A 79-year-old friend with a PSA of 12 (was 6 two years ago) does not want to get a biopsy for various reasons. He is considering getting an MRI instead. How much will that tell him? I got a biopsy when it was recommended so am not clear on how much one can learn from MRI of the prostate.
Avoiding a Biopsy: A 79-year-old friend... - Prostate Cancer N...
Avoiding a Biopsy
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An ordinary MRI is pretty useless, unless the prostate tumors are very large, but he would still need a biopsy. An mpMRI is pretty good at finding significant prostate cancer, but he would still need a biopsy.
if he’s really anxious about the biopsy, tell the urologist you want to be anesthetized. I know it’s rare, but worth a shot.
Beginning in 2015, in my late 60s, during an 18-month period of fairly frequent international travel I experienced repeated diffuse pain in lower back and abdominal areas, which led me to consult several GPs or internists. I did several PSA tests (non-linear results fluctuated between 3.8, 4.0 and 4.4 over a many-month period) and did an abdominal-region sonogram, which found the prostate and other organs/structures to be 'normal'.'
The GPs opined that my PSA numbers were also 'normal.' It was only in the late summer of 2017 that I finally consulted a urologist, who thought my PSA numbers were not 'normal' and of course did a digital rectal exam and found a hard 'nodule' on the prostate. He recommended a biopsy in short order. Being in Eastern Europe at the time, I was hesitant to do the biopsy there and opted for an MRI instead. The MRI confirmed the existence of a tumor, with some extra-capsular extension. As soon as I returned to the US in early October 2017 I did the biopsy with a good DC urologist, which yielded Gleason 9 (4+5) results in many, if not all cores.
So, in early December of 2017 I did a laparoscopic RP at Johns Hopkins, which revealed invasion of one seminal vesicle but not to 11 lymph nodes, and the surgeon was able to deliver negative margins. With a young child in Europe I could not stay in the US for 39 weeks to do radiation of the pelvic area. My post-op PSA of 0.1 slowly began to rise over the following summer of 2018 and I soon went on ADT of ELIGARD 45mg and daily 50 mg of Casodex.
I experience persistent side-effects from the surgery and (manageable) side-effects from the ADT, but my PSA, as of a month ago, has remained at 0.02. Fingers crossed.
Thank you for reading my longer account. M y main point is - I agree with Tall_Allen - that a biopsy is still required to determine the nature of the cancer and to arrive at a Gleason score. Crucially important.
I do know a couple of men in their late 70's who don't want to know their Gleason score. I guess it depends on each man's notion and approach to his life-expectancy.
No one wants a biopsy, but if it’s done correctly it is not particularly painful and provides essential information a MRI cannot, as has been said. Perhaps you can change his mind.
A history of hemorrhoid issues might make going under easier. I was knocked out for mine. The doc didn't think I could take it. Afterwards he thought maybe i could have. I later had a fusion biopsy under a local with no problems
Not sure why he doesn't want a biopsy, but with that PSA he needs to do something. Mine was only 7.5 and I had Gleason 9 prostate cancer on half of my prostate. When they did my biopsy they gave me a shot of pain deadener in the area and I hardly felt the biopsy, just a sort of poking feeling, so it wasn't that bad. It was a little awkward, though, kind of like a colonoscopy. 🙂
I did a variety of diagnostic tests in an attempt to avoid, or at least delay having a biopsy. I could not get a requisition for an MRI in Canada, (likely because several DREs and prostate ultrasounds indicated nothing of concern) so I paid for one in Buffalo. The radiologist said I had 2 large tumours in the prostate. Then, I accepted the fact that I needed the biopsy, which I had shortly afterwards. If your friend is worried about anticipated pain, as I was, I'd suggest asking the person doing the biopsy to apply extra lidocaine (and for enough time for it to take effect) and ask ahead of time for whichever sedative they provide. I found the snapping of the needle more uncomfortable than the pain of the procedure, which was quite manageable. I'd do it again without hesitation, if it were necessary.
My husband has been recently diagnosed with early stage & therefore very treatable prostate cancer. His PSA was 6.6 but his PSA density was 0.23 which triggered biopsy. Rectal exam, ultrasound & MRI picked up nothing suspicious, just a slightly enlarged prostate. It was the biopsy that identified the presence of cancer in 7 of the 24 cores.
He didn't look forward to the procedure especially as he has historical haemhorroids (which incidentally were affected but settled ).
Doing something now has given him a better prognosis. We would encourage your friend goes for the biopsy from our personal experience.
request a biopsy through the perineum, rectal approach biopsies are known for a higher infection rate post biopsy. Am mpMri beforehand will target the area they need to take the core samples from. I am 63. I had my biopsies done through this approach with a light general anaesthetic, minimal discomfort after, just a surprising amount of blood over a period of time in ejaculate.
You will not get a definitive diagnosis of prostate cancer and grade without a biopsy.