Re: 3D transperineal mapping biopsy

[Guest guest]

Dennis Humphries wrote:

> I posted for the first time several months ago regarding my

> case. I'm 55, Gleason 3+3 (<5% of 1 core, first of 12 samples,

> then same out of 18 samples on a later biopsy), diagnosed

> February 2009. I chose Active Surveillance. I was concerned

> about my rising PSA (3.8 at diagnosis, up to 7.8 by April 2010)

> even though all tests, including biopsies and MRIs and even a

> bone scan (due to a " questionable " area found on the MRI), come

> up clean except for that tiny bit. I have since been referred

> by my urologist for a second opinion at the Duke Cancer Center,

> and the final test they want to try before saying " oh, well "

> and continuing to watch my PSA, is a " 3D Transperineal mapping

> biopsy " , also referred to by my urologist as a " saturation

> biopsy " . I am very leery of this given the possible side

> effects; it is quite an invasive procedure.

Dennis,

I haven't had the procedure and can't comment on it, however I

wonder if the biopsies you've already had reveal any other

possible causes of your high PSA.

It is my understanding that inflammation of the prostate

(prostatitis) can cause an elevated PSA. Nobody knows exactly

what causes prostatitis. Sometimes it's a bacterial infection

which, sometimes but not always, can be cured with antibiotics.

Most of the time, or so I've read, it's not caused by infection,

but by other damage to the prostate, e.g., from mineral deposits

like calcium, or perhaps from other irritations.

I have read reports by people who have said that their biopsies

revealed inflammation. Did yours? If so, maybe that is why your

PSA doubled. Conceivably (to me anyway - who doesn't know enough

to know one way or another), all of the manipulations you've had

on your prostate from biopsies to digital rectal exams, to

x-rays, could have irritated the gland or introduced an

infection.

Do you experience any pain or apparent swelling in the perineal

region? I did when I had prostatitis. Sometimes it felt like I

was sitting on a golf ball. It could be a clue.

I don't know enough to know if this is a real possibility, but I

don't know that it's not either. And if a glib doctor just

dismissed it without giving it serious thought, I'd like him to

explain just what does cause prostatitis. If he says " I don't

know but the biopsy and DRE's couldn't have done it " , I'd like to

know just how he knows that - especially given that he doesn't

know what does cause it.

Well, as I say, I'm no kind of expert and I'm probably sending

you on a wild goose chase. But maybe you can meet with one of

the urologists again, the one you think is the smartest and most

knowledgeable, and ask to go over the actual printed report from

your last biopsy and see if there's anything there to be

discovered besides the fact that you appear to have an

insignificant cancer.

You might also ask to track the PSA more closely, e.g. every 3

months, or even more often, in lieu of getting a saturation

biopsy. The PSA test is simple and cheap and you might see a

trend that indicates that you don't have a runaway PSA increase

at all, but just a temporary elevation.

Also ask about other blood tests - free PSA is commonly used.

Some doctors test for prostatic acid phosphatase, though I have

no idea if it's of any use in your case.

Be sure to avoid sex for at least 48 hours before any blood

tests. I would also avoid a DRE before hand. If the doc wants

to do it, have him do the blood draw first.

Finally, ask if an endorectal MRI, which is a pain in the butt

but is not as invasive as a biopsy, would be of any use.

Best of luck.

Alan

[Guest guest]

Unlike you I did NOT have any positive cores on standard biopsy (one 12 core and

one 18 core) but I did have extensive LG and HGPIN. My urologist recommended a

mapping biopsy to me but I eventually deferred just for your reasons. It is

extremely invasive taking a core every 5 mm and would have resulted in 50-100

cores, taken through the perineal area, if I recall right.

There is research that indicates that repeated invasion of the prostate in

biopsies causes changes and increases risks of complications, namely, impotence

and incontinence.

Even though my PCA3 was high (86) I discovered that PIN tissue expresses PCA3 at

nearly as high a rate as cancerous tissue, although finding that data was

difficult.

I would suggest, based on the very small positive core result, having another

lab review the biopsy assessment. Pick one of the most prominent.

