Decision re Biopsy

Decision re Biopsy

User

Posted 26 Oct 2021 at 18:03

Hi. I am having difficulty deciding whether to have a Biopsy & would be grateful for some feedback.

I have always peed for England (I think anxiety related & also added a Diuretic - Indapamide to my Blood Pressure meds about 18 mths ago) but post lockdown decided to check with GP as I felt it had become more urgent & sometimes a few times at night.

In May 2021 I had DRE at Surgery, normal. Raised PSA of 8.52. Referal to Urology Dept. Further to offer of monitoring PSA or mpMRI I elected to go for mpMRI. Results were then discussed at Urology appointment: '1mm PIRAD 3 Lesion with early enhancement with a high PSA density of 0.23'. Option of repeat PSA in 3 months or LATP Prostrate Biopsy or GA template Biopsy. I elected for further PSA test.

I had a second PSA test in September 2021 this was 8.48 so a little lower. Further Urology appointment. The clinicians view was that my options remained much the same as in May. That the only way to have clarity was to have a Biopsy but that I could continue monitoring PSA. I decided to continue monitoring PSA with option to request Biopsy if I changed my mind.

My conundrum is to decide which way to go. I am in a relatively new relationship with a Lady whom I am growing very fond of. The side effects of the LATP Biopsy from the information I have found on this site & from discussion with a friend who has had one suggest that it is a pretty unpleasant procedure & blood in urine & semen along with albeit a pretty small possibility of erectile disfunction are not exactly the perfect start to a newish Romance! That said we are both grown ups (well she is!) I'm 69 & she is 60 & a very down to earth and sensible woman.

I have no family history of cancer & I'm generally fit. I want to avoid starting down the road of having invasive procedures if this is at all avoidable. But equally I am a worry wort & don't want to take unnecessary risks.

My decision at the end of the day but any input would be gratefully received.

Warm Wishes

Chris

User

Posted 26 Oct 2021 at 22:12

Hi Chris,

I’m not really sure on the difference between the biopsies. My OH had transperineal biopsy (I assume this is LATP) he didn’t really have any problems with it. He didn’t have any blood in urine and only one time in semen. He ended up with a Gleason score of 4+3 so that was the worst part.

I know everyone is different but just wanted to let you know that it’s not always bad.

Best of luck in whatever you decide.

User

Posted 26 Oct 2021 at 23:21

Well the biopsy itself is not too troublesome, but getting on the treadmill of unending procedures is. At your age you probably have cancer, but that is no surprise 70% of men your age have it.

The real issue is, will it ever do you any harm? Well if nothing else kills you before you get to 90 it probably will. The fact your PSA has not changed in six months suggests this is currently a sleeping dog. If I were in your position I would have a PSA test every six months, and if it didn't go up I'd be happy with an MRI every couple of years.

Of course I'm not you, and my attitude to risk will be different to yours.

Dave

User

Posted 27 Oct 2021 at 00:20

I suggest you go for a transperineal biopsy without delay. It’s only a day case.

You will end up with a massive bruise on your perineum for a week or too, and strawberry-coloured semen (not sure as to the taste) for two or three weeks. The more you ejaculate the quicker it will return to normal.

When you get the results, you will find out if you have cancer or not, and then able to plan for the future on the basis of facts, not speculation and ‘What ifs?’.

Enjoy your new-found love-life.

Best of luck.

Cheers.

User

Posted 27 Oct 2021 at 07:34

The only way to know whether or not you have prostate cancer (and at your age you probably do have it) is to look at cells under a microscope. A TRUS biopsy is undignified and uncomfortable, but not painful. I would strongly urge you to have the biopsy - a few minutes of discomfort is nothing compared to dying from advanced prostate cancer. If you have it, catch it while it's still treatable and get it sorted.

Yes, you'll have blood in your urine for a few days and your semen for a few weeks. It's purely "cosmetic" and really no big deal.

Best wishes,

Chris

Edited by member 27 Oct 2021 at 10:07 | Reason: Not specified

User

Posted 27 Oct 2021 at 07:42

Yes, has to be your decision on whether to have a biopsy but you may feel it appropriate to broach the subject with your lady friend if you have not yet done so before coming to a determination. Tthe procedure and possible treatment will affect her to a greater or lesser extent. Almost all partners accept and support their man and many do so by joining us here. Unfortunately, we have had a few cases where the partner decides they want to break the relationship even occasionally after many years but this can be for other reasons and a PCa diagnosis is the final straw.

