Posted 2/27/2022 8:44 AM (GMT -5)
Hi Mel,
Yes, I had nine TRUS biopsies (ranging from 12 to 20+ cores). The tenth, sandwiched between the others, was the path exam of the tissue fragments removed during my TURP for BPH, which found no cancer. These were done over a 20+ year period. My PSA was slowly rising but it also fluctuated. I was put on finasteride (generic Proscar) and tamulosin (generic Flomax) which helped very much for many years, until they were overtaken by my BPH, resulting in my opting for a (successful) TURP. After my TURP, my current uro (who did my TURP and, eventually, my RP) wanted 6-month checkups (PSA test each time, DRE once a year until he felt an induration and then every 6 months--the induration eventually went away.)
Whenever my uro at the time though my PSA rise rose a bit higher than what was expected from my BPH, a biopsy was recommended. I never hesitated about this nor did I ever think "enough already" after the repeated negative results (except for my first uro in GA, my four uros over the years here in NC were all at Duke Univ. Hospital or had trained there). Just before my last (and positive) biopsy, my uro felt a new nodule, and my PSA had gone up as well. It turned out that the nodule was benign, but 2 of my 14 cores were positive: one was 50% (5+5), the other 3% G9 (4+5). Yes, this meant I was very high risk.
Doing the math for repeat biopsies, it was highly unlikely that my cancer had been around very long (in fact, the RP path report estimated my tumor burden at only 5%). Also, my imaging suggested this was prostate-confined and my PSA (corrected for finasteride) was under 9. I decided on surgery, liking my chances of a good outcome, but prepared for adjuvant therapy if needed. I was fortunate in being in the approx. 20-25% of G9-10 men who have a pT2 R0 N0 outcome after a RP. My final G score was (4+5) and my Decipher score was low-risk for mets. The curious thing was that BCBS denied coverage for my post-RP Decipher test claiming that I was no longer high risk. (Anticipating non-coverage, I had negotiated a very small fee with the testing company after my RP but before ordering the Decipher test, which is why I didn't bother to appeal the decision--they probably would have said "We'll pay for the test if and when you have BCR.")
Regardless of one's Gleason score, if you are pT2 N0 with negative margins and have undetectable PSA post-op, SOC according to all treatment algorithms is no adjuvant therapy and no further treatment (barring BCR). According to several studies (and bolstering BCBS's decision about non-coverage of a Decipher for me), the risk of BCR following this particular outcome is actually not correlated with one's Gleason score. So here I am. I'll be 5 years post-op this August.
The moral of my story (at least the one I tell myself) is that the vigilance and skill of my uro/surgeon, my willingness not to question "I think we should biopsy" advice, and a good dollop of luck are all to thank for my good outcome (so far at least). At one visit post-RP I ask my uro "If you hadn't felt the nodule, would you still have pushed for a biopsy based only on my last PSA rise [3.6-->4.3 on finasteride]?" He shook his head left and right for a bit, looking at the info on his screen and said "We certainly would have at least discussed it." (My prostate had grown back to 66 cc after my TURP in 2013, which reduced it from 90 to 30 cc.)
Hi-grade PC is, fortunately, the less common variety (roughly 20% of diagnoses if I remember), but the biggest gun in the arsenal against it is early diagnosis and treatment! No one dies from prostate-confined cancer. The key is (a) knowing you have it and (b) knowing if and when you need to take action to prevent it from spreading or metastasizing. I asked my uro what his ideal age for the start of PSA screening is, and he said 40, so you catch the uncommon cases of serious disease in younger men.
Djin