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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2008Why 18 cores instead of 12?
Hi all, Im going in for a prostate biopsy in 2 weeks or so. The Urologist says he wants to do 18 sticks. Most people I have spoken with have never had more that 12. So far as I know, there is nothing special about my presentation: 55 yo male, enlarged prostate X 15 years PSA rose from 2.4 in 2001 to 5.25 in 2008, no symptoms, no nodules or tumors on DRE. Why the extra cores? The doctor sort of made a half joke that as long as he's in there, there's no difference between 1 stick or 18. GMAFB. I'm a paramedic and I know very well what the difference is. I'm not happy with that kind of answer. He also put me on Avodart for a month before the procedure. Anybody ever heard of that? 1) Are there any extra complications from the extra sticks? 2) Are there any studies showing more cancer is found from 18 sticks as opposed to 12? TIA > Hi all, > [quoted text clipped - 16 lines] > He also put me on Avodart for a month before the procedure. > Anybody ever heard of that? Yes. Like Proscar it may shrink the prostate. > 1) Are there any extra complications from the extra sticks? > > 2) Are there any studies showing more cancer is found from > 18 sticks as opposed to 12? Yes, see http://content.karger.com/ProdukteDB/produkte.asp?Doi=82703 It's not entirely unusual to do 18 punctures in larger prostates. > TIA Piker, I had 18 sticks. Number has to do with prostate volume. Mine was large, 90cc plus. The after prostate is much smaller. Remember that the cancer is found via a stick. The large the prostate, increased sticks to find. You can have cancer that is not found; just depends if the cancer was where the stick (sample) was. If I have confuse you, take a lemon and stick 12 toothpicks in it. Then take an orange and stick 12 toothpicks in it. Now much of the orange did you miss with the 12 sticks? GD > Hi all, > [quoted text clipped - 23 lines] > > TIA > Im going in for a prostate biopsy in 2 weeks or so. > The Urologist says he wants to do 18 sticks. Most people > I have spoken with have never had more that 12. Good luck, Piker, It's not that we don't like you, but we really hope to revoke your temporary pass in a couple of weeks. This is not a club anyone wants to join. As you 18, I'd go for 24. Years ago, they did 6 and they missed a lot of cancer. Then they went to 9, then 12. Most now to 12, but I've heard a lot of guys here who did 12 twice and they found it the second time. The more you get, the better chance you have of your cancer being detected IF you have cancer. And, IF you have cancer, you WANT it detected before it escapes the capsule. > The doctor sort of made a half joke that as long as he's > in there, there's no difference between 1 stick or 18. > GMAFB. I'm a paramedic and I know very well what the > difference is. I'm not happy with that kind of answer. Yeah, six! You are right not to be happy with that answer. It is incomplete and does not address the reason for 18. However, he is right and I addressed the reason above. > He also put me on Avodart for a month before the procedure. > Anybody ever heard of that? I have seen few doctors do this, but it makes sense. Avodart is intended to shrink your prostate. It will not, I think, shrink your cancer. The smaller the prostate, the bigger the cancer, and the more needles, the better the chance of finding it. > 1) Are there any extra complications from the extra sticks? No. There is a very slight risk with biopsy, but they give you a strong antibiotic (Cipro?) for it. >> He also put me on Avodart for a month before the procedure. >> Anybody ever heard of that? [quoted text clipped - 3 lines] > smaller the prostate, the bigger the cancer, and the more needles, the > better the chance of finding it. Steve, I've been on Proscar (similar to Avodart, but a bit less potent) for about eight months. My prostate gland is about 40% smaller than it was. The PSA reading typically falls by 50% with Proscar. Mine is down about 70%. Can you tell me the basis for your belief that Avodart reduces prostate volume but does not shrink the cancer? If there's research on this, I'd sure like to study up. Alex >> I have seen few doctors do this, but it makes sense. Avodart is intended >> to shrink your prostate. It will not, I think, shrink your cancer. The >> smaller the prostate, the bigger the cancer, and the more needles, the >> better the chance of finding it. > I've been on Proscar (similar to Avodart, but a bit less potent) for about > eight months. My prostate gland is about 40% smaller than it was. The PSA [quoted text clipped - 3 lines] > volume but does not shrink the cancer? If there's research on this, I'd > sure like to study up. None, whatsoever, Alex. Like I said, "I think." Now, I would say, "I thought". The salient part was his doc is trying to shrink his prostate prior to the biopsy. I thought Proscar and Avodart did that, but I didn't know it affected PSA. On April 6, Alex wrote responded to Steve K: > I've been on Proscar (similar to Avodart, but a bit less potent) for about > eight months. My prostate gland is about 40% smaller than it was. The PSA [quoted text clipped - 3 lines] > volume but does not shrink the cancer? If there's research on this, I'd sure > like to study up. I'll inject myself in an effort to be helpful. Avodart (dutasteride) is approved by the FDA only for tx of BPH, not cancer. It effectively reduces the size of the prostate and it is hoped that that will relieve the urinary blockage at the area where the urethra passes through the gland. It blocks the enyzme 5-alpha reductase (5AR). That enzyme metabolizes testosterone (T) to dihydrotestosterone (DHT), which is several times more effective than T in nourishing PCa cells. Here is a portion of the latest FDA-approved label for this med: "Dutasteride reduces total serum PSA concentration by approximately 40% following 3 months of treatment and approximately 50% following 6, 12, and 24 months of treatment. This decrease is predictable over the entire range of PSA values, although it may vary in individual patients. Therefore, for interpretation of serial PSAs in a man taking AVODART, a new baseline PSA concentration should be established after 3 to 6 months of treatment, and this new value should be used to assess potentially cancer-related changes in PSA. To interpret an isolated PSA value in a man treated with AVODART for 6 months or more, the PSA value should be doubled for comparison with normal values in *untreated men*." (emphasis added) *NOTE*: This applies to men who are on tx for BPH, not for PCa. This has been a source of confusion ever since Proscar's label included similar verbiage. Fundamentally, once a man is dxd with PCa, his PSA readings are what they are, Proscar/Avodart notwithstanding. Here's something I had not heard of, from the label: "Men treated with dutasteride should not donate blood until at least 6 months have passed following their last dose to prevent pregnant women from receiving dutasteride through blood transfusion." Seems that it can cause birth defects in males. Details are extremely important, and can be found at http://www.rxlist.com/cgi/generic/avodart.htm Regards, Steve J Something to add to my above rant: Use of Avodart or Proscar in tx of PCa patients is "off-label," which does NOT mean illegal. Some medics (I know of one, not mine thank Bog) are afraid to prescribe it for any tx except that of BPH. They simply don't have the imagination to think for themselves, IMO. In short, they are not scientists. I'll stop now. Regards, Steve J > Something to add to my above rant: > [quoted text clipped - 10 lines] > > Steve J Do I gather that you are taking Avodart for your PCa? I had BPH long before the PCa was detected and have been taking Flomax for it. Helps a little but not much. I would have thought the radiation would have reduced the prostate volume but noooo. So I'm still taking Flomax and still have the BPH symptoms.  SignatureDedman -- Posted via a free Usenet account from http://www.teranews.com > Hi all, > [quoted text clipped - 11 lines] > The doctor sort of made a half joke that as long as he's > in there, there's no difference between 1 stick or 18. Makes sense to me... why not more now, instead of possibly missing, and having to do it again in a few months? Bottom line is that you sound unhappy with your uro... fire him and get a 12 core guy you like. SignatureJK Sinrod www.MyConeyIslandMemories.com |
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