Prostate biopsy irritation

Parent Cafe
41

It is not always predictable. Many men will die (of other causes) with prostate cancer, but a few will die of aggressive prostate cancer. Most are slow growing and do not need treatment, but choosing the non-treatment option means taking the risk that if it is aggressive and deadly, delay can be fatal. Unfortunately, current medical knowledge may not be able to tell at the early stage which is which.

According to http://www.ncbi.nlm.nih.gov/pubmed/21189374 , the number needed to screen with PSA to prevent one prostate cancer death is 503 to 1,410, while the number needed to treat to prevent one prostate cancer death is 18 to 48.

42

I am by no means an expert on this, but there are a lot of variables that go into treatment decisions. Without getting to personal, in DH’s case PSA levels were monitored for a long time before the PCP (primary care physician) and wife nagging finally led to a consult with a urologist… There is a family hx of prostate CA in DH’s family (fa and bro), and that, combined with a history of BPH, in the family, led to the treatment course he chose.

Good luck to your BIL, igloo.

43

Again, I agree with ucbalumnus. The prognosis for prostrate cancer varies. There are many new tests out there that predict the aggressiveness of the cancer. Time will tell how accurate these are. Hopefully, these will eventually help patients avoid unnecessary surgery and radiation.

Igloo, it sounds like your BIL chose IMRT therapy which is usually administered daily x 6 weeks which is one of several ways to treat (including surgery, radiation seed implantation, proton beam treatment and active surveillance). All options are good depending on the Gleason score, number of cores involved and metastasisto lymph nodes or bone. As I mentioned above, there are a lot of new drugs and immunotherapy targeting prostate cancer, that are helpful in prolonging life for PCa patients.

I still feel PSA monitoring is really important and my husband will be tested yearly. We have a lot of patients diagnosed in their 40s and 50s who are caught early and given the best chance for more years if not survival.

44

Jordandsmom1,

The proton beam treatment seems interesting. What are the downsides of proton beam treatment?

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Dstark, honestly, that’s the one form of therapy I don’t know much about. My doctors never refer for it. They don’t believe in it as a long term therapy. Anecdotally, we have had several patients choose this and fail, and then require salvage therapy. They equally recommend surgery, radiation and active surveillance based on the Gleason score, grade and volume of disease as well as the patient’s overall functional status.

46

Jordansmom1, well the proton beam treatment sounded too good to be true.

I guess the downside is it doesn’t work. :slight_smile:

All kidding aside, I appreciate your posts.

How effective is active surveillance? Are doctors able to watch and then catch troublesome tumors before it is too late?

47

dstark,
My DH has been under active surveillance for about 15 mos.

48

Jym626,

Because so many prostate cancers don’t kill and active surveillance is not invasive I can see that as a choice.

49

Until it’s not enough. That’s where we are.

50

That stinks.

Sorry to read that.

51

Sorry to LOL, but thought “irritation” meant, uh, irritation at the biopsy site, not irritation with bureaucracy/the hassle :B

I have a friend with prostate cancer metastasized to bone cancer. Not a good prognosis. I guess you just have to weigh your options and decide which is worse. (by the way, the guy was very active, biking, jogging, the dx was out of the blue)

I do think that patients should have some choice to go non-nvasive (would an ultrasound or MRI work at all?) instead of invasive after multiple tests.

PSA levels, yeah, the jury is out on “saves lives to test for them” vs. “a waste of time, too many false positives”. Women go through lump tribulations a lot too though, between fibrocystic breasts and having lumps biopsied and negative, and back and forth for some.

Best of luck, and do your best. Most of us have to deal with medical stuff at some point, and “an educated consumer is our best customer” (forget if that was from a clothing store). I agree with pressure if you know your doctor well - my spouse almost had his thyroid removed due to cancer because he was trusting our family ENT we had known for years, and we got a second opinion from MSK and they said no cancer, but are following him up. The bummer was him going back to the ENT for something else, and my spouse mentioned “yeah, I don’t have cancer per MSK” and the ENT was like “that’s good” as opposed to asking more about how to avoid serious surgery (and lifetime repercussions of thyroid removal) for others.

And BTW, another friend who had lung cancer pretty bad got a phone call about the biopsy results in the car driving home from the hospital - it’s a generalization, but if results aren’t very quick, they are usually good. She didn’t even know she had cancer and went in for a needle biopsy.

Very quick phone call after the test, well, take a deep breath before you answer the phone.

52

“Active surveillance” can be invasive, depending on the definition. If the definition involves more frequent prostate biopsies, it is invasive (with the usual medical risks of such, even if cancer is not found).

53

Good point, ucbalumnus. The biopsies, which commonly involve taking 12-14 samples (at least that’s true for the first one-- later ones might be done by MRI directed biopsy or MRI fusion biopsy, and will likely be more focused on the areas of abnormality ) are anything but non-invasive.

Rhandco,
Best of luck to your friend. And yes, your read of the thread title was similar to mine last night. Thought perhaps it was about some persistent site irritation after the biopsies, so it caught my eye. When it turned out to be a complaint about the time to get the “all clear” message, well that was disappointing to say the least. Sadly, it didn’t make me LOL.

By the way, the “educated consumer” line was from Sy Syms. The stores closed in 2011.

54

It is not just the waste of time (and money) on screenings that will produce lots of false positives, but the fact that the diagnostic procedures (biopsy) and treatment procedures (surgery, radiation, etc.) are invasive and carry significant to substantial medical risk (note the analog to breast cancer screening for women).

Undesired effects of prostate cancer treatment are listed at http://www.pcf.org/site/c.leJRIROrEpH/b.5822789/k.9652/Side_Effects.htm ; consider the risks in context to the (optimistic) number of 18 men treated to save 1 (5.5%) from death by prostate cancer.

55

With posters, you can usually tell if a poster is a man or a woman.
Not with ucbalumnus. @ucbalumnus, are you a man or a woman?

56

Man ( and SN likely refers to alumnus va. alumna)

57

Ok…thanks.

So @ucbalumnus, you are never going to have a psa test?

58

@jym626,

Thanks.

I would never get an 800 on the verbal section of the SAT. :slight_smile:

59

Based on current evidence and lack of any personal/family indications of high risk of aggressive prostate cancer, do not see any reason to have it in the future.

(Did have one in the past specified by a PCP who wanted to test everything possible; left that PCP because it seemed that the PCP was more interested in running up billable events than anything else.)

60

Thank your lucky stars. The standard protocols for treating prostate cancer have improved enormously.

My father had a high PSA in the early 80s. they did a biopsy, which at that time was maybe three cores. negative. Three months later they did another, and not only did they find cancer, but when surgery was done it had spread outside the gland to the seminal vesicles. If he had had the now-standard biopsy spread, which is more along the lines of 10 or 12 cores, it might have been found before spreading.

My H had the broader biopsy standard nowadays. The cancer was found. He had surgery. The cancer was confined to the gland, but right up against the bladder. After several years, he had a rising PSA, scans, and radiation to the prostate bed. Everything has been fine since.

My father died of metastasized prostate cancer. If he had had the more up to date treatment, I don’t think he would have.