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PSA of 12.7 MRI Clear

User
Posted 25 Sep 2018 at 22:39

Hello Everybody , 

I'm new to the forum and would gratefully appreciate any comments/advice that you may be able to give.

I have an enlarged prostate and a PSA of 12.7 ( which was 13.9 ), I take Tamulosin but not Finesteride and have had two MRI scans two years apart with ' nothing sinister ' shown and no change in the prostate.

I was referred to the leading consultant from my usual consultant as he wanted him to have a look at my case, who now thinks its worthwhile to do a Truss biopsy on the strength of the PSA level alone which has somewhat alarmed me.I have heard all the horror stories associated with them and more importantly I'm struggling to see the worth in putting myself through this procedure at the moment If I don't really need to.

If the MRI scan's had shown something up , then I would have gone along with having a biopsy immediately.

Is my consultant being over cautious ? - or am I kidding myself and should I just bite the bullet and have the biopsy done.

 

Many thanks

Merlin

User
Posted 25 Sep 2018 at 23:45
There's nothing particularly alarming about a TRUS biopsy, Merlin. In terms of unpleasantness, I'd put it roughly on a par with having a filling at the dentist. Pressure, a scratch as the local anaesthetic goes in, and then a loud "click" and a vibration as each sample core is taken. Believe me, the anticipation is a lot worse than the event!

I really would suggest having the biopsy. My MRI was clear, too, but the biopsy found cancer. It's the only way to be sure.

Chris

User
Posted 26 Sep 2018 at 00:04
Having had both a TRUS and a template biopsy, from the patient's perspective, I'd say there are pros and cons with each. True, you might end up having a template biopsy after the TRUS (as I did), and you don't feel anything during the template biopsy because it's done under general rather than local anaesthetic. On the other side of the coin, I had far more side effects following the template than I did the TRUS. The general anaesthetic made me feel very unwell indeed for many hours after the procedure, and I had major problems with urinating for several days after because my prostate had swollen so much as a result of the large number of cores taken.

I wouldn't particularly worry about having either done again, but the TRUS for me is easier to handle in terms of after-effects.

Cheers,

Chris

User
Posted 26 Sep 2018 at 00:28
John had a clear scan but the TRUS biopsy found cancer. His PSA was 3.1.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 26 Sep 2018 at 07:33
Hi Merlin

For peace of mind if I were you I'd opt for a TRUS biopsy. Like Chris says its not that bad, just end up with a sore butt for a few hours afterwards.

User
Posted 26 Sep 2018 at 11:20

Thank you all so much for taking the time to post , its greatly appreciated.I think the only option is to take your advice and go ahead with the TRUS now you have been kind enough to explain the situation.

 

Many thanks again and I wish you all well for your health and happiness

All the best

Merlin

Edited by member 26 Sep 2018 at 11:32  | Reason: Not specified

User
Posted 26 Sep 2018 at 11:23
You're making a sensible decision, I think. Cancer really isn't something to be uncertain about - if it's there, you need to know.

All the best, and please let us know the outcome of the biopsy.

Chris

User
Posted 26 Sep 2018 at 11:36

Thanks Chris

I cant begin to tell you how much you have helped, my Consultant and his staff have been fantastic but I think first hand experience from those who have had to go through this minefield is invaluable.I'll be sure to post the results and in the meantime all the best to you and yours

Merlin

User
Posted 26 Sep 2018 at 11:39

Hi MerLin,

Beware of the TRUS biopsy, template biopsies are much more accurate, especially with a vague situation such as yours. Here’s one of Britain’s top prostate cancer oncologists:

https://vimeo.com/169926390

Cheers, John.

 

 

Edited by member 26 Sep 2018 at 12:11  | Reason: Not specified

User
Posted 26 Sep 2018 at 15:01
Many thanks Jasper,Lyn,and Neil for your help and knowledge,I'm on a very steep learning curve as you can probably tell and I already feel a little better about the challenges I may have to face thanks to your good selves

All the best

Merlin

User
Posted 26 Sep 2018 at 15:07

Thanks John,

Well, thats food for thought ,this is were my confusion lies with the issues -I haven't seen all the notes appertaining to my case but initially they did say that I had a couple of small enlargements on two prostate nodules ( that again , haven't changed in two years ) but the lead consultant said he wasn't worried by those at all but then said a biopsy would be the best way forward

Regards

Merlin

User
Posted 26 Sep 2018 at 15:56
Hi Merlin,

The problem with TRUS biopsies, I have learned during a very steep learning curve since last November, is that some men have that test, and then because of indeterminate findings, have to go on to have a template biopsy as well.

