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Re: A biopsy is.....

Dr Scholten,

Having had 13 negative biopsies over the last 10 years I agree with a lot that you have to say. A color doppler targeted biopsy finally found a large 2.5cm tumor in anterior transition zone that even an MRIS had missed. A color doppler biopsy done by a skilled radiologist like Fred Lee or Duke Bahn is an effective alternative to regular biopsies or 3 D mapping.
JohnT

Re: A biopsy is.....

Dr. Scholten,

My mapping biopsy took 51 needles. I had some minor flow problems going in, so I was glad that I was catheterized. Things improved quickly after the first day.

Your approach is certainly non-invasive and would definitely be for someone who doesn't want needles, surgery or radiation. Doesn't it pose the risk of missing some very aggressive prostate cancer - Gleason 8 or above or the atypical varieties - where the patient would be better advised to go for more drastic treatment measures?

Re: A biopsy is.....

Hello,

I suspect that those who have Gleason 8 or more will have short doubling times, ie less than 3 years. In my book the workup in the first year is a PSA every 2 months. So delay would not be substantial. Doubling time less than 3 years would mean start of IHT.

Besides information from PSA derivates and DRE's, Gleason 8 patients might present with symptoms more often than those with lower scores.

Question to those on the list who presented with Gleason 8: did you have symptoms?

Best regards,

Henk Scholten, Haarlem The Netherlands

Re: A biopsy is.....

There was this article (there have been others) that seem to make PSA alone quite suspect:

1: Urology. 2009 Feb 19.
Prebiopsy PSA Velocity Not Reliable Predictor of Prostate Cancer Diagnosis, Gleason Score, Tumor Location, or Cancer Volume After TTMB.
Bittner N, Merrick GS, Andreini H, Taubenslag W, Allen ZA, Butler WM, Anderson RL, Adamovich E, Wallner KE.

Department of Radiation Oncology, University of Washington, Seattle, Washington.

OBJECTIVES: To evaluate the effect of prostate-specific antigen (PSA) velocity (PSAV) on prostate cancer diagnosis, Gleason score, tumor location, and cancer volume in men undergoing transperineal template-guided mapping biopsy (TTMB). PSAV has been associated with greater Gleason scores and greater prostate cancer-specific mortality. METHODS: From January 2005 through September 2007, 217 patients underwent TTMB. The inclusion criteria included a persistently elevated PSA level and/or diagnosis of atypical small acinar proliferation or high-grade prostatic intraepithelial neoplasia on previous biopsy. The prostate gland was arbitrarily divided into 24 regions, and a median of 58 cores were obtained per patient. The patients were divided into 3 velocity cohorts according to the following changes in PSA level in the year before biopsy: /=2.0 ng/mL. The PSAV was evaluated as a predictor for prostate cancer diagnosis, Gleason score, tumor volume, and cancer location. RESULTS: The mean patient age was 64.2 years, with a mean prebiopsy PSA level of 8.5 ng/mL. Prostate cancer was diagnosed in 97 patients (44.7%). The study population had undergone an average of 1.8 +/- 1.0 biopsies before TTMB. PSAV did not predict for prostate cancer diagnosis (P = .84), Gleason score (P = .78), the percentage of positive cores (P = .37), or tumor location. CONCLUSIONS: Among patients with persistently elevated PSA levels despite previously negative biopsy findings, PSAV did not reliably predict for a diagnosis of prostate cancer nor did it correlate with prostate cancer grade, volume, or location using TTMB.

Re: A biopsy is.....

Hello,

Maybe you miss the point. This TTMB 50+ core thing remains a biopsy and a biopsy is....

Undoubtedly it finds more tumours, but this is quantity not quality. Even so, it still may very well miss small false kittens whose only sign is a fast PSA doubling time.

Best regards,

Henk Scholten

Re: A biopsy is.....

Read my story and the "blind stick"...Color doplar ultrasound eliminates the: "I hope I get it" mentality. Dave

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