Forgoing Regular Prostate Biopsies

[Chrisopopolis]

I was diagnosed with T1c, Gleason 3+3, Pca in late 2019, with a PSA level of 3.5. The DNA test on the cancer tissue (found in 30% of 1 core out of 13, in the zone shown on the MRI), predicted 1% chance metastasis within 10 years and put me in a Very Low Risk category. My subsequent PSA levels have fallen to approximately 3.0 and stayed there. I will have an MRI taken tomorrow and my urologist at UCSF is recommending another biopsy be taken now.

I am electing to forgo the biopsy unless the MRI shows changes that would warrant further invasive screening. I had several complications from the first biopsy (Prostatitis, bleeding in the urethra for two months afterward, and significant side effects from the antibiotics) that make me less inclined to agree to more biopsies.

Any thoughts or shared experiences would be appreciated.

Chris

[Tall_Allen]

You wrote that there was cancer found "in the zone shown on the MRI." That increases the risk that they missed some significant cancer that was there. If your MRI confirms an elevated PIRADS score, I think it is prudent to have a confirmatory biopsy of at least 4 cores from the suspicious area. It should be a transperineal biopsy, which can be done without antibiotics.

[Chrisopopolis in reply to Tall_Allen]

Yes, my understanding was that the cancerous tissue was found in the same area the MRI indicated as suspicious. I appreciate the idea of a more focused transperineal biopsy that wouldn’t require antibiotics. I’ll talk to my urologist (Shinohara) about this if the MRI PIRADS score increases. My antibiotic reaction was to Cipro as Addicted2cyclling had guessed.Thanks for your input.

[Bigm789 in reply to Chrisopopolis]

Take levoquin instead once daily instead of 2x vs Cipro

[cesces in reply to Tall_Allen]

I thought that the current state of art with MRI scans was that for purposes of making treatment decisions, they are as good as biopsies.

[Tall_Allen in reply to cesces]

Absolutely not.

[tsim in reply to cesces]

Not yet, choline-citrate ratio spectroscopy mapping has great promise but it's a long way from replacing the biopsy. If you're interested, here's a little light reading from when the research began:

ncbi.nlm.nih.gov/pmc/articl...

[addicted2cycling]

I'm thinking you had a *targeted TRUS* with the fluoroquinolone antibiotic ciprofloxacin (Cipro), that the FDA has cautioned (Black Label warning) the medical field regarding dangerous side effects and agree with T_A that a transperineal biopsy with a greater number of cores in the MRI indicated area be performed.

[tsim]

Change in PIRADS would certainly be a trigger

[Clutterduck]

In the UK. I was diagnosed with an enlarged prostate 15 years ago, just after I turned 50. I had around 3 negative biopsies around that time, with the 2nd and 3rd each more painful than the previous one. (Detailed test results weren't provided to patients back then.) I had similar after-effects such that I have stated that I am reluctant to submit myself to another biopsy. I have been on Dutasteride for the whole duration and my seminal fluid production is very low. I have been prescribed Tamsulosin a couple of times but this doesn't seem to provide any benefit; it stops ejaculation completely, so I have stopped taking it.

I have annual PSA tests with recent scores of just under 4. My condition is manageable, although I do have some pain - particularly at night when it keeps me awake. I can relieve this to an extent by sitting up in bed and I usually fall back to sleep. I sleep separately from my wife so that she can sleep undisturbed. I was referred to a urologist last year but he had nothing to offer. I have never been offered an MRI.

[addicted2cycling in reply to Clutterduck]

Thanks for joining HU. You did not give any information other than age being 66 so the wealth of knowledge here on HU will find it hard to funnel helpful information back to you.

If you care to provide --- e.g. >> height, weight, exercise activity level, diet, stress level, type of biopsy (most likely less than adequately accurate TRUS method), supplements ....

PAIN is not good so it might be advantageous to consider a 3TmpMRI as a non-invasive checking of prostate region.

[Clutterduck in reply to addicted2cycling]

Thanks for your reply, however my intention was really to give my story in response to the OP’s request for shared experiences rather than to ask for advice. The biopsies were trans-rectal. I would appreciate an MRI scan but have not been offered one on the NHS NICE protocol. It’s particularly difficult to access NHS services at present because of the coronavirus and this is likely to remain the case for several years.

[addicted2cycling in reply to Clutterduck]

Sorry for BUTTING IN 😀, I did not mean to offend. Just found it interesting and sad that the biopsies were painful. Trans-Rectal are not very accurate and that is why the Transperineal is becoming the preferential method.

GOOD LUCK 👍 in obtaining an MRI.

[Clutterduck in reply to addicted2cycling]

I’ve read that some people have local anaesthesia but others don’t. I can’t remember whether I did or not. I got the impression they kept wanting me to have another because they weren’t getting the right result 🤣. It’s a hit & miss method (literally) and brutal. I wasn’t aware of a transperineal technique. I’ll have to investigate.

[addicted2cycling in reply to Clutterduck]

Here's a link for Transperineal Biopsy under a local anesthesia info ---

grandroundsinurology.com/tr...

Another link r.e. -- State of the Art info ---

grandroundsinurology.com/tr...