Biopsy fear

Are you being ridiculous? No......but, yes. I think it is too soon to biopsy as there are ways to help determine whether you should biopsy. Your urologist is good in wanting some additional tests and some, but not a lot, of time to watch this.

Your PSA is low, in fact in the normal range for a cancer free man of your age. However, there are some rare strains of aggressive prostate cancer that emit very little PSA. So this has to be ruled out.

As for the biopsy, it is unpleasant but I would rather do it than a root canal. It is a very common straightforward procedure that is the only way to diagnose cancer. Don't commiserate over it yet. Let's see how these other tests turn out and get a trend of PSA over the next several months. Don't freak out until it is necessary!!

To follow up on Break's point:
In addition to the MRI, there is a PCA3 test (you pee into a cup after a rigorous DRE) that would be warranted in this case.
Based on your PSA, there is no reason whatsoever to do anything. BUT, a questionable DRE is another story and THAT might automatically warrant a biopsy. I think you should get a second DRE opinion.

Mel

I really don't have anything new to add to the good advice you've already been given, but I felt compelled to chime in since I felt a kinship to your screen name. I wouldn't take a biopsy lightly and I think it's way too soon for an invasive test like that. Good luck to you Mike_T!

If the doctor felt something unusual during DRE, that would scare me and would like to know what the reason is. The biopsy itself was really not a big deal at all (personal experience). The infection risk and the possibility of antibiotic resistant bacterias is scary with trans-rectal biopsy. The risk of serious infection is less with a transperineal biopsy, because the needle doesn’t have to pass through the rectum to access the prostate. Your PSA values does not call for a biopsy but the DRE might? Get a second opinion.

Agree with everyone here. Especially about not getting a biopsy based on a DRE by a PA. HAve the Dr do it.

Your PSA is stable and in the normal range.

I won't comment on the need or otherwise for a biopsy, but if/when you do need one, I would seek your Uro's view on low level sedation, especially given your anxiety level.

My Uro told me he would not consider doing a biopsy without sedation. He applies the same approach to cystoscopies.

Sure it takes a bit of extra time and there is a moderate recovery period, but for me that was well worth it. Completely pain and anxiety free (unless sedation makes you anxious too 😉

You heard it all above. A Biopsy without a Prostate Health Index (PHI) or PSA3 blood test AND mpMRI would be overkill, line the pockets of Dr's, cause you immeasurable stress and little else.

You're being 'over worked-up' for this point in the proceedings... and a biopsy without mpMRI and targeting these days is backward.

You just did the most right thing you can do at this point, you came here. Read and learn what all these terms are and what a proper diagnostic progression would look like. Alas you then need to advocate for yourself with the Dr's; but it's worth it.

SHOULD you get a PHI greater than 25 it would lead to a mpMRI and only after that is read as positive would biopsy be your wisest course of action... Relax, grab a beer, your wife, read and be assured that there are a hundred men here who have walked in your shoes and can help steer you right.

Thank you all for your for your comments and sharing your experiences. This has helped, and has shaped how I think I'm going to proceed. Many of you echoed thoughts I have which gives me more confidence.

What a great resource.

Mike, just wanted to add my welcome to HW. Sorry you need to be here.

This is a great place. Do keep us updated on your progress and ask all the questions you have.

Lots of smart folks around here.

Andrew

I wanted to followup on my story, history is above. This board was helpful to me when I started down this path 2 years ago and what I want to share is how the relationship with my doctor changed things.

The idea of a biopsy really had me freaked out. I wasn't able to get any forward movement until I talked to a urologist who understood this. The other urologists I'd seen were factual, the biopsy is the next step, let's do it. This doctor took that pressure away. I saw him twice before he ordered an MRI. The results I got back convinced me a biopsy was in order. When I got the biopsy, it was done with sedation and turned out to be no big deal. (BTW, the earlier urologists never mentioned sedation as an option.) The biopsy results showed cancer in the areas the MRI identified, but also in other areas as well. At that point, he talked about my surgical options and side effects, and said I needed to talk with a radiation oncologist next before making a decision about what to do. It wasn't until I decided upon surgery that he voiced his opinion that he also thought that was the best decision.

Fast forward, I had a RALP 5 weeks ago. All the lymph nodes he removed were clear, as well as the fat around the prostate, so things look good. I see him again in a few weeks to start monitoring PSA levels with ultra-sensitive PSA tests (since my earlier levels didn't indicate much).

This doctor's patient skills made all the difference for me. He guided me through making a decision, rather than deciding for me.

_______________________________________________
Age: 61
11/15 PSA 1.7
5/17 MRI
7/17 Biopsy 10-12 cores positive/17 samples, Gleason 4+3
10/17 RALP
Stage T3a

Post Edited (Mike_T) : 11/16/2017 9:23:11 AM (GMT-7)

Mike—
Thanks for the update. From one 61 year old T3a to another — best wishes for the future, and may your PSA come through “undetectable”!

I'm a big advocate of shared decision making. It sounds like you have a great urologist. I wish you a speedy and full recovery, and undetectable PSAs.