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to biopsy or not to biopsy?

I am still asking newbie questions...

I have urology appointment this week. Been on Cipro for one month to treat possible infection. If psa has not changed from 3.79 - is a biopsy recommended?

I understand that it can hurt and pain killer is recommended. Also there is a 1-3% chance of ending up in hospital to treat serious infection. And up to six weeks to heal up. But the usual recommendation is to biopsy with 12 needles.

Surgery of other treatment is an entirely different question, I understand. At what point do I need to know what I am dealing with?

Thanks - any advice is appreciated. Sorry I am not up to speed yet.
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NY Times article

Researchers examined the records of 5,519 men with a base-line P.S.A. under 3. They followed them for seven years with yearly tests and a biopsy if the level rose above 4.

They also analyzed P.S.A. velocity — the rate of change in readings from year to year. But after adjusting for age, base-line P.S.A. and other factors, they found little evidence that ordering a biopsy for men whose velocity was greater than 0.35 helped find prostate cancer. And it was particularly useless in uncovering the most aggressive types of cancer, the ones most important to treat.

http://www.nytimes.com/2011/03/01/health/research/01prostate.html

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Bloomberg:

Doctors are changing their approach to prostate biopsies as evidence mounts that the danger of complications from the procedure may outweigh its usefulness identifying some cancers.

An increasing incidence of potentially lethal, difficult- to-treat bloodstream infections tied to prostate biopsies has become so serious that urologists are reassessing when, how and even if they do the procedure.

http://www.bloomberg.com/news/2013-04-24/prostate-cancer-test-causing-sepsis-spurs-biopsy-concerns.html

Re: to biopsy or not to biopsy?

that's not a crazy-high PSA number. how old are you? a PSA history is helpful as well, to give proper advice.

Re: to biopsy or not to biopsy?

Sorry

About 4-5 years ago my psa was under 2 I think. Not checked for a few years - partially due to doctor error checking wrong box.

Checked twice this year and about 3.79 each time - I can dig around for exact numbers if needed.

I am 55 years old.

DRE showed slightly enlarged prostate but no bumps or irregularities.

Here is the info I shared in another post:

Current age 55

PSA history:

2000 0.8
2005 1.1
2006 1
2007 1.3
2008 1.6
2009 2.6
2010 not done?
2011 not done - dr checked wrong box apparently
2012 not done
2013 3.78 - May
2013 3.79 - June

Re: to biopsy or not to biopsy?

PSA tests closer than 3 months apart are useless. you could have an infection. take the ABs and wait 3 months.

Before the PSA, don't have sex or do anything sexual for 72 hours.

Then, get back to us. :)

Re: to biopsy or not to biopsy?

so waiting is recommended at least for a few months - if not longer.

Thanks

Re: to biopsy or not to biopsy?

yes, wait the proper interval and see. that's not a high PSA at all for your age. DRE showed nothing unusual.

Re: to biopsy or not to biopsy?

UPDATE - QUESTION - TO BIOPSY OR NOT TO BIOPSY?

After two years of 3.7 readings the PSA test today was 4.7

Dr recommending biopsies.

What do you think?

His stats - which I also wanted to check for accuracy;
at 4.7 PSA

40% chance of finding cancer
10% chance that it is aggressive cancer - the kind worth treating
2% chance of serious infection from biopsy

History of PSA
2000 0.8
2005 1.1
2006 1
2007 1.3
2008 1.6
2009 2.6
2010 not done?
2011 not done - dr checked wrong box apparently
2012 not done
2013 3.78 - May
2013 3.79 - June
2014 3.7 - (Not sure of date or exact figure)
2014 3.5 - October
2015 4.7 - March

Age now 57 years

Thanks

Re: to biopsy or not to biopsy?

what's the harm? it's not like you've had one every year. that's a fairly significant PSA rise.

W

Re: to biopsy or not to biopsy?

What is the harm? Up to 7% sepsis possible? (John Hopkins article)

Also some sites say a second PSA test is in order - 1/2 of high PSAs go down in a couple months.

"The number of men whose elevated levels returned to normal in a subsequent test ran from 44 to 55 percent, depending on the threshold. Of those who could be tested again after their level had dropped down to normal, a great majority, 65 to 83 percent, remained normal."

I will have to look up the source if needed.

All that said - I am leaning towards getting biopsied.

Also wondering if I should I put this on the front page as a new thread for more input or is that pointless?

Thanks

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