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Biopsy or not? Does Biopsy spread Cells

User
Posted 10 February 2015 09:37:30(UTC)

Hello all

As in profile, have not been diagnosed, and MRI is inconclusive. PSA has been constant and now at 4.04 for my age 53, but PSAf is at 13%. DRE normal, PCA3 in 2011 was 27 so ok. MRI indicated Utricular Cyst of 8mm which is grown since 2011 MRI. The Urologist did not mention, only once I got report have I investigated.

I have not had biopsy.

My dilemer is whether to or not? There is no evidence yet that biopsies spread cells, although the logic is there as biopsy bleeds such that maybe cells also spread. I have read articles where people have had 60 samples over 5 biopsies all negative, then all sudden find cancer in bones and have died. This is extreme case, but given I have not had biopsy, what else can I do?

MRI was onlt T2 with DWI, but there is also MRI with also DCE and MRS which can produce PIRADS which is more intensive mapping. Also I heard of Colour doppers for more definition plus there is also the testing for EN2 started in 2011 as per reports but still under trial.

Anyone got any ideas? Most likely I will need biopsy but I wish to explore all options before.

Dean....remains confused...

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User
Posted 17 February 2015 04:54:51(UTC)

Update
Had consult with Urologist at MRI Centre. He was very good and thorough. Showed me the MRI comparisons on computer. He explained the white contrast on both 2011 and 2015 as being present, but 2015 was just clearer which he explained could be due to me being better hydrated at time of MRI.
For sure there is inflammation but NO visible tumour which in part is good, but as the white area is present he explained why this "may" mask PCa. I asked why Gleason score 3+3 and 3+4, he said the 3+3 would be if potential UNDER the mask for lion of 4-6mm and the 3+4 is due that 5% of lesion at 1-2mm can be a 4, he said its statistical and based on the contrast white showing greater area.
He agrees that inflammation should be treated first then re MRI. He also recommended to avoid biopsy unless absolutely necessary. He says no urgency as he does not think its aggressive and anything is clearly contained. Also size is good and slightly increased but this can be the points taken, but as PSA is stable then density is higher which also is good thing. The only worry is PSAf but again its boarder line. The cyst is from birth, no inflammation but he said the biopsy may also cause damage here so its best to avoid until we are sure. MRI is just another tool and yes there is contrast area but it is grey area. Cheers Dean

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User
Posted 10 February 2015 09:37:30(UTC)

Hello all

As in profile, have not been diagnosed, and MRI is inconclusive. PSA has been constant and now at 4.04 for my age 53, but PSAf is at 13%. DRE normal, PCA3 in 2011 was 27 so ok. MRI indicated Utricular Cyst of 8mm which is grown since 2011 MRI. The Urologist did not mention, only once I got report have I investigated.

I have not had biopsy.

My dilemer is whether to or not? There is no evidence yet that biopsies spread cells, although the logic is there as biopsy bleeds such that maybe cells also spread. I have read articles where people have had 60 samples over 5 biopsies all negative, then all sudden find cancer in bones and have died. This is extreme case, but given I have not had biopsy, what else can I do?

MRI was onlt T2 with DWI, but there is also MRI with also DCE and MRS which can produce PIRADS which is more intensive mapping. Also I heard of Colour doppers for more definition plus there is also the testing for EN2 started in 2011 as per reports but still under trial.

Anyone got any ideas? Most likely I will need biopsy but I wish to explore all options before.

Dean....remains confused...

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User
Posted 10 February 2015 10:03:02(UTC)

No options in reality. The MRI suggests you have prostate cancer but is not certain. Only a biopsy can tell you that there is cancer there, what Gleason score and which type of cancer. There are 27 different prostate cancers and some do not respond to usual treatments so it is essential info. The members here tend to be those who have had problems, there are hundreds of thousands out there who have had biopsies and treatment and then got on with their lives - there are many more who had negative biopsies and apparently have not had cancer rampaging through their body as a result of a few needles. Just do it.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 10 February 2015 10:03:02(UTC)

No options in reality. The MRI suggests you have prostate cancer but is not certain. Only a biopsy can tell you that there is cancer there, what Gleason score and which type of cancer. There are 27 different prostate cancers and some do not respond to usual treatments so it is essential info. The members here tend to be those who have had problems, there are hundreds of thousands out there who have had biopsies and treatment and then got on with their lives - there are many more who had negative biopsies and apparently have not had cancer rampaging through their body as a result of a few needles. Just do it.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 10 February 2015 10:10:29(UTC)

Lyn
Thanks and this was my general assumption, the only doubt is the Cyst as this can both increase inflammation plus also potentially impact on PSA, though PSA has not changed in fact reduced.
I have asked for another appointment with Urologist to discuss the Cyst and why they did not mention. It seems that biopsy is the easy way out, as it solves all questions, maybe not so. Unfortunately as you mention most people here has been diagnosed and as such its more about way forward, pity there was not more sites discussing prior to? Thanks for comments and I not worried about needles as had several sporting Ops, its more why have until fully evaluated and this Cyst itself is a challenge. Also I have no symptoms as all, only lower PSAf.