Two friends separately warned me, with the words: “Don’t let them palm you off with a TRUS biopsy”, as they had both had had one and ended up with a template biopsy as well in the end. And when on the ward recovering from my template, there was a guy with severe cancer who had had to have a second one as well.

This forum is littered with similar comments about double biopsies, when one would have probably been enough if it was a template.

The TRUS biopsy is favoured by the NHS as it is relatively cheap and quick, and much cheaper than a template under general anaesthetic. I must admit, although I turned down a TRUS based on the advice above, my tumour was so large the it would have been detected in a TRUS, as it was evident on the MRI scan.

Another friend with BUPA insurance went straight for a template biopsy, and TRUS was never mentioned!

However, in marginal cases such as yours, where you may or not have a big problem, best to go for the “Gold Standard” test as outlined by the oncology consultant in the video.

Let’s hope it’s all a false alarm!

Cheers, John

User
Posted 26 Sep 2018 at 16:10
Some do indeed go on to have a template biopsy as well, John. I did myself. But most do not. Why put yourself through a much more major procedure (general anaesthetic, etc), when it probably won’t be necessary?

Kind regards,

Chris

User
Posted 26 Sep 2018 at 16:36

Originally Posted by: Online Community Member
Some do indeed go on to have a template biopsy as well, John. I did myself. But most do not. Why put yourself through a much more major procedure (general anaesthetic, etc), when it probably won’t be necessary?

Kind regards,

Chris

Because in Merlin’s case the raised PSA is of such concern that his consultant has recommended a biopsy although nothing was evident on MRI, so why go for the one the top specialist in Britain in the video described “as bad as we thought it was”?

You are yet another case in point. If you had had a targeted biopsy in the first place you would not have had a second.

Anyway, best of luck to everyone, and as I say these days, keep breathing!

Cheers, John

User
Posted 26 Sep 2018 at 21:24
Thanks again ,Im thinking I can only go on the advice of my consultant in the long run and grin and bear it -I still have got some time to weigh things up but Its due this coming Monday and Im already very anxious about it ( which is a feeling Im sure everyone on this forum has experience of )

Cheers

Merlin

User
Posted 26 Sep 2018 at 22:52

If no suspicious areas are seen on an MRI but significant cancer is suspected, a TRUS biopsy is like sticking maybe 12 needles in a haphazard way into a plum, (in this case a rather large one), and hoping one or more of these needles takes a core showing any significant cancer. If cancer is found it does not show how extensive it is. Furthermore, if no cancer is found it does not mean that there is none. There is also a greater risk of a UTI. So this could prove quite unhelpful in your case.

With a Template biopsy, if no significant cancer is found in the many cores that are taken using a grid, the high probability is that only insignificant cancer is present, if at all.

Certainly, the Template biopsy is more involved and is normally done under anaesthesia (which I would recommend), although occasionally is done under an epidural. I would only want the TRUS one where the MRI showed a very suspect area to target.

Incidentally, I have had both types of biopsy and am due to have another template one next month due to low but persistent rise in PSA following HIFU in 2015 as salvage treatment for failed RT. In my case there is a slightly suspicious area but the Template biopsy should show how relevant this is for further treatment or perhaps whether PSA rise is down to insignificant tumours.

Edited by member 26 Sep 2018 at 22:56  | Reason: Not specified

Barry
User
Posted 27 Sep 2018 at 08:39

Merlin, hi

i sympathise with your situation, I too took a moment to consider whether or not to have a biopsie after a PSA of 8 and an MRI.  I was concerned about the risk of infection and the general discomfort etc.  Not the most joyful procedure it had to said

But  checking in here and asking pretty much the same question as you, I was overwhelmed by messages advising me to go ahead   So I did   Turns out it was the best decision I have possibly ever made.

i have stage T2c prostate cancer. Confirmed. being stage 2 it is conf within the prostate. I am now waiting for my op to remove the prostate.  Had I not had this test I would never have know and most likely would have been in s much worse situation in a few years time, facing palliative rather than curative treatment.  

The biopsie will tell you for sure, the other tests are not certain.   So I'd advise you as I was advised

Have the biopsie.  There is nothing to lose and everything to gain.  

Wishing you well

 

Geoff 

 

 

 

User
Posted 27 Sep 2018 at 11:46
Thanks so much for getting in touch Geoff, I think you have hit the nail on the head and its good of you to get in touch

I wish you well and a speedy recovery from your op

Kind regards

Merlin

User
Posted 27 Sep 2018 at 11:49

Thanks Old Barry,

Talk about being between a rock and a hard place.........thanks for getting in touch and for your comments

 

Kind regards

Merlin

 

User
Posted 28 Sep 2018 at 22:55

Not a problem, it's how it was for me.  having the test was so out of character for me, just consider myself very lucky to have found iut

 of luck to you too

 

geoff

 
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