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I shared your reluctance to have biopsies too frequently. This came about from my first transrectal biopsy 8 years ago that led to an infection which became an abscess that was stubborn to various antibiotics. After several months I had the abscess drained and the drain became a fistula. There were three different attempts to repair the fistula, and after nearly two years my bum was finally fixed. After that experience, my two later biopsies were done through the perineum under a light general anaesthetic. Much cleaner and much more comfortable. Also this procedure gives better targeting of the prostate.
My PSA was up around 6.4 and I started a course of Avodart (for urinary improvement). After nearly three years my PSA had dropped to 2.28, so I was very relaxed. Then consecutive tests went to 2.46, 2.92 and 3.18. This was enough to trigger a multiparimetric 3T MRI, which identified a "tumour suspicious area with intermediate to high grade features". This area of suspicion was targeted by a transperineal fusion biopsy and a Gleason 4+5=9 tumour was the diagnosis. That certainly attracted my attention and I had robotic surgery less than three weeks later.
So I believe the fundamentals of sound management is:
1. Trust your own judgement as much as, or more than your doctor's judgement. You have had more time on your case than your doctor and have had a closer look at all the details. In my own case, my GP thought that my recent PSA history looked OK, but I thought it needed attention.
2. Maintain close monitoring of your PSA history. After reasonable stability, distrust any small to medium trend of PSA elevation, even in smallish numbers. Also trust in the value of free PSA numbers.
3. Have a multiparimetric 3T MRI from a highly reputable practitioner who specialises in prostate MRI.
4. Have a transperineal (not transrectal) fusion biopsy that targets any suspicious looking area on the MRI. If the MRI looks OK, consider having a biopsy anyhow.
Well Don as I warned you, "the don't trust your doctor brigade" would soon be out of their boxes. It never ceases to amaze me how they can be "so frivolous", with another person's life. Needless to say when their strategy came back to bite them on the bum, guess where they ran?
Don, last year I announced that I would not post on a thread that John Bonneville was involved in because of his argumentative, abrasive and insulting style. Unfortunately, in an attempt to add something to this topic, I broke this rule. As one in the "don't trust your doctor brigade", I decided it was time for a biopsy when my GP didn't think I needed one. I went ahead anyhow and 4+5=9 was the result.
After being an avid reader of, and occasional poster on this forum for more than eight years, I am now back in my box. Terry put up with John Bonneville for years, but my skin is not as thick. I will not be posting on the YANA forum again.
The "don't trust your doctor brigade" have lost another comrade. Gone forever? Unlikely methinks.
Don the previous poster's comments re, "I decided it was time for a biopsy when my GP didn't think I needed one", is of course the expurgated version. You may care to enquire of the previous poster as to how many years passed before they chose to have the biopsy? The 4+5 was the direct result of the previous poster taking charge. Sheer folly in my opinion.
I personally would consider just getting my PSA rechecked in 6 or 12 months. Your velocity is low. My PSA was 3.2 but my velocity was 85 % so I had a biopsy where they found a little low grade ( gleason 6 ) cancer. I was 58. The biopsy was no fun...lots of blood in my urine for about a month.
You appear to have established a baseline of 3.5 to 3.8 over the past two years. Regarding 3.78 as the top of the baseline range, I find a bump up to 4.7 in five months ambiguous; not an emergency, but not to be ignored either. I would suggest a repeat PSA in three to six months. A urologist would have a better idea of the appropriate time interval.
I had two biopsies, didn't have much trouble with either. The procedure wasn't bad; each needle insertion produced a sensation which was very startling, I couldn't help bu jump, but it was not painful. I had blood in my urine for a few days, but it was expected, and I didn't find it a problem.
Thanks for all the responses. Seems like there are worse case scenarios - worse then what my friend had. None the less they still seem to be fairly rare.
I am getting a free psa test tomorrow then will get results probably 4 days later. If it is low I will definitely get the biopsies. If it is high - over 25 then I have to decide.
Seems like everything before biopsy is just guessing. Even a low PSA does not really say much I guess. It tells you percentages. Not whether you have something or don't. So biopsy = a much better chance at knowing something solid.
Probability of finding prostate cancer based on % free PSA in men with a total PSA between 4 ng/ml and 10 ng/ml
% free PSA ---- Probability of prostate cancer
0%–10% ----- 56%
10%–15% ---- 28%
15%–20% ---- 20%
20%–25% ---- 16%
More than 25%--- 8%
SOURCE: Journal of the American Medical Association, May 20, 1998.
16% chance still seems pretty high. 8% chance - hmm - is that worth not doing the biopsies? It could come back under 10% - which then means 56% chance of cancer - then it is a no brainer I think. But 20 to 25% free?
I'm glad to hear that. On second thought, I decided sooner would be better, and returned to the thread to suggest that, but you beat me to it. Good call.
"I am getting a free psa test tomorrow then will get results probably 4 days later. If it is low I will definitely get the biopsies. If it is high - over 25 then I have to decide."
When I researched it back in 2009, I found that a very low free PSA ratio correlated highly with a higher grade tumor. I don't recall anything about the probability of any tumor, but I might have missed that or forgotten it.
"Even a low PSA does not really say much I guess."
One PSA doesn't say much. But a change from an established baseline is significant. If you've been bumping along between 3.5 and 3.8, 4.7 is a spike above an established baseline. I am less concerned with free PSA ratio than if the 4.7 repeats. If PSA repeats at 4.7, I think a biopsy is probably advisable, regardless of free PSA.