User
Posted 10 February 2015 23:42:51(UTC)

I don't really understand your issue. My husband was 50, with a PSA lower than yours & no symptoms and his scan was clear but when they operated it had already spread to his bladder. Your scan indicates that you probably have PCa already and that it is in more than one area of the gland - you are not going to know for sure until you have the mapping biopsy.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 11 February 2015 13:43:15(UTC)

Lyn. Cheers appreciate all comments. Then you might also question how did it spread? I assume he had biospy? you are correct the MRI indicates this, however, it states Inflammation with "may be". All I'm trying to review is the inflammation first. I have 8mm cyst which "maybe" part of this inflammation. I have also read that others had lower PSA, but also they had 4 biopsies all negative, then later found it spread. Why this? The Prostate is within a capsule and if it leaks it spreads. If you bleed when you have AIDS or other disease to other with open wound then chances is that you may also get this. Point being is that Biopsies are cores, then there is blood and the capsule is penetrated. There is no hard evidence yet that this is from Biopsies, but even if there was, do you think they would come out and announce it? All I am trying to do is close all loopholes and check all possibilities. I have made appointment with Urologist also at the MRI centre whom is specialist, then if he clarifies the MRI or options or none, then of course the next logical process is Biopsy. I was also told back in 2011, by also the same people, that even if there was PCa, that it would be such slow moving that I would most like die before that of PCa. So what changed from 2011 till 2015? Oh, yes that Cyst has grown which was small and not even mentioned in 2011 but is compared within the report as being present in 2011. So my point here, which I'm clarifying is does this impact on PSA? yes or no? Its a long road that I have been on since 2007 and each time they say do not worry. Do they really know? I'm not sure but then again I also wish to ask and clarify. Hope maybe this explains why.

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User
Posted 11 February 2015 13:59:08(UTC)

Hi

You were told Pca was slow growing. That is quite difficult to confirm for definite without knowing the Gleason score or what type of PCa it is. They can only determine that ,as far as I'm aware, by analysing the cells in the lab. So that would mean a biopsy, turp or prostectomy to do so.

I would discuss the risks with the consultant and then make a decision. Having said that if it were me I would want to know what I am dealing with

Bri

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User
Posted 11 February 2015 14:11:04(UTC)

Bri you are correct it can only be confirmed from this list. MRI's use same scoring as Gleason in scores out of 5, so based on MRI and the contrast pumped in veins they get image, then they score like that of pathology...though it is not pathology. In 2011 I was 1's and some 2's and with only PSA of 3's and PSAf of 28% then the Gleason was 1+1 or 2+2. Due to the high potential of inflammation then the radiologist and urologist stated that most likely BHP or Benigh. Yes I want to know if its fast spreading as then of course you wish to mitigate, however, slow spreading then treatment options are not so much fun as then sometimes best not to know as many die without even having known of potential PCa, in this case testing makes it worse. My entire point here is that this Cyst which is noted is benign....but then what change as the MRI score is 3+3 or 3+4. My Urologist said they are over cautious. Why he say this? maybe due to cyst, but he never mention this to me as I only got report after the consult. I've read lots now on this Cyst and even here 2% have shown that they can contain cancer cells, but it means also 98% does not. Likewise the MRI and the PIRADs of MRI state even with MRI study of 143 people (yes small sample) that for MRI assumptions of 3 only 19% had PCa and 81% beneign....unfortunately as Lyn mention there is not many gone down MRI route as this is relatively new with limited locations...maybe I am lucky and maybe not, but also as time goes there maybe more technology to assist. My original question was around others if similar as unfortunately PSA is not black nor white, neither is biopsy as we have seen, so why make more grey unless necessary. I hope Im around to tell the tales...cheers

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User
Posted 12 February 2015 23:26:14(UTC)

I think you are being very choosy about which bits of our replies you acknowledge - re Not many going down the MRI I said nothing of the sort (the point I was making was that his MRI grossly underestimated the seriousness of the situation) and if you think there is a possibility that my husband's cancer spread from his prostate to his bladder in the space of 5 or 6 weeks because of a biopsy you are barmy, I think.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 13 February 2015 07:28:14(UTC)

The evidence seems to be that the risk of cancer seeding from a biopsy site is exceedingly low. However, in your own case, it sounds like you would struggle with the thought of that happening, so maybe in this isolated incidence, you may feel more comfortable relying on MRI evidence.

