Repeat Biopsies

Worrying is completely normal, but treatment is highly effective. You get it sorted out and you get on with your life.

Best wishes,

Chris

Nice guidelines are changing, and the transperiniel biopsy is now the preferred choice. They probably had some old TRUS biopsy equipment they wanted to use up before it's sell by date.

Anyway as Lyn says we nave had some pirads 5 MRIs which turned out all clear, so you may not have a problem. I think with the elevated PSA the fact the MRI is suspicious and the fact you are 60 you have more chance of having cancer than not, but it may be very low grade and not need treating. Has anyone shoved a finger up your bum (DRE) and said it feels wrong, that would tip the scales in favour of a biopsy. The only problem with having another biopsy is that it is another day or two of work. If you really wanted to avoid another biopsy you could consider three or six month PSA tests. If that isn't going up fast then you could possibly postpone the biopsy until the PSA does start going up, obviously only in consultation with the medics.

You pose a rhetorical question about why a check for PCa is not part of an NH check and then partially answer it when you raise the question of possibly being over diagnosed. If all men of let's say aged 50 had their PSA tested, this would mean many more men with insignificant tumours would demand treatment adding to those that already have what is considered to be overtreatment. The UK is by no means the only country that considered but rejected general PSA testing at 50 (usually the prelude to treatment) because of unnecessary harms to many men whose PCa would not have needed treating. Then from a practical aspect it would not be possible for Urologists, Oncologists, Radiologists etc to cope with the extra throughput, they struggle to cope as it is now, often exceeding NICE guide line times. This does of course mean that some men who would benefit from earlier diagnosis are not seen early enough.

I don't know where you saw that NICE guide required the first biopsy to be a TRUS; my London Hospital went over to Transperineal years ago and a top doctor at the Royal Marsden also said how poor the TRUS biopsy was plus there is a greater risk of infection with it.

Many thanks for the answers and information.  So mnay things to consider. Just a few thoughts.

1) My concern about multiple biopsies in quick succession is about wound healing and inflammation. Wound healing is a process that stimulates cell division and tissue remodelling through cytokine and growth factor signalling. At least in the lab, it seems that these are some of the factors that can promote cancer cell growth. My question really was about whether this is anything to be concerned about not (e.g. a PIN cell could get promoted to an adenocarcinoma cell with the relevant signals). I understand from the answers that in practical terms this is nothing to worry about.

2) My comment about radiation therapy in younger people leading to increased cancer risk later was not from google but from a specialist nurse. I do know that radiation is difficult to contain and the possibiity of harm from aberrant DNA damage repair is a possibility. I guess what I was asking was what were people's experience in real terms. It feels very much that different clinicians have their different treatment preferences, often based on extensive experience rather than latest scientific appraoches. Mnay thanks for giving some %s of risk that is very helpful to put things into perspective.

3) It was the nurse that told me that the NICE guidelines said to do TRUS first (I didn't read them before). I guess that I was dissappointed to have to do it twice now when I originally raised the issue of what was the best way considering the location and size of the lesions.

4) Yes I had a DRE, in which GP felt asymmtery which the trigger the subsequent MRI and biopsies.

5) I do understand that while prostate cancer is regarded as a solid tumour (unlike leukemia), it isn't solid as in a hard lump, it is more that the cells are more tightly packed (hence restricted diffusion under MRI). I am just surprised that given the size of the lesion and having a relatively small prostate that all 9 needles targeted to the lesions (2 of which are in the peripheral zone) completely missed as this was done guided by the MRI and ultrasound. Not sure why they want to do the TP under general when I beleive where I am  the clicnic  helped to establish a way of doing it under local. Probably, it is to do with who is free to do it.

6) I guess I was asking about at 60 you have an NHS heath check, so I would have expected a DRE and PSA at a minimum. While the risk obviously is lower between the ages of 60-65 of aggressive cancer it is still a possibility. It would also give a base line for future tests. At 60 (50 in scotland) you get a test for bowel cancer. Sure, I understand that there are resource limitations, possibility of diagnosis leading to uneccessary  treatments etc. Looking at it a different way (I speculate here), I could have not gone to the GP and carried on as I am with sub-optimal weeing (I am sure that many men do this). If I then went in 5 years time, I could well have been in a different situation with poorer outcome. Indeed I know someone who did exactly this, went to the GP for hip pain, which turned out to metastasis. If he had gone 5 years earlier, or had a regular check, then maybe this would not have been the case if he head early treatment. I suppose that there is a balance between mass testing and individual need which aren't the same things?

"Not sure why they want to do the TP under general when I beleive where I am the clicnic helped to establish a way of doing it under local. Probably, it is to do with who is free to do it."

More likely to be due to them needing to take samples from the area wgich is most difficult to get to.

"While the risk obviously is lower between the ages of 60-65 of aggressive cancer it is still a possibility." 

Aggressiveness tends not to be age related. If anything, the younger a man is at diagnosis, the more aggressive his cancer can be. We have had men on here with incurable PCa in their 30s and 40s - I know a young man who died of PCa at the age of 27.

"am just surprised that given the size of the lesion and having a relatively small prostate that all 9 needles targeted to the lesions (2 of which are in the peripheral zone) completely missed as this was done guided by the MRI and ultrasound"

As stated above, mri can be wrong. The fact that your TRUS was image guided means that you could still get the all clear from the TP. Fingers crossed for good results for you.

Edited by member 15 Jul 2022 at 22:31  | Reason: Not specified

Thanks for the info.... Mine's got delay as I had covid- need to wait 7 weeks before GA... Could have gone with spinal but that is a bit more risky, needs catheter etc...

So just an update with good news!

The second biopsy was done under GA, unfortuately I got urinary retention needed to have a catheter for a week. This was actually very unpleasent and walking and sleeping was painful, so I could not go to work. So got the path results now all cores were benign (every section in the core is looked at). So over the 2 biopsies of 50-60 cores only 1 had some evidence of high grade PIN.  So the MRI was just discordant from the pathology- there can be many reasons for this and I suspect that the structre of my prostate is a bit odd. So I basically have an enlarged prostate with BHP and now PSA will be monitored every 6 months. I also now take a alpha-blocker to releive some of the symptoms- I definitely wee much stronger now.

Thank you all for the support, discussion and information. They have been very helpful over the difficult summer.

Edited by member 22 Sep 2022 at 16:38  | Reason: slight mistake

Thank you

PS made slight mistake in post, I meant to say that I could not go to work- autocorrect got it wrong...

At my biopsy I lay on my side whilst a nurse made small talk. The problem is I find trying to make small talk more painful than having a needle shoved up my ass.