Avoiding a Biopsy

[Sandy752]

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.

[Tall_Allen]

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.

[Sandy752 in reply to Tall_Allen]

Thanks.

[Dont08759]

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.

[longrungo2]

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.

[London441]

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.

[DLewis]

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

[cancerfox]

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. 🙂

[yamobedeh]

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.

[Sandy752 in reply to yamobedeh]

Thank you for your response. My friend is also in Canada and considering the approach you took. I appreciate all the other responses. I offer my friend advice as I'm still here (PSA ,26) 12 years after my biopsy but of course it is his decision.

[Wifey21]

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.

[Aussieguy1]

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.