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Old 04-01-2013, 09:16 AM   #1
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prostate biopsy blues

My PSA has risen from 5.2 to 5.8 to 7 over 4 months. My free PSA accompanying the last PSA test was .09. DRE by 2 uros was normal. No family history of Pca on my mothers side, dont know about my father. No symptoms, very good health. I live overseas, and am in the Florida now, where I had my last PSA, and the doctor recommended a biopsy (TRUS). After agonizing for 2 days, I agreed. IF I were living here, I would have tried a course of cipro first, but I do have work commitments out of the U.S. and some time constraints. Anyway, over the past few days I have read about possible lingering impotence and incontinence as a result of the biopsy, and even though I am scheduled for the biopsy in 2 days, I am starting to think of cancelling. Any info you can pass on regarding how you tolerated your biopsy, and after effects would be appreciated. Excuse me if this has been covered elsewhere, I am new to this site and wanted to this out right away. Anyone with info about Florida uros, or good places for Pros biopsies in case I do cancel? SHould I cancel the biopsy, take the cipro, and if there is no drop in PSA, schedule a biopsy for July when I will be in Florida again. Is there a real downside to waiting the 3 months. By any chance, does anyone have any info on MRI guided biopsies in Japan, where I live? If I do cancel my biopsy, I would prefer the MRI guided the next time I schedule? Thank you.

 
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Old 04-01-2013, 10:16 AM   #2
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Re: prostate biopsy blues

My biopsy went smoothly 11 days ago. Absolutely no side effects at all. My urine was pinkish the first day but nothing after that. I took 3 Advil Tablets on the all-day trip home from the biopsy but really could have skipped them.

The day after the biopsy I had no feelings at all that anything was ever done.

Your mileage may vary but friom what I read here, my experience was typical.

Good luck to you and I hope you have as agood an experience as I did.

 
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Old 04-01-2013, 10:19 AM   #3
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Re: prostate biopsy blues

Wow, that is really terrific. I am happy for you. BTW, did you have a TRUS biopsy, or one of the mri guided procedures? Hope you got good results.

 
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Old 04-01-2013, 01:10 PM   #4
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Re: prostate biopsy blues

IMHO, I think that prostatitis and BPH ought to be ruled out, if possible, as sources of rising PSA before the biopsy. I think that the rush to biopsy often leads to overdiagnosis and overtreatment. I've never heard of impotence or incontinence from even a saturation biopsy, although I suppose it's possible if a lot of nerves are somehow severed.

MRI-guided biopsies are usually only used if suspicion remains after a negative biopsy.

Your low % free PSA is certainly an adverse sign. Another blood test, called PHI is available in Europe and will be available in the US shortly, I hope. I don't know if it's available in Japan. PCA3 (urine test after prostate massage) is approved in the US after a negative biopsy when suspicion remains.

- Allen

 
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Old 04-01-2013, 02:33 PM   #5
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Re: prostate biopsy blues

Quote:
Originally Posted by Tall Allen View Post
IMHO, I think that prostatitis and BPH ought to be ruled out, if possible, as sources of rising PSA before the biopsy. I think that the rush to biopsy often leads to overdiagnosis and overtreatment. I've never heard of impotence or incontinence from even a saturation biopsy, although I suppose it's possible if a lot of nerves are somehow severed.

MRI-guided biopsies are usually only used if suspicion remains after a negative biopsy.

Your low % free PSA is certainly an adverse sign. Another blood test, called PHI is available in Europe and will be available in the US shortly, I hope. I don't know if it's available in Japan. PCA3 (urine test after prostate massage) is approved in the US after a negative biopsy when suspicion remains.

- Allen
Yes, I agree about ruling out bph and prostatitis. It is just that I have so little time in the states. One uro said that my prostate was enlarged as one would expect for a 64 year old, about 60cc. The next uro said that it was not enlarged. The reason I wanted a MRI guided biopsy, is that if I am diagnosed and it is 6 or 7 gleason, I want to opt for TFT cryosurgery, and to do something that focused I believe we need an MRI biopsy, though maybe just an MRI would be sufficient in that case. I would rather not do 2 biopsies if possible, but if I don't do the TRUSS biopsy on Wed, I might not be biopsied till July when I come back, unless I find something I like in Japan. I live in a very rural area, far from Tokyo. There are ample medical services, though it is far easier to handle in English than in Japanese. I called all over the state of Florida and found no one doing MRI guided biopsies, just prostate mris. Boca Raton Hospital advertises the biopsies, but when I called they said they don't do them. I called 2 other clinics who will get back to me tomorrow. One of them, which does the procedure, says they don't accept Blue Cross, but they will call around and find me one that does. So, we shall see. My uro says that waiting a few months probably won't matter, unless my cancer (if I do have it) is aggressive. Kind of a coin toss.
Thanks for your help.

