how many biopsies are taken before discovery of prostate cancer

My son-in-law's father required 3 biopsies before a positive diagnosis could be made. A prostate biopsy unlike the typical excisional biopsy of a suspicious mass is more chancy because of the nature of prostate cancer. Prostate cancer doesn't occur as a single visible or palapable mass as do most solid tumor cancers. Instead prostate cancer is multi-focal which means it occurs in several microscopic clusters of malignant cells. The biopsy which is done by taking several to a dozen or more needle core samples is like sticking a neddle into a lemon several times attempting to spear a pit. This process and the nature of P.C. produces a large number of false negatives. Even with ultra-sound guided needle biopsies its still largely hit or miss over 25% of the time. With a rising PSA its prudent to repeat the biopsy if it comes up empty the first few times. The Mayo Clinic urologist who biopsied my son-in-law's father who came up negative the first two times said,"I know its in there
somewhere and we stop until we find it". Good thing he was persistent. They finally found it and it was very small, localized and early stage but aggressive.
He had a prostatectomy and had excellant post-op pathology. Clear margins, negative lymph nodes and organ confined. Eight years later his PSA is still undetectable and the Dr. considers him home free.

My husband had two negative biopsies. No one seemed concerned, over years. Said that was his baseline PSA level. Then, when his PSA started to rise slightly, they suggested another. Thankfully, because he had two negative ones, they recommended a saturation biopsy which is much more intense and much more accurate. PC was detected.

I wish it were detected earlier. The cancer was aggressive and surgery was done within a week.

However, it was contained. Gleason was 3+4=7. Lymph nodes and seminal vesicles clear, negative margins after surgery. PSA now 0. We are lucky, and greatful. It has only been 13 weeks. No incontinence. Still dealing with some ED issues.

49 years old at the time.

It's been tough. We requested all medical records from the prior urologist (who he had the negative biopsies with) and nothing was found, but, he was at increased risk which we were not aware of. More education on PC and prevention (or increasing chance of prevention) needs to be taught early on. Maybe our lives would have been different, or this would have happened later in life, who knows. We are preaching this now with our son. I don't want to think of him dealing with this.

It depends on how large the tumor is and how large the prostate is

I have a friend who is scheduled for his 9th biopsy. All of the previous ones came back negative and yet, he consistantly has elevated PSA readings. He's in his late 40's and says he wishes they would find something soon. He says he can't take it too much longer.

:(

In my case; three over a period of nine years. Two friends were positive on the first try.

I have a friend who is scheduled for his 9th biopsy. All of the previous ones came back negative and yet, he consistantly has elevated PSA readings. He's in his late 40's and says he wishes they would find something soon. He says he can't take it too much longer.

:(


Hi Able 5,

There actually are other tools your friend could use, tools I sure would use if I were him. (I wish I were him, even with nine previous tries. My biopsy was probably simple for the surgeon as I doubt he could have missed the PC even if he had tried. ;))

One tool is the PCA3 Plus (trademark) test for a protein that is found only in prostate tissue. This test is the second generation, improved version of the uPM3 test that was also a marked improvement over the PSA test. I just did a web search, and it appears there are at least two labs that offer this test. (I knew of only one lab before this search.) If the sample is positive, then the patient has a high likelihood of having prostate cancer. This test can also be used by men trying to decide whether to have a first biopsy. :)

Another tool is a color Doppler ultrasound guided biopsy, though it is apparently not quite as good as a saturation biopsy like the one mentioned in another post, is less invasive, and provides a lot of information based on much more precise targeting of likely cancer locations than a conventional ultrasound-guided biopsy. Recent new blood vessel growth, needed to support growing tumors, shows up red, and that gives a much greater chance of finding prostate cancer and defining its location and extent rather precisely. :)

All this said, having one or more negative biopsies counts as one favorable risk factor assuming the doctor performing the biopsy is competent. :)

Jim

Guess we need to remember that there is no Positive PSA count. PSA does not determine prostate cancer. It can indicate prostate cancer BUT there are thousands of people who live with elevate counts in the hundreds that do not have cancer. There are support groups for these guys. It is stressful. How they will ever know if they do, i have no clue.

But, there is a great deal of info on this. That is the main reason that the cancer society does not back PSA as a cancer test. It is not indicative of cancer. Just that the antigen count is elevated.

Guess we need to remember that there is no Positive PSA count. PSA does not determine prostate cancer. It can indicate prostate cancer BUT there are thousands of people who live with elevate counts in the hundreds that do not have cancer. There are support groups for these guys. It is stressful. How they will ever know if they do, i have no clue.

But, there is a great deal of info on this. That is the main reason that the cancer society does not back PSA as a cancer test. It is not indicative of cancer. Just that the antigen count is elevated.