Rich L

Green Bay, Wi

>

> Hi group,

> I posted for the first time several months ago regarding my case. I'm 55,

> Gleason 3+3 (<5% of 1 core, first of 12 samples, then same out of 18 samples

on

> a later biopsy), diagnosed February 2009. I chose Active Surveillance. I was

> concerned about my rising PSA (3.8 at diagnosis, up to 7.8 by April 2010) even

> though all tests, including biopsies and MRIs and even a bone scan (due to a

> " questionable " area found on the MRI), come up clean except for that tiny bit.

I

> have since been referred by my urologist for a second opinion at the Duke

Cancer

> Center, and the final test they want to try before saying " oh, well " and

> continuing to watch my PSA, is a " 3D Transperineal mapping biopsy " , also

> referred to by my urologist as a " saturation biopsy " . I am very leery of this

> given the possible side effects; it is quite an invasive procedure.

>

>

> I would like to hear from any of you who have had experience with this type of

> biopsy. Did it prove to be useful? Did it turn up any undiscovered cancer?

What

> was the recovery time, and what were the side effects? I would like to hear

> opinions as to whether or not this is worth doing.

>

> Thanks,

>

> Dennis

>

[Guest guest]

Sorry for the day in sending. Was experiencing technical problem with yahoo mail plus.The rise in PSA may be due primarily to benign enlargement of the prostate. The primary benefit of saturation biopsy is to identify area for very selective ablation of the cancerous area. It has been reported that the two drugs for shrinking prostate over a six month period are Avodart and Proscar (or its generic equivalent) may have benefit of preventing cancer or even its suppression of it. If this is indeed the case, then the benefit ov avoiding invasive surgery or radiation treatment, with the 60 percent likelihood erectile impairment. I would be inclined to try the course of the above drug treatment (preferably with Avodart), for six month or more, then go for the saturation biopsy, followed up by selective ablation, if needed.Louis. . . . To: ProstateCancerSupport Sent: Sat, September 25, 2010 9:29:03 PMSubject: 3D transperineal mapping biopsy

Hi group,I posted for the first time several months ago regarding my case. I'm 55, Gleason 3+3 (<5% of 1 core, first of 12 samples, then same out of 18 samples on a later biopsy), diagnosed February 2009. I chose Active Surveillance. I was concerned about my rising PSA (3.8 at diagnosis, up to 7.8 by April 2010) even though all tests, including biopsies and MRIs and even a bone scan (due to a "questionable" area found on the MRI), come up clean except for that tiny bit. I have since been referred by my urologist for a second opinion at the Duke Cancer Center, and the final test they want to try before saying "oh, well" and continuing to watch my PSA, is a "3D Transperineal mapping biopsy", also referred to by my urologist as a "saturation biopsy". I

am very leery of this given the possible side effects; it is quite an invasive procedure. I would like to hear from any of you who have had experience with this type of biopsy. Did it prove to be useful? Did it turn up any undiscovered cancer? What was the recovery time, and what were the side effects? I would like to hear opinions as to whether or not this is worth doing.Thanks, Dennis

[Guest guest]

I appreciate the feedback, but I guess I left a few things out in an effort to

get to the point. So, I'll respond to various things you said.

First, from Alan:

<It is my understanding that inflammation of the prostate

(prostatitis) can cause an elevated PSA.>

That was the first thing my urologist ruled out. He had me on a course of Cipro,

I forget for how long, and the PSA continued to rise. I also should add here

that the rise in PSA was steady over the year and a half, rather than a sudden

spike.

<You might also ask to track the PSA more closely, e.g. every 3

months, or even more often, in lieu of getting a saturation

biopsy.>

I'm already doing that routinely as part of my Active Surveillance.

<Be sure to avoid sex for at least 48 hours before any blood

tests. I would also avoid a DRE before hand. If the doc wants

to do it, have him do the blood draw first.>

Yep, and yep. Doing both already.

<Finally, ask if an endorectal MRI, which is a pain in the butt

but is not as invasive as a biopsy, would be of any use.>

I had one of those earlier in the year. It showed a small lesion on my sacrum

(which turned out, via a bone scan, to be no big deal), but nothing at all in

the prostate. I also recently had a more extensive multi-focal MRI at Duke; the

doctor told me it came back, in his words, " stone cold clean " .

