to Biopsy or Not to Biopsy?

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to Biopsy or Not to Biopsy?

by Snubnosed_in_Alpha on Mon Aug 08, 2005 12:00 AM

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For the past year I have been stalked by a urologist with a prostate biopsy gun. I am 48. Over the past year I have had six PSA tests done. The numbers, beginning in August of 2004 were: 3.1, 3.1, 3.3, 3.8, 4.0 and, two weeks ago, 4.5. Last November a DRE showed nothing abnormal. The 3.8 total was accompanied by a free-to-total percentage of 27%. The most recent 4.5 total was accompanied by a 21% free-to-total. I am told that the free-total ratio puts me in the 10% probability range for cancer. My urologist has recommended biopsy in spite of that for some time now. I have visted the Artificial Neural Network at http://www.charite.de/ch/uro/de/html/prostatabiopsie/prostata_en.html and have entered my numbers. The result is "No Risk." A part of the purpose of this ANN is to determine whether a biopsy is needed. Bottom line: I am sitting on the fence at this point. For obvious reasons, I don't want to do the biopsy. But I would like to hear what you would do if you were in my shoes. Thanks.

Reply to Biopsy or Not

by Patrick1 on Mon Aug 08, 2005 12:00 AM

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I would do the biopsy. Why? First of all, a biopsy, while uncomfortable, is not that big a deal. It stings every sample, and then its over. Secondly, if you catch PC early, it can and probably will save your life. I kept having PSA's in the 3 to 4.5 range. DREs were negative. Unfortunately, I did not have a biopsy (wasn't recommended) nor a PSA for a year. The next PSA was 7.0. An immediate biopsy showed PC in all quadrants with a Gleason score of 9-10! I immediately had a prostatectomy and the pathology report showed metastatic PC, having spread to and presumably beyond the prostate margin, and to the seminal vesicles and to 1 lymph node. I have been on hormone therapy ever since and my PSA is now undetectable after nearly 4 years. I am lucky to be alive and healthy, thank God. If you catch the PC early, the prognosis is excellent, so why not do the biopsy, at the least as an insurance (and assurance) measure. If you do find PC it is probably very treatable at this point Good Luck and Health, Pat K

Sound Advice

by Snubnosed_in_Alpha on Mon Aug 08, 2005 12:00 AM

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Pat K--Thanks for the input. I've put it off while reading everything I could find. You are probably right: I should just get it over with. Did you have the PSAII done during that time? I would be interested to know how your percentages came out. Good to hear that you seem to have it beat. Best, Mark

Re: Sound Advice, Reply to Mark

by Patrick1 on Mon Aug 08, 2005 12:00 AM

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Hi Mark, No, I did not have any info on percentages. Again, I would be inclined not to get too analytical. You are talking about your survival here. So far I have just been extremely fortunate. Pat K.

Analytical

by Snubnosed_in_Alpha on Mon Aug 08, 2005 12:00 AM

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Pat--Thanks again. My problem, though, is that my profession is actually that of an analytic philosopher. I **can't help** but be too analytical! ;-) Very Best, Mark

Re: Analytical

by Patrick1 on Mon Aug 08, 2005 12:00 AM

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Mark, LOL!! That's really funny! My profession is clinical psychology (retired), so I guess I had you pegged. I should know, I'm very analytical myself. Anyway, I'm just concerned about you, due to my own experience. Most likely you are fine, but you might as well find out for sure. Pat K.

Pegged

by Snubnosed_in_Alpha on Mon Aug 08, 2005 12:00 AM

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Pat, Thanks very much for the concern. I am likely a nightmare patient for my doctors as I am determined to decide for myself what is the best treatment. But even my close friends who have supported me in my recalcitrance have recently turned traitor and recommended that I give in to the biopsy. The free-to-total ratio (of 27%) had given me some sense of reassurance as the best studies have suggested that anything above 25% suggests a rather low (7%?) probability of cancer. But since I have dropped to 21% it is looking more like a high stakes gamble not worth taking. I have 4 grandchildren at present whom I wish to know as adults with children. Very Best, Mark

Great Friends to Have

by Patrick1 on Mon Aug 08, 2005 12:00 AM

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Mark, OK, so go for it. Let me know how it comes out. Good Health! Pat

Biopsy.............

by Jmw0913 on Tue Aug 09, 2005 12:00 AM

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Although 4.5 is slightly above average - I hear anything 4.0 and under the don't worry that much about - especially as you get older - but you still seem pretty young. There are many things that can affect the PSA levels such as prostritis (infection) - and other things - in my opinion it is really better safe than sorry. It may be nothing - but at least then you will know that it is nothing. But if it is cancer - prostate cancer can be VERY treatable if caught early on. My Father was diagnosed with prostate cancer in 1995 when they just started doing the PSA testing. He was 73 at the time of diagnosis with numerous other health conditions. His PSA level was 78.5!!!! They told him - not to be aggressive with it - do hormonal therapy - which worked for him for 10 years. He just died in June at 12 days before his 83rd birthday - 10 years after diagnosis of prostate cancer. Imagine how long he could have lived if he had been aggressive and the Doctors did not suggest that "something else will get your 1st" - You are still young and have MANY MANY years ahead of you. This is your health and your future - I would do the biopsy - so you will never have to look back and think - "what if"........ Good luck to you. Janet

Re: Biopsy

by Snubnosed_in_Alpha on Wed Aug 10, 2005 12:00 AM

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Thanks Janet. This seems to be the unwelcome advice I am getting from all sides. I think I have been reasonable in putting it off for a time while monitoring my total PSA and free-to-total ratios. But I just worked out a deal with my best friend, who is 50, and whose father had prostate cancer: if he goes in for his first PSA test (piece of cake) I'll go in for the biopsy (pain in the a$$--literally). Now if I can only muster up the courage to call the doctor and set it up....
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