Debbie,

Can you provide any leads to information on a large group of men with very high PSAs and the support groups? I know that infection and other causes can result in very high PSAs (as well as high but lower PSAs), but I've never heard of support groups for such patients, and I would like to know for reference. By the way, there are men at the other end of the extreme, as you may know: some men with Gleason Scores in the 8 to 10 range, and some men with rare subtypes of prostate cancer such as "small cell prostate cancer," actually underproduce PSA. Fortunately, the vast majority of us are not at these extremes and PSA is a fairly decent indicator of the likelihood of cancer, but by no means definitive, as you stated.

Regular DRE's (Digital Rectal Exams) could help such high PSA men guard against prostate cancer to some extent. Probably the PCA3 Plus and "free PSA" tests could also help.

In the past few years some of these other tests, coupled with PSA, have given us a much better indicator whether or not there is cancer. Another clue that has been refined in recent years is PSA velocity - how fast it is increasing, rather than just a one-time snapshot of a certain PSA level.

Actually, the American Cancer Society is rather strongly supportive of PSA testing, though it also feels that men should be advised of pros and cons of having the test. In fact, a group I belong to gave out some ACS materials on screening to attendees at a recent large health related event.

Here are some excerpts from that 2002 ACS 14 page pamphlet entitled "Facts on Prostate Cancer And Prostate Cancer Testing." "The Best Defense: Early Detection The earlier prostate cancer is found, the better the chances are that it can be treated effectively.... Two tests are commonly used to detect prostate cancer: the PSA blood test and the digital rectal exam (DRE). PSA (prostate-specific antigen) is a protein produced by prostate cells. High levels of PSA in the blood are found with a number of prostate conditions, including prostate cancer.... If either the PSA blood test or the DRE raises concerns, further tests will be done.... The American Cancer Society Recommends: At age 50, talk with your doctor about beginning yearly prostate-specific antigen (PSA) blood testing and digital rectal exams (DRE's) of the prostate gland. You and your doctor should consider your overall health and life expectancy. Men who are in high-risk groups, such as African Americans or men who have a history of prostate cancer in close family members, should begin testing at age 45. Prostate Cancer Testing: A Personal Decision It comes down to this: Each man's situation is different. To decide what is best for you, discuss early detection tests for prostate cancer with your doctor. For your own health and peace of mind, the American Cancer Society recommends that all men understand the benefits and limitations of early detection and treatment of prostate cancer before testing."

I feel that is good but overly conservative. I would like a stronger emphasis on the need for testing, COUPLED WITH SMART DECISION MAKING AFTERWARD (often flawed), but you can see that the ACS generally favors testing.

On the other hand, the US Preventive Services Task Force, a federal Government advisory group, still is neutral toward testing, having fairly recently changed its stance from actually opposing testing. That might have been the group opposed to testing (in earlier years) that you recalled.

Jim

I have a friend who is scheduled for his 9th biopsy. All of the previous ones came back negative and yet, he consistantly has elevated PSA readings. He's in his late 40's and says he wishes they would find something soon. He says he can't take it too much longer.

:(

9 Biopsies.... He's having his prostate removed one needle full at a time! On one hand I really hope they never find cancer, and on the other I hope the biopsy count does not get into the twenties.

I found my first and only biopsy painfull enough.

Roger

Debbie,

Can you provide any leads to information on a large group of men with very high PSAs and the support groups? I know that infection and other causes can result in very high PSAs (as well as high but lower PSAs), but I've never heard of support groups for such patients, and I would like to know for reference. By the way, there are men at the other end of the extreme, as you may know: some men with Gleason Scores in the 8 to 10 range, and some men with rare subtypes of prostate cancer such as "small cell prostate cancer," actually underproduce PSA. Fortunately, the vast majority of us are not at these extremes and PSA is a fairly decent indicator of the likelihood of cancer, but by no means definitive, as you stated.

Regular DRE's (Digital Rectal Exams) could help such high PSA men guard against prostate cancer to some extent. Probably the PCA3 Plus and "free PSA" tests could also help.

In the past few years some of these other tests, coupled with PSA, have given us a much better indicator whether or not there is cancer. Another clue that has been refined in recent years is PSA velocity - how fast it is increasing, rather than just a one-time snapshot of a certain PSA level.

Actually, the American Cancer Society is rather strongly supportive of PSA testing, though it also feels that men should be advised of pros and cons of having the test. In fact, a group I belong to gave out some ACS materials on screening to attendees at a recent large health related event.