Next, from Rich:

<There is research that indicates that repeated invasion of the prostate in

biopsies causes changes and increases risks of complications, namely, impotence

and incontinence.>

Yes, exactly my concern. Exactly HOW much less invasive is this than the damn

prostatectomy? I don't want my life messed up by a DIAGNOSTIC tool...

<I would suggest, based on the very small positive core result, having another

lab review the biopsy assessment. Pick one of the most prominent.>

Steve gave me a list. What should I ask? Should I send them a copy of all my

records to date? Or should I just call and explain my situation and ask who

would be the best person to ask information from?

Now, from Jon in Nevada:

<What was the prostate size indicated

on the ultrasounds done for the biopsies? An enlarged prostate

can raise one's PSA just from the extra benign tissue. An

indicator that is used is the PSA density-- the PSA divided by

the prostate size. A PSA density of less than 0.15 is considered

another sign of small, low-risk cancer and would be consistent

with the single positive core with less than 5% Gleason 3+3.>

Good question. I have it somewhere, but it was not considered particularly

large. I'll quiz my doc at my next visit.

<Currently the best way, short of the saturation biopsy, to

find out more about what is going on is to have a color Doppler

Ultrasound (CDU) done by a recognized expert such as Dr, Bahn

in Ventura CA or Dr. Lee in Michigan....A CDU scan is much less invasive than a

saturation biopsy, and, given what you presented, more likely to dismiss the

chance that the 18-core biopsy missed anything.>

This could be helpful. I'll research it and see if Duke does these, or can refer

me to someone/somewhere who does, or can provide info. Thanks.

Finally, Louis Carliner:

<It has been reported that the two drugs for shrinking prostate over a six month

period are Avodart and Proscar (or its generic equivalent) may have benefit of

preventing cancer or even its suppression of it....I would be inclined to try

the course of the above drug treatment (preferably with Avodart), for six month

or more, then go for the saturation biopsy, followed up by selective ablation,

if needed.>

I also neglected to say that I've been on Finasteride (generic Proscar) for a

couple of months now, and that has decreased my PSA to 3.8 as of a couple weeks

ago. However, the concern is that this is an artificial figure and may be

masking undetected cancer. But yours is also something to consider. And by the

way, why haven't I heard of the focused cryoablation before? This sounds like

the optimal treatment if you don't have a lot (and can handle the saturation

biopsy to find out).

So--I'd still like more feedback on this. I'd especially like to hear from some

of you who have had this 3D mapping biopsy. How did it affect you regarding side

effects and recovery time? Did it uncover anything you didn't know was there?

Did you feel it was worth having?

Thanks again, group, for your support.

Dennis

[Guest guest]

Dennis,

Just to fill in answers to a couple points about comments I made:

-Alternate evaluation of biopsy-just have slides/samples sent to listed labs.

-As for risk of side effects of repeated biopsies or saturation biopsy: I have

found nothing quantitatively assessing the risk. I can only presume (clearly my

thought) that each time there is a penetration of the prostate, there is a risk

of impinging upon or damaging nerves incidentally. I can only " guess " educatedly

that this is the underying potential cause of side effects along with consequent

inflammation resulting from so many incursions in the organ (more common sense

than data).

Personally, when my urologist suggested mapping after two biopsies, I was

somewhat appalled, especially after he described the procedure. Finding

probabilistic and objective data on the risks of and side effect risks of any

procedure is exceedingly difficult in my experience. Ultimately, you are left to

recommendations from " interested " parties which leads many to recommend

consulting an oncologist versed in prostate cancer when determining treatment

options. Unfortunately, when it comes to diagnostic procedures, the definitive

approach is needle biopsy albeit possible scans.

Rich L

>

> I appreciate the feedback, but I guess I left a few things out in an effort to

get to the point. So, I'll respond to various things you said.

>

> First, from Alan:

>

> <It is my understanding that inflammation of the prostate

> (prostatitis) can cause an elevated PSA.>

>

> That was the first thing my urologist ruled out. He had me on a course of

Cipro, I forget for how long, and the PSA continued to rise. I also should add

here that the rise in PSA was steady over the year and a half, rather than a

sudden spike.

