Biopsy v non-Biopsy: Can you be diagnosed without a biopsy?

@csbarry
One of The first things prostate cancer does is go to the bones. Prostate cancer is so painful if untreated, It’s an unrelenting pain. There’s nothing you can do to be without it. You really think you will have quality of life, going through the pain once it starts with prostate cancer.

You can always pick radiation, Minimal side effects.

Do you think once the pain starts your emotional health will be great? Don’t expect to die of something else, Unless your disability is so bad you only have a couple years left.

At 62 you should live to at least 76, I have made it from 62 to 78 with PC. My emotional and mental health are just fine, i’ve had surgery and radiation and multiple different drugs. If you met me, you would have no idea I have prostate cancer.

So funny - I read that about the bones also. I have bone pain that is weird. I asked my Urologist about the “bones first” idea and he blew that off and basically said no. My PSAs are all over the map (high 9.7 - current 8.6). My first Urologist in Jacksonville said “well at least your PSAs are stable so everything should be fine”. I got a new Urologist. There is so much info and so much to misunderstand. My university of Florida urologist (best in the state so they say) never heard of biomarkers in the urine indicating PC - thus my original post. Unfortunately I question everything and argue for my own health. Just because a urologist says X means nothing to me. I will research and attempt to understand it before making any move. I have read every post in this forum and PC is huge - complicated - different for everyone - and the side effects are numerous.

@csbarry

If you are having bone pain and four MRIs have ALL detected a significant cancer (as you originally indicated); then your current PSA is really of limited value in helping to inform the current status of your situation.

I find it hard to believe that any urologist would "blow off" a patient, having a PSA in the range of 8.6-9.7, who complains of "bone pain" and instead try to ease the mind with "your PSA's are stable". Taking your comment at face value, you did exactly the right thing by getting a new urologist.

As I make clear in my posts on this subject, my concern with repeat biopsies is related to men who have been diagnosed, via biopsy, with "LOW RISK" PCa, have a low Decipher score, and where serial mpMRI's indicate stable or regressive lesion results.

Can you say that your four mpMRI's have indicated stable / regressive results and that the last mpMRI was the best of all four?

The key concern with your comment...an absolute "double red flag"...is your indication of bone pain. The diagnosis of Low Risk PCa, via biopsy, is NEVER accompanied with bone pain. Often times there are zero physical symptoms that can be attributed to low risk PCa.

You are right to question, research and attempt to understand everything that may be pertinent to PCa, before making any move.

However, if it were me, I would not delay to find out what is really going on ASAP. Maybe your bone pain is due to something unrelated (I really hope that is the case for your sake), but IMHO your four MRI's indicating the likelihood of clinically significant PCa would make me want to get to the bottom of what is going ASAP, by the best means possible in 2026. In the US that is biopsy, but maybe you could travel to the UK (I also understand China is also doing this) to go directly to surgery without a biopsy.....of course even in these countries, they all do extensive noninvasive tests to ensure the PCa is clinically significant (see video).

As I try to explain to folks, low risk PCa and high risk, metastatic PCa are virtually two different diseases. True Gleason 3+3 (forgetting, for a moment, the inaccuracies of biopsy and its attempt to characterize the entire gland with only a few cores) is an indolent disease. That is completely different situation than metastasized PCa into the bones and other distant locations in the body.

The good news, as Jeff Marchi has indicated (I fully agree with his comments), even when PCa travels to the distant locations in the body there are treatments available, even after progressing to castration resistant PCa...the worst type.

All the best!

Here is my latest MRI. Not sure if that indicates regressive or otherwise. I am PIRADS 4! I have been for the last 3 MRI. My lesions have doubled in size in the last 3 years.
I have weird bone pain! My thumb and wrist hurt constantly for no reason. My angle - twisted last year - is constant pain. I had a L1-L5 lumbar fusion so back pain is a constant.
Yes! My urologist was more interested in doing surgery than anything else. I am an educator with a masters in curriculum design- so I appreciate their scientific journey and they earn every penny they get.
I am retired military and was exposed to hazardous chemicals that now we know causes cancer - AFFF!

@csbarry

First of all let me express my gratitude for your military service, we all owe you and all our service men and women our heartfelt thanks!

I am not a physician, just a fellow PCa patient, who happens to know something about chemistry and research (retired chemical engineer).

I know about PFAS and a quick search found this document, which may relate directly to your situation and potential military exposure to AFFF.
https://www.va.gov/vetapp25/Files2/A25017998.txt
In any case, my quick search indicates that one must have a positive diagnosis of PCa, if you are following up regarding your concern about AFFF exposure.

For better or worse, one cannot claim a PCa diagnosis unless a biopsy makes that finding positive.

As good as mpMRI’s have progressed, they are still not accepted as proof of diagnosis of prostate cancer in the US (if anyone reading knows otherwise, please indicate).

Therefore, if you’re pursuing action with the VA and AFFF exposure, regarding the possibility of PCa, a biopsy will be necessary.

Person to person, I hope you would be found to have no PCa, based on a biopsy and that it turns out only to be BPH and inflammation…certainly a possibility with the size of your prostate.

I’ll be remembering you in my prayers!

All the best!

@handera
Hey. Thanks for the info. No, not looking for any actions against the makers of AFFF. Don’t need the diagnoses but want it for myself.
Thank you for the kind words

@csbarry You're much more trusting than I. I'm a disabled veteran as well and use the VA health care system sporadically. In the eight years I've used them I've seen a grand total of TWO doctors. One was great and the other was a place holder. I'm fortunate enough to be able to use private care in addition to the VA though.

@csbarry Well, as an educated man, why not connect the dots: High PSA - possible cancer…PIRADS 4 - highly suggestive of cancer…lesions doubling in size over a 3 year period - suggestive of malignant cell growth…bone pain of unknown origin - very suspect for metastatic cancer.
Yet, you fail to see how a biopsy might be the most useful and important thing you can do in order to find this out??
I’m sorry, but I think your fear of being diagnosed with the worst possibility - metastatic prostate cancer to the bones - is causing denial on your part. You are smart enough to know better.
Scream and yell at me if you like, but there’s no shame in being afraid of this thing - we’re ALL terrified of it every freakin day.
Phil

@tico14
Yep I email the Sec of the VA constantly. I use them for community care and scripts only. They will never put a knife on me - ever!
Peace

@heavyphil
Man! I get what a biopsy is for! If you watch the video in other posts you will see that there are alternatives to biopsies. That is all I was asking. Mayo is using biomarkers in the urine to diagnose. Proteins spike when you have cancer. If low grade I can wait until I am 110 for the prostate removal. I am 62 today. I have had doctors want to biopsy, scoop out, stick needles and all the things.
I am pausing - looking around - asking questions - reading - watching videos. My life circumstances allow me to.
Thanks Phil.