Biopsy Now or Later

rjrsmnyc

Today, I had a confusing conversation with my urologist. After receiving a PSA result of 10.1, I underwent an MRI and CT scan, which identified two contained lesions. Despite these findings, the urologist suggested waiting a few months before repeating the PSA test. When I did, my PSA level had dropped to 8.4. The urologist mentioned that at 81 years old, I could now opt for a biopsy to determine if it was cancer, but he didn’t seem to be strongly recommending it. Instead, he left the decision up to me—to either proceed with a biopsy now or follow up with him in another four to six months. During every discussion, he reminds me that 80% of men will have some form of prostate cancer but usually die from other causes. I would appreciate hearing if others have had similar experiences with their urologist and what decisions they made.

Wheel

Ask your urologist to order a ExoDx Urine test kit for you. It is so simple. You provide a ytine sample and it is analyzed for bio markers to determine the aggressiveness of the cancer. You can learn quickly whether your cancer is aggressive high grade and go immediately to the biopsy or that it is considered non aggressive low grade.

Wheel

urine sample

rjrsmnyc

Thank you for the info ExoDx. I just wonder why the urologist never mentioned this test before getting a biopsy.

Clevelandguy

Hi,

If it was me I think I would want the biopsy to at least find out how agressive the cancer was. It seems kind of odd your PSA dropped almost two points, I would expect an increase over time not the opposite. In having the MRI your Urologist should be able to determine the size of your Prostate to rule out Benign Prostate Hyperplasia. Also if you had your PSA taken after sex or a long bycicle ride that could expalin the higher first number. A biopsy in the peritoneal region usually has less chance for an infection. A biopsy will confirm the cancer and grade it’s aggressiveness. If you have a 3+3 or 3+4 Gleason score you might not need surgery or radiation at 81 based on your overall health and other medical problems. A discussion with your Urologist and Oncologist can help you decide what your next steps will be.

Dave 3+4

Josephg

I would take your Urologist's reticence for go directly for a biopsy as a sign that they think you are too old to be pursuing that line of diagnosis and potential mitigation actions. As the Clevelandguy stated above, I to would like to know (1) if I have prostate cancer (PCa) or not, (2) what its Gleason score for aggressiveness is, and (3) is it located near the edge of the prostate and likely to escape in the near future.

I like to 'know' what I have or don't have, and I like to make my own decisions regarding my health, and most of all, I like to make data-based decisions.

Old Salt

How long do you still want to live? Your urologist seems to 'think' that you are almost at the end. Do you agree? If so, then it may be reasonable to not do much of anything.

How is your overal health? The average life expectancy for an 81-year old man is about seven years.

rjrsmnyc

https://csn.cancer.org/discussion/comment/1718193#Comment_1718193

I'd like to live a healthy life for another 7-8 years. I am a healthy 81 y/o, with daily gym workout and cardio, no diabetes, cholesterol and blood pressure under control and good, and my heart seems to be in good shape (according to the cardiologist). I do take Eliquis because of my family history. Living in NYC means, I walk a lot, no falls, and want to travel as much as possible in my surviving years.

rjrsmnyc

https://csn.cancer.org/discussion/comment/1718190#Comment_1718190

I agree with you and Clevelandguy, but hesitant about biopsy because uncertain about what it entails and its side effects. My urologist, like so many male doctors, doesn't seem to sense my need for better bedside management. Which all means, I have to dig for more information about getting a biopsy.

Clevelandguy

https://csn.cancer.org/discussion/comment/1718195#Comment_1718195

Hi,

Biopsies are easy peezy, mine was done in the Urologist office, very little pain, more uncomfortable than painful. I did the rectal one, no complications or infections. They seem to be doing more biopsies in the peritoneal area which offers less of an infection risk. I doubt in your Urologist will go any further without a biopsy.

Dave 3+4

rjrsmnyc

I want to send thanks to all who responded to my post. You have been kind and informative in your remarks and that helps me to learn and make decisions. Sometimes, health issues can make one feel so alone, but your thoughtfulness gives me the courage to put fear aside. Thank you.

hopeful and optimistic

rjrsmnyc

Some guide lines that are available to you

You mentioned that you had an MRI. Contained within the MRI report is something called “PIRAD”. A radiologist looked closely at any lesion that he may have found and ranked it by a possibility of a significant cancer(3+4=7 or greater) on a scale, 5 being most likely and a 1 being least likely.
Also the MRI measures the size of your prostate. Larger prostates lie on the urethra and secrete more PSAs. Look for the relation between the prostate size and psa. The lower the relationship the better. Look for under 0.15.

If you get a biopsy, you will want to have a targeted one based on the MRI that you had. This type biopsy is the state of the art and will do a better job a finding any cancer if it exists.

Im also 81. I would want to know where I stand. By the way most prostate cancers found are less aggressive

Old Salt

Yes, a biopsy isn't a big deal. There are two ways of doing this. The transperineal one is the better one because of a lower chance of infection. Since two suspicious lesions were identified, an MRI guided biopsy would be the preferred way to go. Your current urologist may not be able to do this. But since you live in NYC, Memorial Sloan Kettering would be an excellent option.

centralPA

What was the size of your prostate? This will give you PSA density.

Do you have any urinary issues?

What was the PIRADS ratings of your lesions?

Have you had PSA tests prior? What is the history of your tests?

rjrsmnyc

https://csn.cancer.org/discussion/comment/1718202#Comment_1718202

Prostate size: 5.1 cm x 5.0 cm x 3.5 cm for an overall volume of 46.4 cc (series 7, image 20 and series 3, image 19)Intra-vesical protrusion: 0.6 cm

I'm on alfuzosin.

LESION: 1PI-RADS Assessment Category: 4, High (clinically significant cancer likely)T2-weighted images: 4 (lenticular or non-circumscribed homogeneous moderate decreased signal; <1.5 cm)Diffusion-weighted images: 4 (focal marked decreased ADC & marked increased high b-value signal; <1.5 cm)Size: 11 x 9 mm as measured on series 7 image 18 (T2-weighted image)Side: RightLocation within transverse plane: AnteriorLevel of prostate: Base extending to midglandZone: TransitionExtra-prostatic extension: Abuts capsule without visualized EPE 

LESION: 2PI-RADS Assessment Category: 3, Intermediate (presence of clinically significant cancer equivocal)T2-weighted images: 3 (heterogeneous signal intensity with obscured margins; other findings not qualifying as 2, 4, or 5)Diffusion-weighted images: 3 (focal [discrete and different from background] hypointense on ADC and/or focal hyperintense on high b-value DWI; may be markedly hypointense on ADC or markedly hyperintense on high b-value DWI, but not both)Size: 12 x 10 mm as measured on series 7 image 24 (T2-weighted image)Side: MidlineLocation within transverse plane: AnteriorLevel of prostate: Distal apexZone: TransitionExtra-prostatic extension: Abuts capsule without visualized EPE. Abuts the urethra

My PSA test Nov 2023 was 6, and then 10.1, and now 8.4

hopeful and optimistic

According to the literature, a PIRAD of 4 indicates that there is a good chsnce of prostate cancer that is 3+4 or greater.
very important for you to obtain a targeted biopsy as previously mentioned that your urorologist may or may not have the equiment to perform.
At 81 if you have a small amount of 3+4 the cancer can safely be monitored, without aggressive treatment such as surgery or radiation.