Have you talked this through with your consultant? They must have had men with similar anxieties in the past. In my husband's case the biopsies confirmed a low grade cancer, caught incredibly early, and may never cause him problems. This has given us peace of mind.

White rose

User
Posted 13 February 2015 09:30:13(UTC)

Hi Dean

These sites may help:

http://www.cancercenter.com/community/questions-and-answers/prostate-cancer/can-needle-biopsies-spread-prostate-cancer/

http://prostatecancerinfolink.net/2014/08/01/needle-tracking-of-prostate-cancer-cells-during-prostate-biopsy-a-review/

They told me I also have a Cyst in my bladder recently and I hope to find out more about this next month (had train to catch so didn't ask any questions) although I don't think it has any relevance to my PCa. The specialist seemed to think it was nothing to be concerned about.

dl 

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User
Posted 13 February 2015 09:45:17(UTC)

If you follow the thought process that a cancerous cell could possibly spread as a result of the biopsy procedure to another part of the body a step further, one would not have the operation to remove the prostate at all. The operation involves far more extensive cutting or damage than a biopsy's few puncture wounds.

But, if this is your anxiety you will opt for other than an operation. Many believe that the less invasive alternatives offer as much success as surgery.

atb

dave

User
Posted 13 February 2015 10:23:02(UTC)

Devon_lad, thanks good artilces. Its interesting that 42 cases showed seeding but this was 1%. CB5, yes this can be, but I have read lots of people having PCa, all contained, but had several biopsies....then many years no issues...then bang, out of no where they have in bones etc.
Yes frequency of biospies have increased and to say seeding exists or not, we will never know as it will be near impossible to know what caused regeneration.
Lyn, I was not aware of the 5-6 weeks return and I am not trying to then rely solely on MRI. During my investigations on the treatment side, given last MRI, there was many reports where biosopies had precluded from Brachy do to retention issues. Also as you mention, not many had MRI's, but of those I found here and other sites, ALL mentioned that there MRI specifically referred to Tumor or lesion or PCa and NO mention of Inflammation. 2 of mine state Inflammation. Also volume increased from 27 to now 35 in 4 years. All I am investigating is whether it is MORE likely Inflammation or PCA? inaddition, Why not then give Cipron?? and see if this impoves? I got now appointment this Monday to discuss with Uroligist at the MRI centre whom is also very recommended. Biopsy is still booked. Hope this explains and what I have also read is many of were maybe not given options and as such treatment options were then also restricted due to prior decisions. Also most people come to these sites when diagnosed versus prior too, so thanks to everyone here that I have opportunity to see and read these stories to also assist for potential future decisions. Appreciate the comments, but this issue is so grey and we hope for new technology going forward to help this. Good reports I see for HIFU maybe too early, lucky the urologist I see is also where the HIFU head works.....cheers

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User
Posted 13 February 2015 11:34:27(UTC)

My OH had a MRI which was negative but his consultant recommended a Template biopsy as his psa was still high.  Then he was diagnosed.

 

The PCa could not have been caused by the biopsy.   Presumably it grew in the time between the MRI and the biopsy.  He had a nasty infection afterwards, but is thankfully now clear  6 months after high dose brachy and 15 radiotherapy sessions.  

 

Hope you get all your questions answered when you see the urologist.El.

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User
Posted 17 February 2015 04:54:51(UTC)

Update
Had consult with Urologist at MRI Centre. He was very good and thorough. Showed me the MRI comparisons on computer. He explained the white contrast on both 2011 and 2015 as being present, but 2015 was just clearer which he explained could be due to me being better hydrated at time of MRI.
For sure there is inflammation but NO visible tumour which in part is good, but as the white area is present he explained why this "may" mask PCa. I asked why Gleason score 3+3 and 3+4, he said the 3+3 would be if potential UNDER the mask for lion of 4-6mm and the 3+4 is due that 5% of lesion at 1-2mm can be a 4, he said its statistical and based on the contrast white showing greater area.
He agrees that inflammation should be treated first then re MRI. He also recommended to avoid biopsy unless absolutely necessary. He says no urgency as he does not think its aggressive and anything is clearly contained. Also size is good and slightly increased but this can be the points taken, but as PSA is stable then density is higher which also is good thing. The only worry is PSAf but again its boarder line. The cyst is from birth, no inflammation but he said the biopsy may also cause damage here so its best to avoid until we are sure. MRI is just another tool and yes there is contrast area but it is grey area. Cheers Dean

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User
Posted 22 February 2015 19:44:41(UTC)

Hi, I will sit on the fence on this one, my oh had no symptoms back in 2013. He went for tests as his brother had his removed, psa .1 gleason 6 lump on testicle (cyst) 2nd biopsy a year later psa still .1 gleason now 7? I think they disturbed a sleeping dog

 
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