Imaging has improved greatly over recent years but does not always show all cancer, so if you want a diagnosis, it is necessary to have a biopsy which can provide information on the type of any Prostate Cancer found, its position and severity. Some tumors are consided insignificant and no radical treatment is recommended, at least for some time until there is a change. By your age many men have insignicant tumours but some will have significant ones. As with all cancer procedurers some men will find them easy whilst others less so. There is a much lower risk of infection with the Transperioneal one where you normally have general aneaesthetic or deep sedation. You are likely to have a little blood in your urine and semen for a couple of weeks or so thereafter. You can decide if you want active surveillance or one of the treatment options open to you assuming the biopsy confirms you have cancer. You can contact the specialist nurses of this Charity to discuss your situation ,(far better than the anecdotal experience of Joe down aat the pub whose situation may be quite different to yours). Meanwhile, I suggest you download or request a free copy of the Tool Kit which provides a lot of info on PCa and various treatments. https://shop.prostatecanceruk.org//our-publications/all-publications/tool-kit?limit=100

Edited by member 27 Oct 2021 at 07:48 | Reason: to highlight link

Barry

User

Posted 27 Oct 2021 at 13:56

Hi Everyone who has responded. Your time & kindness are greatly appreciated. Differing views but all helpful in my decision making process.

My next PSA test & subsequent appointment will be due in December although not confirmed yet. I think it likely I will wait to see where my PSA is at that stage & take a view accordingly.

My gut is that as I have no family history of cancer (cardio-vascular disease seems to be the disposal of choice with the Grim Reaper in my heritage!). The 'lesion' mentioned from the mpMRI is tiny, 1mm (Urology clinic said this could easily be something other than cancer, inflammation possibly) & my PSA has remained pretty much static, albeit raised. If indeed I do have cancer it is probably less likely to be aggressive so although a decision re biopsy requires an expedient decision, I think it can wait a little longer.

As Dave states it is a question of risk versus benefit. I'm a bit of a mixture having raced cars, ride a motorcycle & lived & worked in Ski Industry in France for a while, so I am at one level not risk adverse. However I also have a tendency towards worrying & being a fuss pot ( my Girlfriend, very unfairly of course, calls me a Princess....the cheek :)!)

Once again thanks & my very warm wishes to you all

Chris

User

Posted 27 Oct 2021 at 14:13

I think the decision is up to you but if i had a PSA of 8+ i would want to know if i had prostate cancer no matter what oncology say.

I had PSA 2.19 at the age of 70 picked up by a private medical that showed microscopic blood in my urine and i wanted to find out if i had cancer.I was lucky that my doctor was on the ball and after tests they found 5 positive cancers out of 20 samples with a Gleason 3+4=7 and that gave me half a chance of slowing it down.

If you click on my Avatar you can see my journey so far.

Good luck John.

User

Posted 27 Oct 2021 at 14:22

Thanks John to you also for your response. Again greatly appreciated.

Best Regards

Chris

User

Posted 02 Jun 2022 at 12:43

Good Afternoon,

I wanted to update & see if anyone has any thoughts that might help. Since my original post in Oct 2021 I had a further PSA Test in December 2021 this was lower at 6.57. I had a telephone conversation with the consultant & he suggested a repeat MRI & PSA test in May 2022. I had the MRI which was pretty much identical to the MRI from May 2021 PIRADS 3 with the tiny lesion 1.12 from 1.11 in May 2021. My PSA was up again to 8.67. At this point I arranged a further face to face appoint with Urology Dept & had another PSA test, this time dropped again to about 6.5. At the meeting with the Urology Dept we discussed moving forward. My options remain pretty much the same as they were a year ago. Continue on PSA surveillance or have a Transperineal Biopsy. I'm frustrated with myself as I'm finding it hard to come to a decision. The Consultant feels it is very unlikely that I would have an aggressive cancer as the PSA goes up & down and MRI is stable and lesion tiny so they are leaving decision to me pretty much. If I stay with current regime of monitoring it doesn't seem as if I'm putting myself at unacceptable risk and having the Biopsy won't change the fact that I will need to continue monitoring. The downside is that I won't have a clear diagnosis and Biopsy is only way to be sure. I guess at age of 70 there is a fairly high chance I may have some cancer cells however indications are any cancer is unlikely to be aggressive. I am a worrier so I am leaning toward biting the bullet & having the Biopsy though the whole process & aftermath scares me to be honest.

