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Confusion over having a prostate biopsy
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moyr1834 posted:
I am a 65 year old with no family history of prostate cancer. In late 2008, my PSA went from 3.11 to 4.56 and my internist recommended going to a urologist. He did a biopsy which came back negative, and the post biopsy PSA went up to 7.7. Not too long after this, I read the National Cancer Institute report that PSA testing and biopsies were being overdone and creating a lot of anguish and pain, which certainly described what I went through. I felt that the biopsy was a waste of time. I decided not to go back to the urologist for any follow-up visits. For the past three years, my PSA's were all around 4.5, but this year, it came in at 6.3, and my internist recommended going back to the urologist. So, I went to a new urologist, a few weeks after, and he runs a PSA test that came in at 5.1 with a free to total ratio of 14%. He's urging me to go through a biopsy and tells me that not catching cancer early can lead to a "late prostate cancer that is incurable and would lead to a very painful demise." He sent this to me in a certified letter. I talked to him over the phone and told him of my concerns over having another biopsy and discussed the NCI survey, which he completely discredited. Is a 5.1 PSA an open and shut indicator to have a biopsy, or do I have other alternatives, like having another test or directly going to treating BPH, which I feel has been causing all the elevated PSAs.
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billh99 responded:
I suggest that you read the entry below Can Prostate Cancer Screening Improve Men's Lives? It is much better than the NCI.

In general here is the problem.

1. While PC can raise PSA it does not always.
2. Other things can cause a raise in PSA.
3. Most, but not all PC is slow growing most people die from something else.
4. But if PC does spread it can cause a painful and debility death.
5. While the biopsy can tell if you have current aggressive disease there is no test to tell which PC can turn aggressive in the future.

So no 5.1 PSA is not an open and shut indicator.

But you also have a free PSA test.

http://en.wikipedia.org/wiki/Prostate-specific_antigen#Free_PSA

From that it looks like you might have a 30% chance of having PC.

directly going to treating BPH, which I feel has been causing all the elevated PSAs.

BPH is not diagnosed by PSA. There is a questionnaire of symptoms. And if you have PSA then you should be treating it regardless of the PSA.

BTW, my PSA was not that high, but I had bad PSA and when other treatments did not help I had a TURP procedure.

And a pathology report on the material removed showed the PC.
 
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moyr1834 replied to billh99's response:
Thanks for taking the time to reply to my post and providing the useful links to help me make a decision. I think the key is #5 of your breakdown of the problem, and the fact that there is no test to tell which PC will turn agressive. If I choose to have a biopsy, it's to answer whether or not I have an agressive cancer, and not just for determining the presence or absence of cancer. As I understand the argument, there is no statistical evidence of benefit gain from early detection and cure of PC, because of the high numbers of overtreatment required to catch the one cancer that would turn agressive and kill the patient. I didn't seem to see any statistical evidence that elevated PSA is an indicator of an increased chance one would have an aggressive cancer. Is this thinking correct, based on what is currently known?
 
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billh99 replied to moyr1834's response:
increased chance one would have an aggressive cancer. Is this thinking correct, based on what is currently known?

I really have not looked into this enough to say much.

I do know that some "young" people that get an aggressive form of PC do not have elevated PSA.

And also that people with "very" high PSA have much poor prognoses. But I don't know where very high would be, maybe 10, 20, or even 50.

There is some thought that rate of increase in PSA is an indicator of aggressiveness.

You might want to look here.

http://www.ustoo.org/

The section under About PC.
 
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Basir U Tareen, MD replied to billh99's response:
This is a difficult dilemma faced by urologists and patients every day.

There are some algorithms you can find online now where you enter your information and it tells you likelihood of a positive biopsy.

Bottom line is this:

1. If you have made up your mind that you would not treat prostate cancer even if you had it, then don't do a biopsy and stop checking your PSA

2. You are exactly right in saying that not all cancer needs to be treated at the time of diagnosis and in many cases not at all. The key is having the information -- which the biopsy gives you.

3. If you are strongly opposed to a biopsy, have BPH, and still are concerned about missing a significant cancer, ask your urologist about the possibility of starting a 5-ARI (Avodart of Proscar). It will treat the BPH and cut your PSA by 50% -- typically within 6-12 months. If your PSA is rising on one of these medications, that's a red flag.

best of luck
Dr. Tareen
 
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jameshodge responded:
So many men are confused over this same topic, so at least you're not alone. Try consulting another urologist in your area. If I were you, I'd try and find other ways of determining if this is cancer. Read up on Super Beta Prostate reviews and other reviews to see which supplement are effective in increasing prostate health. Hope you find the right answer !
 
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worldbionews responded:
Confusion about biopsy or no biopsy is a real crisis. Help advocate a solution by signing this petition: http://chn.ge/12WDubX


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