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Preparing for 1st biopsy. Advice welcomed.


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Old 01-13-2018, 05:29 AM   #1
JimNYC
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Preparing for 1st biopsy. Advice welcomed.

I’m going for my 1st biopsy in 1 weeks and reading up on PCa (Scardino, Walsh, etc.) in preparation for likely bad news. Here’s my situation so far. For the past decade my PSA remained in the range of 3-5. Nothing was detected by DRE by 4 different urologists. I had laser TURP in 7/11 and 3/15 for BPH. This past Oct ’17 my PSA jumped to 6.2 and I consulted (Dec ’17) an urological oncologist with 35 yrs experience with prostate cancer. He found a PSA of 7, free PSA of 19%, and a 4Kscore that reads a 28% chance of Gleason 7 (if I remember his words accurately). A MRI (multi-parametric 3T with contrasts) shows an enlarged prostate (81mL) a peripheral zone lesion (PI-RADS 5 “circumscribed homogeneous moderate hypointense mass confined to the prostate”) in the base. A “mild invasion into the base of the seminal vesicle” on the left. The transitional zone is consistent with BPH. In two weeks he’ll perform a transrectal ultrasound (Fusion) prostate biopsy.

Am I going about this correctly? What more should I be asking? What more should I read? Regardless of outcome, I’ll seek a 2nd opinion. For that I’m considering Sloan-Kettering here in NYC but would be open to other suggestions.

 
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Old 01-13-2018, 07:14 AM   #2
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Re: Preparing for 1st biopsy. Advice welcomed.

Hi Jim,

Welcome to this board!

Your diligence in PSA testing over the years is now paying off, but in an odd way. Your enlarged prostate, 81 mL, which is the same as 81 cc - the measure more commonly used, would "explain a PSA of about 8 from healthy prostate cells. However, that PI-RADS of 5 pretty much trumps the PSA and the other tests, suggesting a cancer of at least Gleason 7.

I suspect that, because the vast majority of that PSA looks like it comes from healthy albeit enlarged prostate cells, there isn't much more cancer except for the suspicious sites. NYC has some of the best prostate cancer resources in the world. One of the sites, which I'm positive you know about, is renowned for its experts with world-wide reputations, including surgery, radiation, and other approaches, as well as its research. That center is often "writing the book" for other doctors to read and follow.

I'm confident you will get fine guidance for preparing for the biopsy. The team will use a prophylactic(s) drug to minimize risk of infection (which is low anyway), perhaps do a rectal swab to make sure any resistant bacteria are accounted for and handled (depends on the geographic area for the degree of risk from these bacteria; I'm not sure about New York), numbing agents to minimize pain and discomfort, and advice to you about what to expect and report if unusual.

For most of us, especially in the hands of a good team, a biopsy is not such a big deal. On the other hand, as with so many things, a very few of us draw the short straws and have difficulties; most of the difficulties are now anticipated in advance with the rectal swab and prevented. In the rare event a problem occurs, your team would know what to do to get you back to good health rapidly.

Good luck!

 
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Old 01-13-2018, 08:55 AM   #3
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Re: Preparing for 1st biopsy. Advice welcomed.

Thanks for your thoughts and advice. I especially appreciate your comments on the biopsy as I brace myself. I believe I'm in good hands. We'll see how it goes.

Let me also add, for the other readers, that Playthe88s raises similar concerns prior to his biopsy in the thread "Fear and Frustrated." I hadn't read that thread before posting my post. It's worth reading for more insight. Your recent 18th anniversary review is also appreciated.

 
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Old 01-13-2018, 10:22 AM   #4
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Re: Preparing for 1st biopsy. Advice welcomed.

Regarding your fusion biopsy:

Jim - Would you mind telling us how your biopsy will be/was done? Fusion biopsies that guide the doctor in real time with advanced imagery, as I understand it, are becoming more common, especially at major centers. Some are done "in bore," meaning the biopsy is actually performed inside the bore (tunnel, space for the patient) of the imaging device; other fusion biopsies are not done in bore, and I'm curious how that works too. Will yours will be done in bore? I'm curious where and how the doctor literally "fits in" to all this, and, if the imaging is an MRI machine, what his biopsy instruments are made of, steel obviously not being a good choice in a powerful magnetic field. I'm thinking you may not know this until the biopsy has been performed.

Last edited by IADT3since2000; 01-13-2018 at 10:24 AM.

 
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