3D transperineal mapping biopsy

[Guest guest]

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]

Hello Dennis,

I have to agree with Alan Meyer's comments regarding prostatitis

potentially being the cause of your PSA rise. Usually this is

eliminated from consideration by going on a 20 day course of

antibiotics- 500 mg/day of Leviquin or Cipro. Given the range of

tests you have had, I am surprised that this was not mentioned.

I have recurring bouts of chronic prostatitis, which have elevated

my PSA to over 7. 20 days of Leviquin drop it back the 5 to

6 range (PSA density 0.09 to 0.10), which seems to be my

current Active Surveillance norm with three small tumors,

Gleason 3+3.

There is a key factor regarding the two biopsies you already had

that you did not mention. 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.

Current literature indicates that MRIs of the prostate, even the

endorectal MRI with spectroscopy (MRSI), tend to miss small

low-Gleason cancers. Since these cancers are the most

appropriate for Active Surveillance, some doctors, especially

in Europe, now use a negative MRI as an indicator that a

biopsy is NOT warranted, even if small indolent cancers were missed.

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. The CDU scan also

can identify active prostate inflammation or prostatitis as well

as evidence of calcifications from past prostatitis. The patient

can see the scanned images on a monitor during the exam

and as Dr. Bahn explains what is found the process greatly

enhances the patient's understanding of his disease. If Dr. Bahn

sees a suspicious area on the CDU, he cores it, thus accurately

targeting the sample. In my case his targeted biopsy last

year picked up two small tumors missed twice by endorectal

MRSI scans at UCSF. 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.

You can learn more about CDU and Active Surveillance at:

http://tinyurl.com/2cropk

which is an article from PCRI Insights, Feb. 2007.

For some reason many urologists, especially those in the

East, seem completely unaware of how much more

advanced a CDU scan is in the hands of an expert than

the grey-scale ultrasound used in their own practices.

The Best to You and Yours!

Jon in Nevada

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2a. 3D transperineal mapping biopsy Posted by: "Dennis Humphries" d.bearnc@... d.bearnc Sat Sep 25, 2010 6:29 pm (PDT)

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