High PSA, biopsies, cancer

[Jaydubbs]

I have been combing the forums regarding PSA test, TRT, biopsy, non-invasive diagnostics and related.

I am 70yo, and take 40mg Test Cyp twice weekly. I have ben on TRT for almost 2 years. I do have ED issues but that predates TRT use by several years and was not the reason for starting TRT in the first place.
I recently got a psa score of 14 and my Uro wants biopsy on the test results only. I have NO family history, am Caucasian, I don't get up during the night. I havent had a DRE in a year and there has been no mention of other less invasive diagnostics (4-score, urine, possible prostatitis, MRI guided or other?) I am being handed off to a doctor who does the biopsies.

Also I live 2 hrs from my Uro ( I kept him after I moved away because it was easy only going there every few months.) I can imagine this will result in many 2-hr drives.

I feel better than I've felt in memory. I understand that biopsy can cause permanent or long term harm and I want to investigate other procedures.

I live in the Cleveland area. Would love it If anyone can recommend a Urologist up to date on these issues.
TY

 

[t_spacemonkey]

you are willing to look into alternative therapies; Prostate problems - MMS Testimonials - Master Mineral Solution, Miracle Mineral Solution

 

[Deleted member 16042]

14 is indeed high. If you are having no prostate or lower urinary tract symptoms, I am a bit more worried. If you had symptoms, it could just be from BPH. If you had any urinary tract infection symptoms, could be infection. I would not put off diagnosis, but I also would not rush anything. Some urologists are very good at provoking undue urgency. If it is prostate cancer a week or two to do research and make a decision isn't going to make any appreciable difference. I would not however put it off for months.


I personally believe in more value from MRI before biopsy. Waiting for the order to come through for my third in 4 years...

The standard exploratory TRUS biopsy misses a tremendous amount of the gland, and there is no specific targeting of suspected trouble spots. It is just an evenly spaced spread in a grid pattern and all the territory between the grid points can contain lesions.

An MRI will show potential lesions which can then be targeted for biopsy either with MRI fusion overlay, which overlays the MRI image with the ultrasound used during the biopsy targeting, or better yet, targeted biopsy "in bore" of the MRI machine, where the practitioner does an MRI scan for every sample taken to ensure proper targeting. The "in bore" MRI biopsy is harder to come by. I traveled out of state to have that done once. (Tangent: My own case has been an odd one, the prostate problems are from a combo of BPH, and infiltration of the gland with leukemia cells, not prostate cancer. My PSA has been as high as 11.2)

To my knowledge, whereas complications from prostate surgery and removal are all too common, serious biopsy complications are not so much. Discomfort and anxiety, yes, of course! It is not pleasant.

I did have trouble, due to a very suspicious MRI, had 26 cores taken in bore MRI, which is a lot. I had to go to the ER 24-48 hours later because I could not urinate, and get a catheter for about 5 days, which was quite the misery. Ejaculate will turn black from bleeding for a few weeks, which is normal, but disturbing.

 

[Jaydubbs]

14 is indeed high. If you are having no prostate or lower urinary tract symptoms, I am a bit more worried. If you had symptoms, it could just be from BPH. If you had any urinary tract infection symptoms, could be infection. I would not put off diagnosis, but I also would not rush anything. Some urologists are very good at provoking undue urgency. If it is prostate cancer a week or two to do research and make a decision isn't going to make any appreciable difference. I would not however put it off for months.


I personally believe in more value from MRI before biopsy. Waiting for the order to come through for my third in 4 years...

The standard exploratory TRUS biopsy misses a tremendous amount of the gland, and there is no specific targeting of suspected trouble spots. It is just an evenly spaced spread in a grid pattern and all the territory between the grid points can contain lesions.