 
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Old 04-01-2013, 03:01 PM   #6
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Re: prostate biopsy blues

I have had 2 12-needle biopsies. They were both non-events. Small amount of blood in stool first, none later. Pinkish urine for 4 hours, none later. There was a pressure-like feeling on the buttocks. It felt better when lying on stomach. Got home at noon, slept for 3 hours that afternoon. After waking, everything was normal.

The biopsy itself was not difficult. The doctor applies an anesthetic locally through the device inserted into the rectum. He says that each needle will feel like a rubber band snapped on the skin. That is a very good description. The needles do not hurt although you can feel them. You are thinking of what is happening and where this thing is and you are hoping it is finished quickly, even though there is really no pain.

Good luck with the procedure.
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Old 04-01-2013, 07:11 PM   #7
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Re: prostate biopsy blues

It may make sense for you to get a diagnosis before you decide on a treatment. Focal cryo is great if you are one of the 20% or so of the men with early stage prostate cancer in whom the disease is truly focal. For the remaining 80% of us, it is multi-focal, meaning there are tiny bits of it scattered about. MRIs are not very good at seeing those tiny bits. Color Doppler US, in expert hands, or fused multiparametric MRIs/ultrasounds, in expert hands, may be better. I think it will be hard to get any insurance to pay for any kind of MRI guidance on a first biopsy, and to my knowledge, none cover CDUS.

If you have an enlarged prostate - as diagnosed by ultrasound - a 5ari, like Proscar or Avodart, will shrink it over a period of several months, while reducing the PSA that is due to BPH. That will establish a new baseline PSA level for you, which will improve its diagnostic accuracy. It also may reduce or eliminate insignificant amounts of low grade cancer that may be present.

- Allen

Last edited by Tall Allen; 04-01-2013 at 08:26 PM. Reason: typo

 
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Old 04-01-2013, 07:26 PM   #8
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Re: prostate biopsy blues

I have not yet found a place in Florida tht will accept insurance for the MRI guided procedure. I already got a pre-procedure call from my urologist for the trus procedure on Wednesday. At this point, I might just go ahead with it and go from there. I am still in undecided, but have not much time left to play with.

 
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Old 04-02-2013, 06:40 AM   #9
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Re: prostate biopsy blues

Yes--I did have a TRUS biopsy. It was at the Cleveland Clinic and 20 samples were taken. pc was found in 8 samples---all on the left side which is the side where the DRE showed some firmness.

I will have seed Brachy at the same facility on April 28.

I hope this is helpful to others here.

 
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Old 04-02-2013, 09:49 AM   #10
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Re: prostate biopsy blues

Best of luck, speedster. I am sure all will turn out okay, now that you have your diagnosis. I have cancelled my TRUS, and am still looking for a place that will accept my BCBS for a MRI guided prostate. I may have found a radiologist who will take my insurance in Sarasota, Dr. Gerald Grubbs, who does the procedure. I am waiting for a call back. Again, I wish all the best for you.

 
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Old 04-02-2013, 09:51 AM   #11
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Re: prostate biopsy blues

UCLA uses the Artimis 3D MRI fusion biopsy procedure (Dr. Leonard Marks). They also do HIFU and Chryo.

 
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Old 04-02-2013, 11:43 AM   #12
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Re: prostate biopsy blues

Thanks for this info, nyca. If the procedure I am waiting for a call back on doesn't pan out, I will definitely look into that when I return to the U.S. in July. I have decided that if I cannot get a procedure while I am in the U.S., I will go back to Japan, take the cipro, retest psa, and schedule a mri biopsy from there for when I return in July.

 
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Old 04-04-2013, 03:38 AM   #13
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Re: prostate biopsy blues

Ok, I am scheduled for an MRI for next tues, consult wed, if needed mri guided biopsy thursday. Doc is Dr. Gerald Grubbs in Sarasota. Has anyone heard of him? He is the only doc I could find near me who does the procedure covered by BCBS. The biopsy, if I need it, is not one of the 32 core ones like they do at U of Colorado. It is targeted, based on the results of the MRI.

 
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Old 04-04-2013, 10:00 AM   #14
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Re: prostate biopsy blues

He is listed as a interventional radiologist. Can't you find a urologist who you can use? You really don't need the saturation biopsy at the point you're at, just a traditional biopsy with MRI guidance. Your psa is rising, but it isn't sky high; you could wait a while if you really want to look around for another doc. Don't panic.

 
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Old 04-04-2013, 11:53 AM   #15
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Re: prostate biopsy blues

It seems that most urologists don't use the mri guided procedure, it is done mostly by radiologists it seems. I could be wrong on this. My own urologist was not happy that I am going this route, actually, and I have my misgivings myself. I feel at this point I have made a informed decision and will go through with it. As I have written, I am in Florida now, but I live in Japan, and wanted to do something while I was in the U.S., that is why I have moved things along more quickly than I would have if I were living here.

 
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