I feel a bit of a fraud in honesty as I think my position is favourable in the great scheme of things when there are so many brave souls on here with much greater problems.

If anyone has any thoughts it would be great to hear.

Kindest Regards

Chris

User

Posted 02 Jun 2022 at 15:37

If your PSA is fluctuating up and down then you're right in saying it's probably nothing to worry about; the "red flag" is a steady increase.

Sounds like a good idea to carry on with, say, 6-monthly testing a keep an eye on things.

Cheers,

Chris

User

Posted 06 Jun 2022 at 18:30

Hi Chris,

Thanks for your input, greatly appreciated. Benefit of having biopsy is that I will have a diagnosis & being a worrier I would at least know where I am. However I am balancing this against that, even if cancer is found then all the indications are that it is very unlikely to be aggressive & I would still need to continue to monitor the situation. Question I am asking myself is do I want to go through the biopsy process which may not change my situation in terms of ongoing monitoring (unless the biopsies come back benign of course) & is not without risk.

I used to be indecisive but I think I maybe alright now!

Thanks again

Chris

User

Posted 06 Jun 2022 at 19:20

If you have a biopsy, you will have a much better idea of your situation. If the biopsy comes back negative for cancer, that's a win. If it comes back positive, then you will be able to get a diagnosis and if necessary, start treatment. So either way, you cannot lose. Do not be put off by stories of the risks and pain of a biopsy. I had a TRUS, the 'classic' sort, and while I cannot say it was pleasant, it was certainly no worse than, say, having a filling at the dentist.
best wishes, whatever you decide,
Hermit.

Edited by member 06 Jun 2022 at 19:21 | Reason: typos!

User

Posted 06 Jun 2022 at 20:19

I agree with hermit biopsy tolerable best way forward went back to work after mine 👍

User

Posted 29 Jun 2022 at 14:12

Hi gaz61 & Hermit,

My apologies for the delay in responding. I took the decision to have the Transperineal Biopsy done last Monday under GA (chickened out of Local!). Aftermath unpleasant but I was expecting this. I have a Urology appointment next Thursday so expect this will have the results.

Thanks for your input, much appreciated.

Kindest Regards

Chris

User

Posted 29 Jun 2022 at 17:22

Glad it went ok. Not the most pleasant of experiences, but it's best to know one way or the other. Don't get too stressed if the result is positive - most men have prostate cancer at your age, as you know.

All the best,

Chris

User

Posted 29 Jun 2022 at 19:01

I agree with Chris tolerable if not nice but soon over 👍

User

Posted 30 Jun 2022 at 14:58

Thanks again for responses. I remain optimistic as view of Consultant is that fluctuating slightly raised PSA & no real change in MRI in a year suggest that aggressive form of cancer is very unlikely. Next week I'll know!

Have a good weekend. I'll be watching British Grand Prix with old friend's on the box! I used to race myself back in the day (the original Minis!) & we used to camp out at Brands Hatch & watch the Race with a full fat hangover after a night in the Portobello Inn :)!

Best

Chris

User

Posted 02 Jul 2022 at 09:20

Hi Lyn,

Yes not a particularly relaxing time for a fella! Everything seems to be ok for me in that department although aesthetically not a good time to join a Dating site!

Best

Chris

User

Posted 12 Jul 2022 at 17:32

I got my Biopsy results last week. Gleason (3+3) 6. So Active surveillance, regular PSA tests & Annual MPMRI for me going forward. I guess at age 70 I had about a 70% chance of having some form of Prostate Cancer so all in all a pretty good result from my perspective. Another reminder that life is short & we need to get on with what's important to us!

Thanks again for everyone who responded to my posts & every good wish to everyone using this facility.

Very Best Wishes

Chris

User

Posted 12 Jul 2022 at 17:52

Yes definitely AS for the time being. I'm sure I heard of a trial of a test to identify cancers which may become aggressive Vs ones which stay docile. It would be very useful for you to know which version you have.

Dave

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