Another Blood Test

I got the results of a recent blood test from my primary physician.  My PSA is still rising, now up to 2.9.  This was the same lab that measured a 2.4 just under a year ago.  Subject to day-to-day variations, this isn’t an alarming increase, but it still isn’t a good sign, either.  Generally, an increase of 0.75 per year is considered a warning sign.  My increase is below that, so hopefully more consistent with prostatitis or BPH.  It also shows my daily regimen of prostate supplements (selenium, saw palmetto, anti-oxidants, etc) is not helping so far.  I plan to consult my local urologist in a few months time.  I’ll probably get another blood test at that point, including free PSA.

Welcome to Prostate Biopsy Blog

If you’ve been recently diagnosed with an elevated or abmormal PSA level, there’s a lot of information here for you.  I’m not a doctor, nor do I have any medical training.  I do know how to use Google, so there are plenty of links where you can educate yourself.  That way, you know what to ask your doctor and when to seek another opinion.

For the whole story of my adventure in prostate fun, start at the very bottom and read upward.  I wish you the best of health and good luck in your diagnosis and treatment.

Prostate Biopsy Alternatives: Are They Necessary? Are They Worth It?

This will be my last blog for a while.  I’ll make sporadic updates, mostly if I have a checkup or want to post about a news story or something related to prostate health.  There’s one question I can now answer, but only for myself.  Was it necessary?  Was it all worth it?  Outside the standard tests that would normally be done for someone in my situation, did I waste time, money and effort trying to avoid a prostate biopsy that I ultimately had anyway?

In terms of time, I spent the morning of  Christmas Eve getting a prostate massage that was necessary for a PCA3 urine test.  I spent a night and two days in New York City for a power doppler ultrasound.  I spent 5 nights and the better part of 6 days on a trip to Washington D.C. for an MRI and a targeted fusion biopsy at the National Institutes of Health.  Granted, I got to visit with some friends on those trips, so it wasn’t a waste of time outside of the medical procedures.

In terms of cost, my PCA3 test was covered by insurance.  My portion was $9.60.  The visit to the NIH was free and they even paid a good part of my travel related expenses.  The big cost was the $950 for my power doppler ultrasound with Dr. Robert L. Bard in New York City.  I had to pay all of it up front, being told that at least part would be covered by most insurance plans as an out of network expense.  Ultimately, my insurance plan (Anthem Blue Cross) did consider the full amount as a covered expense.  Unfortunately, we have a high deductible plan and since it was the beginning of the year, I was not directly reimbursed by insurance for any of the amount.  On the plus side, it will count toward my deductible and out-of-pocket maximum limits for later in the year and will also be paid in pre-tax dollars once we are repaid from our HSA.

In terms of effort and risk, only the trip to the NIH was a big hassle.  I wish it could have been done in just a few nights, rather than 5.  Being sedated is always a risk, as are the risks of an invasive procedure like a biopsy and even just a hospital stay in general.

The trade off for the time, cost and hassle?  I now have peace of mind in that it is quite unlikely I have an undiagnosed prostate cancer.  I had hoped to avoid a biopsy, but ultimately my relatively high PSA and a couple areas identified as “very low risk” on my 3T MRI led me to decide that I should go ahead with the biopsy I had hoped to avoid.  At least the biopsy was targeted, presumably reducing the chances of a false negative.

So, was it worth it?  Would I do it all again?  Knowing what I do now, I probably would not have done the power doppler ultrasound.  At the very least, I would have tried to find a different physician to do it; preferably one who had published, peer-reviewed results, wasn’t so “commercial” in terms of hawking books and supplements and one who clearly agreed to provide a full copy of all images to me for future reference.   The PCA3 test is non-invasive and relatively low cost and effort.  The fusion MRI and biopsy was a bit of a hassle, but offset by zero cost and a nice weekend in Washington D.C.  If I have indications of risk in the future, I would strongly consider these two diagnostics again, depending on what other options are available at the time.

Obviously, my situation is unique.  Everyone else has different circumstances and different preferences on treatment.  In that I’m not a doctor and have no medical training, my opinions are not valid for anyone else.  What I do know is that everyone should question their doctor if they think they aren’t getting enough information to make an informed choice, especially if that decision involves cancer or another serious condition.  The internet is a powerful tool for research and if you find your physician was too busy to answer your questions or perhaps even underinformed about options, you should definitely seek out another physician or specialist for a second or third opinion.

If you find yourself in a similar situation as mine, I wish you the best of luck in your research, diagnosis and treatment.  Peace, and good health!

