1. < Prostate Cancer

Best procedures

Posted by jaydub @jaydub, Feb 6 2:54am

I am in my early 70s. My PSA test scores were always in range, my last normal test being in the Fall of 2020. A PSA test in January of this year came back at about 27, and a follow up (after 48 hours of no bike riding, no sex) at about 17. Today, the urologist to whom I was referred did a digital rectal exam and found a nodule he said was about 1 cm in size. They also did an ultra sound which revealed my prostate to be mildly enlarged. I'm scheduled for a biopsy procedure in his office a few weeks from now. The doctor sounds well-informed and has good "bedside" manner. Is having that procedure the right way to go?

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hbp | @hbp | Feb 6 8:30am

Biopsy is absolutely right. It does not hurt. Good luck.

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mn281 | @mn281 | Feb 6 10:40am

A biopsy certainly makes sense to determine why your PSA is so high and whether there is cancer. Prior to my biopsy I had an MRI which showed a lesion that was likely causing the high PSA (PIRADS 4). While the MRI didn't confirm cancer, it gave a much clearer picture of where to focus biopsy sampling. I'm glad I did this first step as they were able to take more cores from the site of concern. I also had a transperineal biopsy (no prep needed) and didn't feel a thing.

Best of luck!

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gently | @gently | Feb 6 8:30pm

I think it's the way to go. Then ask for the genetic testing of the tumor.

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trusam1 | @trusam1 | Feb 6 9:40pm

Yes! You might want to use the time waiting for the biopsy to begin learning more about the diagnosis and management of prostate cancer. A great place to start is Patrick Walsh's book: https://www.amazon.com/Patrick-Walshs-Surviving-Prostate-Cancer-dp-1538726866/dp/1538726866/ref=dp_ob_title_bk

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hammer101 | @hammer101 | Feb 7 8:54am

Definitely get the biopsy done. Also, as another post recommended, start doing your research on prostate cancer, treatment plans, and centers of excellence. I would not recommend going to a local doctor based on convenience. The quality of your life, for the rest of your life, will depend on the skills of your doctor and his/her team.

Good luck,

Jim

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jc76 | @jc76 | Feb 9 6:03pm

@jaydub
Absolutely. The biopsies are needed to definetely remove the prostrate samples and get a pathology report. Prior to biopsies you should have a MRI with contrast to show areas of concern.

Do not worry about biopsies as long as you have them done transperinal and with anesthesia. When you get results the urologist will brief you and most likely refer you to a oncologist/radiologist for options of treatment IF the biopsies reveal cancer.

A strong suggestion is to have a Decipher test. This test uses the already taken biopsies and does a genetic test on them. It is much more accurate diagonsis as pathology is subjective many times. My Decipher moved me from intermediate to low risk and changed my treatment recommendations.

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mikewo | @mikewo | Feb 9 8:08pm

I went to Mayo and would get an MRI before any biopsy. Your urologist is just going in blind and hoping to hit the lesion. Once you have the MRI results you can get an MRI fusion guided biopsy which is highly accurate. Can your urologist tell if there is more than one lesion? I did a fusion guided transperineally biopsy with 30 cores due to my large prostate 120 grams. At 70 you have Medicare and they pay for these procedures. The urologist at Mayo hit the lesion and the rest of my prostate was benign. After your biopsy results are in then Mayo will do a PSMA Pet scan to see if the cancer has spread anywhere else in your body. I had a friend who did what you are thinking of doing with his local urologist but had to do it all over when he went to Sloan Kettering in New Jersey like I told him to do at the get go. Don't do amateur hour with your health. I also did the biopsy with a local and felt nothing. A general anesthesia is not needed.

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3 replies
jaydub | @jaydub | Feb 10 6:53am
In reply to @mikewo "I went to Mayo and would get an MRI before any biopsy. Your urologist is just..." + (show)
@mikewo

I went to Mayo and would get an MRI before any biopsy. Your urologist is just going in blind and hoping to hit the lesion. Once you have the MRI results you can get an MRI fusion guided biopsy which is highly accurate. Can your urologist tell if there is more than one lesion? I did a fusion guided transperineally biopsy with 30 cores due to my large prostate 120 grams. At 70 you have Medicare and they pay for these procedures. The urologist at Mayo hit the lesion and the rest of my prostate was benign. After your biopsy results are in then Mayo will do a PSMA Pet scan to see if the cancer has spread anywhere else in your body. I had a friend who did what you are thinking of doing with his local urologist but had to do it all over when he went to Sloan Kettering in New Jersey like I told him to do at the get go. Don't do amateur hour with your health. I also did the biopsy with a local and felt nothing. A general anesthesia is not needed.

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Thank you. That's great advice.

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rkurtzjr | @rkurtzjr | Feb 10 1:18pm
In reply to @mikewo "I went to Mayo and would get an MRI before any biopsy. Your urologist is just..." + (show)
@mikewo

I went to Mayo and would get an MRI before any biopsy. Your urologist is just going in blind and hoping to hit the lesion. Once you have the MRI results you can get an MRI fusion guided biopsy which is highly accurate. Can your urologist tell if there is more than one lesion? I did a fusion guided transperineally biopsy with 30 cores due to my large prostate 120 grams. At 70 you have Medicare and they pay for these procedures. The urologist at Mayo hit the lesion and the rest of my prostate was benign. After your biopsy results are in then Mayo will do a PSMA Pet scan to see if the cancer has spread anywhere else in your body. I had a friend who did what you are thinking of doing with his local urologist but had to do it all over when he went to Sloan Kettering in New Jersey like I told him to do at the get go. Don't do amateur hour with your health. I also did the biopsy with a local and felt nothing. A general anesthesia is not needed.

Jump to this post

Agree completely

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kjacko | @kjacko | Feb 11 10:30am
In reply to @mikewo "I went to Mayo and would get an MRI before any biopsy. Your urologist is just..." + (show)
@mikewo

I went to Mayo and would get an MRI before any biopsy. Your urologist is just going in blind and hoping to hit the lesion. Once you have the MRI results you can get an MRI fusion guided biopsy which is highly accurate. Can your urologist tell if there is more than one lesion? I did a fusion guided transperineally biopsy with 30 cores due to my large prostate 120 grams. At 70 you have Medicare and they pay for these procedures. The urologist at Mayo hit the lesion and the rest of my prostate was benign. After your biopsy results are in then Mayo will do a PSMA Pet scan to see if the cancer has spread anywhere else in your body. I had a friend who did what you are thinking of doing with his local urologist but had to do it all over when he went to Sloan Kettering in New Jersey like I told him to do at the get go. Don't do amateur hour with your health. I also did the biopsy with a local and felt nothing. A general anesthesia is not needed.

Jump to this post

I had two MRI’s with contrast; one in 2016 and one last July. They both came back clean. In August I had a biopsy which showed cancer in two cores. While an MRI is helpful, it’s not always correct. I had a RP in November and so far so good. 🤞🙏🏻

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