Here are some excerpts from that 2002 ACS 14 page pamphlet entitled "Facts on Prostate Cancer And Prostate Cancer Testing." "The Best Defense: Early Detection The earlier prostate cancer is found, the better the chances are that it can be treated effectively.... Two tests are commonly used to detect prostate cancer: the PSA blood test and the digital rectal exam (DRE). PSA (prostate-specific antigen) is a protein produced by prostate cells. High levels of PSA in the blood are found with a number of prostate conditions, including prostate cancer.... If either the PSA blood test or the DRE raises concerns, further tests will be done.... The American Cancer Society Recommends: At age 50, talk with your doctor about beginning yearly prostate-specific antigen (PSA) blood testing and digital rectal exams (DRE's) of the prostate gland. You and your doctor should consider your overall health and life expectancy. Men who are in high-risk groups, such as African Americans or men who have a history of prostate cancer in close family members, should begin testing at age 45. Prostate Cancer Testing: A Personal Decision It comes down to this: Each man's situation is different. To decide what is best for you, discuss early detection tests for prostate cancer with your doctor. For your own health and peace of mind, the American Cancer Society recommends that all men understand the benefits and limitations of early detection and treatment of prostate cancer before testing."

I feel that is good but overly conservative. I would like a stronger emphasis on the need for testing, COUPLED WITH SMART DECISION MAKING AFTERWARD (often flawed), but you can see that the ACS generally favors testing.

On the other hand, the US Preventive Services Task Force, a federal Government advisory group, still is neutral toward testing, having fairly recently changed its stance from actually opposing testing. That might have been the group opposed to testing (in earlier years) that you recalled.

Jim

Maybe Jim

We are part of the Cleveland Clinic. My husband's surgeon was Dr. Klein. His associate, Dr. Steven Jones (i believe that is how Steven was spelled) talked to us about rising PSA's and that the significance of the count is not significant of anything as far as cancer goes. He was adamant about that. He told us about patients of his who's PSA counts were in the hundreds and the CC has support groups for those patients. Many many of them live that way. I believe he may have wrote a book on it also. He's written many.

I don't have more info. My husband's PSA didn't go high and unfortunately he did have PC. So, we never got more info. :(

Debbie

Maybe Jim

We are part of the Cleveland Clinic. My husband's surgeon was Dr. Klein. His associate, Dr. Steven Jones (i believe that is how Steven was spelled) talked to us about rising PSA's and that the significance of the count is not significant of anything as far as cancer goes. He was adamant about that. He told us about patients of his who's PSA counts were in the hundreds and the CC has support groups for those patients. Many many of them live that way. I believe he may have wrote a book on it also. He's written many.

I don't have more info. My husband's PSA didn't go high and unfortunately he did have PC. So, we never got more info. :(

Debbie

Hi Debbie,

Thanks for the details. The Cleveland Clinic is certainly a premier institution for prostate cancer, and I'm familiar with both doctors you mention. In fact, at the IMPaCT conference in September I got to ask an audience question to Dr. Klein and talk to him afterward at a presentation entitled "Chemoprevention of Prostate Cancer", which was basically about finasteride. (He gave a great talk.) A Dr. J. Stephen Jones from the Cleveland Clinic talked to us at the International Conference on Prostate Cancer 2006 in Washington, DC on overcoming impotence, and he has written a book about that. It's probably the same doctor.

I'm betting that Dr. Jones meant that PSA was not conclusive about prostate cancer status, and that would be hard to argue against. He probably also intended to make the point that infection can result in very high PSAs that do not involve cancer. However, I'm sure Dr. Klein feels that the PSA level and behavior gives a very strong clue to what is going on, and I suspect Dr. Jones would join him in that.

I just checked the free Government site www.pubmed.gov to be sure of where Dr. Klein stood, using this search string for Dr. Klein: " klein e [au] AND PSA AND prostate cancer ". I got 56 hits, and if you click on the authors list of the first hit and read the abstract, you will see a strong statement based on a study along this line. He is the senior (last) author of the study, signifying that he was basically the authority backing and overseeing the study.

If you feel like calling Dr. Jones and checking just what he meant, I would be intereted to know.

Take care,

Jim

Hi Jim,

Yes, that is the Dr. Jones. They are both good doctors, but I do prefer Klein.

I did ask Klein about PSA when we saw him. He indicated that PSA has no set number to indicate cancer. Some people naturally produce more antigen than others. That is why a baseline PSA is a nice thing to have at a younger age. In fact, my husband had that and his was naturally set at 5. At a young age. No cancer, nothing. But, when it started to creep, and they watch velocity, they knew something was up. At 5, he had his first biopsy, just to be sure. Terrible at 30. Now he is 50 and was diagnosed.

Funny that Dr. Jones indicated that PSA can rise for many reasons. Hormones, infection, natural prostate size, etc. can't remember all of them.

I'll ask Klein when we see him in a few months. I'd rather not call. Unlike you, I don't want to know more about PC, I want to know more about healing.

Debbie

... Unlike you, I don't want to know more about PC, I want to know more about healing.
Debbie

I wish I were in your husband's position: very likely cured. Then I would probably soon lose interest in prostate cancer.

