four years ago - 48 like you - I went through a period of maybe three months where I had the urge to pee, but when I stood there I would pee a little and then stop and start to walk away and, darned if I didn't turn around and stand longer and pee a little more and repeat that about three or four times. So I had a little trouble initiating the stream and it was weak and I just wouldn't empty my bladder. So I thought about going to the doc and then decided, Hey you just have an enlarged prostate! And I knew that Saw Palmetto can help some men with that so I started taking it and within two weeks it was all better. Anytime I stopped taking it, the problem would return. I tried stopping maybe twice or three times and each time it would return. So finally I just decided that I'd take the Saw Palmetto forever. So then four years after that I have my first PSA at 52 and it is 15.3 and I have a biopsy and I have Gleason 3+3 and I opt for robotic laparoscopic and that goes well and the pathologist looks at my prostate and sees this one ginormous tumor about an inch in diameter that wasn't picked up on the ultrasound that I had with the biopsy and my prostate had more cancer than the biopsy predicted and I was upgraded (downgraded?) to a Gleason 4+3. So, given the grade, surgery was probably the best choice in hindsight. Margins free of cancer, no seminal vesicle involvement. Continent when the catheter was removed other than for some drips now and then. Nerves spared. Looking back ---- which many of us tend to do -- I should have gone to my family doc at least when I had the pee problem. Perhaps I had an infection or an inflammation and I should have had a long course of Cipro or another antibiotic to try and clear it up? Maybe I should have taken Finasteride - Proscar? While there is no clear link between Benign Prostatic Hyperplasia and PCa, there is pretty good evidence that infections and inflammations in the prostate can nudge prostate cells into become pre-cancerous - Prostate Intraepithelial Neoplasia (PIN) - cells. So I probably should have been more aggressive with that back then and not just taken the Saw Palmetto. Something to consider would be to increase your Saw Palmetto dose. I take 160 mg of Serenoa repens - Saw Palmetto - extract twice a day. So I take double your dose. You could double what you're taking and see if that helps with the stream. In any case, if I were you (and I'm not) - and I'm not a doctor - I would take 30 mg of Lycopene a day and/or eat lots of processed tomato products, drink a glass or two of red wine a day, and consider adding green tea extract. As soon as I knew that I had PCa after my biopsy I also added Paw Paw twig extract (I know it sounds weird). Knowing what I know now I would probably buy PC-Res (a clone of PC-SPES that was removed from the over the counter market back in 2002 because it had trace elements of Warfarin and DES - a synthetic estrogen in it). If my PSA comes back when I have it done in July I will start taking PC-Res. It is a combination of eight Chinese herbs. Before its removal from the market it had been showing remarkable results in controlled studies at major university-related cancer centers. The Warfarin and DES in it were in trace amounts and not nearly enough to explain its effect. Anyway..... that's more than you asked and more than you probably wanted to know. Best wishes to you! Whatever happens, you're going to be OK! OCL >Hi, >I am new to this group and have a question. I am 48 year old male with [quoted text clipped - 12 lines] > >Lee Given your low PSA reading, the logical NEXT thing to do if you're having difficulty urinating, is to get an EXTERNAL renal and prostate ultrasound done. Although the imaging on this is a bit hazy, you can get a report if your kidneys and bladder are OK, they can give a close approximation of your Prostate volume, plus they get you to empty your full bladder and then return to measure the amount of urine retention after voiding. When you revisit the Urologist, he may wish to perform a Cystoscopy on your bladder and urethra to determine any cause of obstruction. Then the Uro should perform a DRE and if he finds palpable lumps, get referred to a reliable Specialist Clinic that does Biopsies on a regular basis. The better the operator, the more accurate the Biopsy. The Uro will have already put a preliminary T staging on the Tumour. If no palpable lumps are felt, you may have BPH or Prostatitis, which are treated in other ways. NB: Some Uros don't find palpable lumps and evidence of a Tumour is not revealed until a SUCCESSFUL Biopsy is done and Reported on showing Gleason Scores demonstrating malignancy for the most significant sampled cores sampled. It's like finding your way through a minefield, blindfolded, but you can rationalise about it all by applying some logic and also getting 2nd and 3rd opinions. -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC > Hi, > I am new to this group and have a question. I am 48 year old male with [quoted text clipped - 10 lines] > > What is this groups' opinion? First, the docs say that the biopsy won't spread the cancer. Second, the biopsy is not a big deal. I didn't like it because I knew what he was doing and I have a vivid imagination. I had it both without the topical anesthetic and with it. Neither time did I really feel anything. It's just I don't like needles or surgery. In my case, there was a teeny bit of blood in my urine and red ejaculate for a week. Not a big deal. Third. If your doc says you need a biopsy, you need it. Both myself and an associate have had false-negative biopsies. Think about that. PSA is rising. The first biopsy comes back "all clear". You go about your business, fat, dumb, and happy for a year or so. Then, on the 2nd biopsy or the 3rd or 4th, they finally find cancer. In my case 2 years passed. The sooner you know the better. Early on, you have lots of treatment options, surgery, robotic surgery, external rad alone, external rad and seeding, seeding alone. Later, there are fewer options and the odds of a cure drop. Lee, how long have you been getting PSA tests? If longer that a couple of years A) I commend you, and B) you should be able to see what your PSA has been doing. If it has been increasing steadily to 2.0, I'd get the biopsy. If this is your first, and it probably is since most men are told to start at 50, then I think I would ask for the fPSA. Especially if you are squeamish about the biopsy. But, in reality, the biopsy is nothing to fear. I never felt a thing. Some do, but I did not. For that matter, a biopsy can miss the cancer. A PSA or fPSA is not absolute, but it's nice to have the whole picture.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > Hi, > I am new to this group and have a question. I am 48 year old male with [quoted text clipped - 12 lines] > > Lee Lee, I was 50 when my PSA adventure began. I think you will suffer far more from anxiety about the biopsy than you will from just getting it. steve U Hi Lee: By far for me the worst part of the biopsy is finding out that you have PC afterwards. The actual procedure is nothing to be concerned about if it's physical pain that you are worried about. B.A. |
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