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Originally Posted by WN3OPF
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SO, I not really sure what I should do. Any advice would be greatly appreciated!
Good health to everyone!
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Hi WN3OPF,
I'm a newbie to the board but an eight year veteran of a challenging case of PC, and I thought you would like to know about a couple of other approaches to the proposed saturation biopsy (actually, one good way of approaching the issue).
You've already had good advice in several posts, with views from very different perspectives.
For men trying to determine whether prostate cancer is likely present without a biopsy (or another biopsy), a new test is available that is a lot more precise than the PSA, though it still lacks the conclusiveness of the biopsy. It's a urine test (following an "attentive" DRE) known as PCA3 Plus, and is available from at least two labs. You can learn about it by searching the web. The sample can be collected anywhere and then sent to a distant lab. The PCA3 Plus test is more informative than a "free PSA," though that test, already mentioned on this thread, would also be helpful. I don't believe the PCA3 Plus test has been approved yet by the FDA, but I've heard that insurance coverage is usually no problem.
Another approach, this time involving a biopsy, is a color Doppler ultrasound (CDU) guided biopsy. While many imaging machines have a setting for color Doppler ultrasound, they lack the imaging horsepower to do the job, and special expertise is required, as I understand it. (I'm now a veteran survivor but have never had any enrolled medical education.) Therefore, there is only a handful of sites in the US with the capability to do this well. CDU is able to find new blood vessels in the prostate and color them red; since new blood vessels are needed to support new tumor growth, the biopsy doctor gets a better view of the likely edge of any tumor. A CDU guided biopsy provides superior information about the extent, shape, and location of prostate tumors. I've heard it is not as precise as a saturation biopsy, but it is also less invasive. (That said, a saturation biopsy, done under a general anesthetic, is supposed to be quite tolerable. I accept that, though it's a little hard to believe.)
Many of us are believers in diet/nutrition/supplements, exercise, stress reduction and mild medications to help combat prostate cancer or hold it at bay, and an approach like that might be all you would need, provided you did regular monitoring to make sure the cancer was not taking an aggressive turn. There are several good books about this supportive approach.
The mild drugs are both in the "5 alpha reductase inhibitor class," and are known as finasteride (the name for Proscar now that it is available as a generic), and
Avodart. Finasteride has been proven in a gold-standard type clinical trial to prevent about 25% of prostate cancer and do it safely.
Avodart looks even better on paper, but results from its PC prevention trial (REDUCE) will not be available until about 2009. However,
Avodart is available and approved now for treating BPH as anyone with a TV knows, and it can be used under the perfectly legal "off label" prescription concept for other purposes if a doctor will prescribe it.
Finasteride has been pretty well proven to improve the effectiveness of both the DRE and PSA trend interpretation, as well as providing additional clues about the existence of prostate cancer.
Good luck,
Jim
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