Unfortunately, my cancer is both challenging and incurable with current technology, and it is likely I will have a limited number of additional rounds of intermittent triple hormonal blockade with maintenance, probably at least one or two more, but then I'll have to retreat to the next line of defense. That kind of situation is one heck of a motivation to learn more about the disease. Another big learning motivator is a conviction that what I have learned about nutrition, diet, supplements, exercise, reducing stress and hormonal blockade is making my treatment approach much more successful than it otherwise would be, including minimizing side effects.

It does keep me off the streets.

Jim

I haven't lost interest or I wouldn't be here. Just want to focus on the healing some. We are only a few months post op and my father in law is dying from PC at this time. Hospice is helping now.

I know a lot more than I ever wanted to know :( unfortunately because I've had to live it.

But I do think there needs to be balance. Always stay on top of info and be knowledgeable but if you are going to beat this and live, then live. Don't spend all your time researching, reading and living PC. Enjoy life some and leave it behind. Learn what you need to do, fight the fight and live like crazy. That's what we all need to do. I'm at the living stage. I've learned plenty, fought lots. I feel that god doesn't give us a cure and more time to overwhelm ourselves with cancer forever. He wants us to enjoy the time we have :)

You never know... there could always be that "hit by a bus" tomorrow

Jim,

I did check and the Cancer Society does not back PSA as a cancer test. Since there is no definitive number indicative of cancer, it cannot be defined as a test that indicates cancer. They do however, recommend that it is a good test to take to help urologists determine if further examination is required. Given that no other tests exist. Thousands and thousands of needless biopsies are done annually due to PSA tests. This is the main reason that so much research is being done to create a better testing method.

A urine test is currently in test group that is proving to be more effective.

That's the info I was provided by the Johns Hopkins Prostate Newsletter - contact us.

Debbie

...
But I do think there needs to be balance. Always stay on top of info and be knowledgeable but if you are going to beat this and live, then live. Don't spend all your time researching, reading and living PC. Enjoy life some and leave it behind. Learn what you need to do, fight the fight and live like crazy. That's what we all need to do. I'm at the living stage. I've learned plenty, fought lots. I feel that god doesn't give us a cure and more time to overwhelm ourselves with cancer forever. He wants us to enjoy the time we have :)

You never know... there could always be that "hit by a bus" tomorrow

Hi again Debbie,

Your thoughts strike me as right on for the vast majority of prostate cancer survivors and care givers. My wife would certainly agree, and she would like to see me spend more time on other things, including a large church mission project we are coordinating.

But there are a few of us that are almost uniquely suited to thrive on the fight itself, and I believe I am one of these few. The nature of my case has motivated me to learn a lot. Also, my background has surprisingly suited me extremely well for this war that I never anticipated. I was educated in experimental psychology involving intense study of experimental design and heavy use of statistics, with a lot of mathematics on the side. Those tools, though a tad rusty, are serving me so well now, enabling me to understand research, appreciating true progress, but also spotting serious flaws. Almost all of my career was involved indirectly with scientific research and development, so I have a feeling for many R&D issues. Having been blessed with these advantages, I feel almost an obligation to use them to help fellow survivors.

I also am convinced we all do much better in retirement if we spend time in a worthy mission, and this mission is certainly worthy.

Believe me, I'm enjoying the heck out of every day. :)

Jim

PS - I hope you do not soon grow tired of communicating about the fight.

Hey Jim,

I'm in a different place in life I guess. I'm 49. I want to live like there is no tomorrow. I want to beat this and help others along the way if I can but I won't let it consume us. I won't. Then the cancer won. One way or another, it won.

Jim - have you any figures on how much PCa is triggererd by DRE and biopsies?

Jim - have you any figures on how much PCa is triggererd by DRE and biopsies?

I think a lot of us wonder about whether biopsies spread cancer, especially as we have biopsies performed. It's a great question, and I can contribute a little to a tentative answer. My impression is that no one knows the exact percentage due to biopsies, but such spread seems to be rare. My impression is that DREs do not spread cancer.

I'm going to take this question and feed it into a new thread called "Does biopsy ever cause prostate cancer? Some research findings" The answer has a lot of detail.

Jim

While obsessing over whether DRE's and biopsies can cause or spread P.C. ,unlikely to the say the least, its easy to lose sight of the Risk/Benefit Ratio which determines whether most procedures are worth doing. Most things in life involve some risk and few if any medical procedures have absolutely zero risk as is true of most activities of daily living including eating, drinking,excercising or going to the mall. So lets not lose perpective and worry about everything in life.
Colonoscopies have been known to puncture a weakened colon causing life threatening
peritonitis but that small possibility isn't a reason to avoid cancer screening by this proven procedure.