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I have a question about whether I should have a biopsy or not... My urologist would rather I wait for 5 months to see what happens with my PSA but is also prepared to let me get a biopsy now if I decide to. Any thoughts would be greatly appreciated
I am a 41 caucasian with no history of prostate cancer in my family, who until recently took propecia ( finisteride 1 mg). After visiting my doc in Jan of this year for mild urine flow problems ( most likley caused by anxiety) my PSA came back as 1.9, after finally convincing him to let me see a Uro, I had a flow test, cryoscopy and DRE and TRUS everything was normal although the TRUS showed I had prostate stones and my prostate looked a little irritated.
I had a subsequent PSA in Mar which was 1.7 and one in June which was 1.8, and then I stopped take the propecia and my PSA rose to 2.2 in July.
My Uro is of the opinion that I should wait until Dec to see what my actual PSA is when the propecia is out of my system, and then have a biospsy if it's needed and said if it was cancer it was either v. aggressive sort because my PSA was so low or would be v.small and hard to find and could be missed.
Obviously I am a little concerned about waiting longer than I have to because everything I have read about PCa indicates that it's the fast growing aggressive cancers you need to catch... And I appreciate that I am in the normal range for my age ( if at the high end) but am worried that when my real psa is known it will be in the region of 3.8 due to the propecia... Which is way over.... Any thoughts would be appreciated
My guess is that you have a very bad case of PSA anxiety and that you are looking for someone to say "Have a biopsy - and the sooner the better."
That is not what I would do, but I have been in this strange world of prostate cancer, I have a better understanding of the odds, and I can deal with uncertainty with very little anxiety.
For my money, your elevated PSA is far more likely to be from your prostate problems, which I assume are long standing, else you would not be on propecia. The fact that you have an irritated gland and stones are further pointers to the likelihood of non-PCA related PSA.
We must all do what suits us best. In your case, I'd think that what would suit you best is to have a biopsy.
Remember that biopsies are not risk free. You have something like a 1 in 30 chance of getting a life threatening infection. As a 41 year old caucasian your chance of dying from prostate cancer in the next four years is a lot less than 1 in a 1000. Given that you've already had a cryoscopy, DRE and TRUS that all came back normal I just don't see why you would worry about PC.
Tom, I just had a radical prostatectomy last week so my thoughts may be some what different than most and is mostly based on hindsight after just getting my pathology report.
To me the answer to biopsy or not depends on if you are the type of person that can live with uncertainty or one that needs a difinitive answer. I've had two biopsies, after the first I elected to watch and wait, which I did for one year, but not without some worry some days. The second biopsy was slightly worse so I elected surgery.
My pathology report indicated a small tumor less than 2 cc out of 34. I'm guessing this had been there for more than 10 years.
So in retrospect as I sit here dripping, not only should I have not had the surgery but I think I would have been better off had I not had the biopsy!
I believe this is the same logic the American Society of Oncologists used when they recommended to do away with routine PSA screening for men over 50. It does more harm than good, leads to worry and over treatment.