An MRI will show potential lesions which can then be targeted for biopsy either with MRI fusion overlay, which overlays the MRI image with the ultrasound used during the biopsy targeting, or better yet, targeted biopsy "in bore" of the MRI machine, where the practitioner does an MRI scan for every sample taken to ensure proper targeting. The "in bore" MRI biopsy is harder to come by. I traveled out of state to have that done once. (Tangent: My own case has been an odd one, the prostate problems are from a combo of BPH, and infiltration of the gland with leukemia cells, not prostate cancer. My PSA has been as high as 11.2)

To my knowledge, whereas complications from prostate surgery and removal are all too common, serious biopsy complications are not so much. Discomfort and anxiety, yes, of course! It is not pleasant.

I did have trouble, due to a very suspicious MRI, had 26 cores taken in bore MRI, which is a lot. I had to go to the ER 24-48 hours later because I could not urinate, and get a catheter for about 5 days, which was quite the misery. Ejaculate will turn black from bleeding for a few weeks, which is normal, but disturbing.

As it turns out, I have been diagnosed with PC (4+3=7 Gleason). Now wading through information here and elsewhere to guide the decision. The Uro who did the biopsy is a Surgeon and has suggested surgery.

​

 

[Deleted member 16042]

As it turns out, I have been diagnosed with PC (4+3=7 Gleason). Now wading through information here and elsewhere to guide the decision. The Uro who did the biopsy is a Surgeon and has suggested surgery.

​

Sorry to hear that.

Yes, surgeons predominantly want to do surgery, but there are other options if the cancer is localized and contained well within the gland. TULSA PRO, HIFU, Laser, etc

I had my 3rd MRI and the lesion is looking a bit worse, and prostate volume has increased. The lesion has been determined possible low grade cancer, but very low risk for high grade, and well within treatment margins for TULSA-PRO. I am scheduled for that plus a vaporization procedure to take care of a medial lobe which contributes to BPH, enlarged prostate symptoms. Essentially 80-90% of the gland will be ablated. The advantages of TULSA PRO over surgery is far less risk of ED, though will result in dry ejaculations.

Every case is different. Hope you find the best option for your own needs!

And if you haven't found it yet, try the Inspire prostate cancer forum https://www.inspire.com/groups/zero-prostate-cancer/

 

[Vtail]

I had an MRI 3 years ago because my PSA had been trending upwards. At that time my PSA had gotten up to about 4.4 and I was getting up to pee 2 or 3 times per night. The MRI showed a slightly enlarged prostate but nothing suspicious. For the last couple of years my PSA has been bouncing between 3.5 and 4.5, and on the last test it hit 5.4. Although for some reason these days I only get up once per night to pee, and sometimes none. My urologist wants to send me for another MRI. He said that if the MRI shows anything suspicious he will then do a fusion biopsy. If the MRI does not show anything suspicious, he wants to do a biopsy anyway (but it would not be a fusion biopsy). Does this make sense to those more experienced on this topic? I thought if the MRI was clear, then all is good for now.

 

[Jaydubbs]

I had an MRI 3 years ago because my PSA had been trending upwards. At that time my PSA had gotten up to about 4.4 and I was getting up to pee 2 or 3 times per night. The MRI showed a slightly enlarged prostate but nothing suspicious. For the last couple of years my PSA has been bouncing between 3.5 and 4.5, and on the last test it hit 5.4. Although for some reason these days I only get up once per night to pee, and sometimes none. My urologist wants to send me for another MRI. He said that if the MRI shows anything suspicious he will then do a fusion biopsy. If the MRI does not show anything suspicious, he wants to do a biopsy anyway (but it would not be a fusion biopsy). Does this make sense to those more experienced on this topic? I thought if the MRI was clear, then all is good for no

Be aware that most PCa is asymptomatic and many of the "symptoms" associated with enlarged prostate frequent and difficult urination are NOT PCa.
I had a Trans perineal biopsy 8/1 which did reveal cancer. Not sure why your doc wouldn't do fusion biopsy. I would think he or she would want the best targeting possible. The problem with biopsies is that cancers get missed.

 

[Vtail]

Not sure why your doc wouldn't do fusion biopsy. I would think he or she would want the best targeting possible. The problem with biopsies is that cancers get missed.

This particular doc said the fusion biopsy is done only if the initial MRI shows something suspicious.

 

[MDavidW76]

Ask for PSE test and PET scan