>

> <You might also ask to track the PSA more closely, e.g. every 3

> months, or even more often, in lieu of getting a saturation

> biopsy.>

>

> I'm already doing that routinely as part of my Active Surveillance.

>

> <Be sure to avoid sex for at least 48 hours before any blood

> tests. I would also avoid a DRE before hand. If the doc wants

> to do it, have him do the blood draw first.>

>

> Yep, and yep. Doing both already.

>

> <Finally, ask if an endorectal MRI, which is a pain in the butt

> but is not as invasive as a biopsy, would be of any use.>

>

> I had one of those earlier in the year. It showed a small lesion on my sacrum

(which turned out, via a bone scan, to be no big deal), but nothing at all in

the prostate. I also recently had a more extensive multi-focal MRI at Duke; the

doctor told me it came back, in his words, " stone cold clean " .

>

> Next, from Rich:

>

> <There is research that indicates that repeated invasion of the prostate in

biopsies causes changes and increases risks of complications, namely, impotence

and incontinence.>

>

> Yes, exactly my concern. Exactly HOW much less invasive is this than the damn

prostatectomy? I don't want my life messed up by a DIAGNOSTIC tool...

>

> <I would suggest, based on the very small positive core result, having another

lab review the biopsy assessment. Pick one of the most prominent.>

>

> Steve gave me a list. What should I ask? Should I send them a copy of all my

records to date? Or should I just call and explain my situation and ask who

would be the best person to ask information from?

>

> Now, from Jon in Nevada:

>

> <What was the prostate size indicated

> on the ultrasounds done for the biopsies? An enlarged prostate

> can raise one's PSA just from the extra benign tissue. An

> indicator that is used is the PSA density-- the PSA divided by

> the prostate size. A PSA density of less than 0.15 is considered

> another sign of small, low-risk cancer and would be consistent

> with the single positive core with less than 5% Gleason 3+3.>

>

> Good question. I have it somewhere, but it was not considered particularly

large. I'll quiz my doc at my next visit.

>

> <Currently the best way, short of the saturation biopsy, to

> find out more about what is going on is to have a color Doppler

> Ultrasound (CDU) done by a recognized expert such as Dr, Bahn

> in Ventura CA or Dr. Lee in Michigan....A CDU scan is much less invasive than

a saturation biopsy, and, given what you presented, more likely to dismiss the

chance that the 18-core biopsy missed anything.>

>

> This could be helpful. I'll research it and see if Duke does these, or can

refer me to someone/somewhere who does, or can provide info. Thanks.

>

> Finally, Louis Carliner:

>

> <It has been reported that the two drugs for shrinking prostate over a six

month period are Avodart and Proscar (or its generic equivalent) may have

benefit of preventing cancer or even its suppression of it....I would be

inclined to try the course of the above drug treatment (preferably with

Avodart), for six month or more, then go for the saturation biopsy, followed up

by selective ablation, if needed.>

>

> I also neglected to say that I've been on Finasteride (generic Proscar) for a

couple of months now, and that has decreased my PSA to 3.8 as of a couple weeks

ago. However, the concern is that this is an artificial figure and may be

masking undetected cancer. But yours is also something to consider. And by the

way, why haven't I heard of the focused cryoablation before? This sounds like

the optimal treatment if you don't have a lot (and can handle the saturation

biopsy to find out).

>

> So--I'd still like more feedback on this. I'd especially like to hear from

some of you who have had this 3D mapping biopsy. How did it affect you regarding

side effects and recovery time? Did it uncover anything you didn't know was

there? Did you feel it was worth having?

>

> Thanks again, group, for your support.

>

> Dennis

>

[Guest guest]

Thank you, Steve, for filling in what I did not have at hand.

Rich L

Green Bay, WI

>

> (snip)

>

> > I would suggest, based on the very small positive core result,

> > having another lab review the biopsy assessment. Pick one of the

> > most prominent.

>

> Here's a list:

>

> Bostwick Laboratories [800] 214-6628

> Dianon Laboratories [800] 328-2666 (select 5 for client services)

> Jon Epstein (s Hopkins) [410] 955-5043 or [410] 955-2162

> Jon Oppenheimer (Tennessee) [800] 881-0470

> Lucia (303)724-3470

>

> Regards,

>

> Steve J

>