First off, welcome to the board. You are making me envious of that low PSA.
Based on that limited bit of information, even a biopsy is questionable, though there could be other sound reasons for doing a biopsy now. Key pieces of information to consider are the PSA pattern, the results of the DRE (digital rectal examination), and any symptoms you have that are signs of possible infection. Did the doctor consider an infection as a cause of the eleveated PSA, or give you an infection workup? Could you provide all this information? I'll follow a copy of your post below with an additional thought in green.
Originally Posted by bott
I want to make sure i'm getting the right tests i need. i'm going in for a biopsy and ultrasound since my psa is 4.20. what other test has anyone had that would be helpful to know about? thanks, Bott
In the recent past, most of us also got a bone scan and a CT scan to assess any distant spread of the disease. However, research has demonstrated that results indicating such spread were extremely rare for both scans unless a man had a quite high PSA, well above 10, and/or a high Gleason grade. Moreover, neither scan picked up all metastases. In fact the bone scan is not sensitive for bone mets until about 10% of the bone is involved, and it takes a tumor at least the size of a pea, fairly large, before the CT scan will show it as a suspicious area. Therefore, in 2009 the American Urological Association (AUA) came out against routine use of such scans, and the National Comprehensive Cancer Network (NCCN) followed suit the next year. Based on what you have provided, pending additional key information, the guidelines would discourage such scans for you.
Harpman suggested a Fusion ProstScint, but the payoff there for a case like yours that may be very low risk, pending additional information, would likely be quite low. (I have had a ProstaScint, though not the Fusion ProstaScint, for my own case, which was high risk. The result was essenatially negative.) Most likely, unless you turn up some high-risk case characteristics, insurance would not pay for the test, even were the biopsy to turn positive. If you have a large amount of extra cash, it might be worth your while. (Note to Harpman: are you aware of any new research that is counter to what I've written? I'm a fan of Fusion ProstaScint in the right circumstances, but I'm not aware of its being used for staging cases that look low risk.)
A new scan is now available through a limited number of doctors, but I believe it is on the verge of wider availability. It is a USPIO (Ultrasmall Superparamagnetic Iron Oxide contrast) scan for lymph nodes known as Feraheme, and it is available only through Sand Lake Imaging in Orlando, Florida. In fact, until last week it was not yet in their public brochures and may not be now. It is a successor to the highly touted scan known as Combidex and available only in the Netherlands. Feraheme scanning is considered extremely sensitive and specific, meaning that it is highly likely to detect any cancerous mets in lymph nodes, one of the two predominant sites for spread along with bone, down to about 3mm, and it is not subject to false alarms. Because it is so sensitive and specific, my layman's view is that it could be a good bet for a low-risk patient considering active surveillance, local therapy, or regional therapy. I'm not sure about insurance coverage for low- and very-low-risk cases.
A color Doppler ultrasound (CDU) guided biopsy adds substantially to the likelihood of detecting cancer and to key details, including precise location, shape and size. The downside is that there is only a handful of locations with the specialized CDU equipment and expertise to perform the biopsy.
I strongly recommend you read the new book (August 2010) "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment Or Loss of Sexual Potency," by Ralph H. Blum and Mark Scholz, MD.
Please keep in mind that none of us can speak with medical authority. Though we have learned about the disease, most of us, including me, have had no enrolled medical education.
Jim, I don't know what kind of occupation you're in, but you may want to consider becoming a urologist. You've given me more info than the dr. i've been talking to. Today I went to the dr. he did a digital exam, going to get a biopsy tomorrow. Thanks for all your research and info. It is very helpful. I'll keep you posted. Thanks again, Bott
I would doubt that the USPIO scan would be used for low risk patients. The criteria for getting the Combidex scan was very strict, evidence of lymphnode involvement, (very high psa or very high Gleason.) The candidates for USPIO are being screened by Drs Strum and Drs Myers to insure that the scan is applicable.
Prosticint with fusion still has some isssues with a high false positive rate.
The best scans are still the color doppler and endo rectal MRIS. I heard that Dr Barantsz, developer on Combidex, was working with UCLA in developing multimodiaity MRIs that fuse DEC MRI with doppler ultrasound and other enhanced MRIs to get a more complete picture of the prostate.
The Following User Says Thank You to Johnt1 For This Useful Post: IADT3since2000 (03-17-2011)