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If you happen to be interested in sponsoring my blog in exchange for a banner advertisement, please send an email to webmaster “at” prostatebiopsyblog “dot” com .  I’d love to recoup the costs for that ultrasound and donate some more money to related charities, like the PCF.   Prostatebiopsyblog.com now gets reasonable google search placement on relevant terms.

Can You Prevent Prostate Cancer?

Maybe you’re like me.  You have some indications like a high PSA level, but your biopsy is negative and you have no physical symptoms.  Maybe you’re in a high risk group or just a health nut.  Is there anything you can do to prevent prostate cancer from starting?  I have searched a lot for alternatives to a biopsy.  In the process, I’ve seen a number of alternative therapies, some touted as a prevention, some as a cure and some maybe as both.

You’ll find them on a search, too.  There are books that tout special diets.  There are websites that claim their secret bio cleansing method will help.  Of course, there are herbal cures and patented mystery pills that promote prostate health.  I’m sure someone has treated prostate issues with magnets, acupuncture, chiro and almost any other therapy you can name.  For patients without prostate cancer proven by a biopsy, these remedies will work like a charm, of course, and they will proclaim they have been cured.  That’s because most of these men had only fear, not prostate cancer.  Prostate cancer usually grows very slowly and is not often very aggressive, so the purveyors of snake oil don’t take a lot of risk hawking their products without any scientific study measuring their outcomes.  Of course, those who ignore the signs and avoid proven diagnostics and treatment will only have themselves to blame if they wait too long and have their options limited as a result.

Patents, testimonials and obscure foreign studies are one thing.  Having statistically significant findings published in a peer reviewed journal are another.  That patent may prevent someone else from selling the same thing, but it doesn’t mean your product works.  That obscure study was not only flawed, it was probably financed by the those who made the product.  Do you really want to risk your life, based on the testamonial of someone who wrote something on the internet? Continue reading Can You Prevent Prostate Cancer?

Prostate Cancer Treatments: The Major Options

While waiting for my biopsy results, I did scare myself by doing a bit of research on treatments.  Many alternatives exist.  The most proven one is an open radical prostatectomy or RP.  In the hands of a very experienced surgeon, this method has the best long term cure rates and among the best success rates for long term incontinence and impotence, too.  A handful of experienced surgeons across the country have done thousands of these surgeries, including the nerve-sparing procedure for those with early stage cancer.

This isn’t to say open RP is the best treatment for everyone.  There’s a robotic procedure (RRP or DaVinci) that is gaining popularity.  It’s too new for long term results, but it looks to be similar to that of the open procedure if you can find a very experienced surgeon.  Again, from my research, the choice of an experienced surgeon appears to be at least as important as the choice of which surgery to have.  A surgeon that has done hundreds, if not thousands, of the same procedure is ideal.  Even better is one who has published results or at least one who will share detailed  statistics on their results with you.  Another thing to ask is for referrals to patients who have had a “trifecta”.  That’s the term for a long term cure of prostate cancer with no long term urinary or sexual issues (be careful on how a surgeon defines incontinence and impotence).  If you’d ask for referrals on home contractors, you should absolutely do the same for someone about to cut you open! Continue reading Prostate Cancer Treatments: The Major Options

Prostate Screening: Does it Help? Does it Hurt?

It’s now three weeks since my biopsy and I’m pretty much back to normal.  All of the annoying side effects are finally gone.  I am really not looking forward to ever having another biopsy.  It wasn’t horrible, but definitely not something I wish to repeat.  In other recent news:

From the New York Times

The PSA blood test, used to screen for prostate cancer, saves few lives and leads to risky and unnecessary treatments for large numbers of men, two large studies have found.  

The findings, the first based on rigorous, randomized studies, confirm some longstanding concerns about the wisdom of widespread prostate cancer screening. Although the studies are continuing, results so far are considered significant and the most definitive to date.

 

Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center, says one way to think of the data is to suppose he has a PSA test today. It leads to a biopsy that reveals he has prostate cancer, and he is treated for it. There is a one in 50 chance that, in 2019 or later, he will be spared death from a cancer that would otherwise have killed him. And there is a 49 in 50 chance that he will have been treated unnecessarily for a cancer that was never a threat to his life.

Prostate cancer treatment can result in impotence and incontinence when surgery is used to destroy the prostate, and, at times, painful defecation or chronic diarrhea when the treatment is radiation.

 

I think it’s clear we need more accurate diagnostics, especially ones that are less invasive than a biopsy.  There is an obvious need to know how large and aggressive a cancer is before deciding if radical treatment is necessary.

 

Update: The New York Times added this article today

Negative Biopsy but High PSA: What Happens Next?

A biopsy can’t rule out prostate cancer.  Some men have 2, 3 or even more biopsies before they finally detect cancer.  Sometimes, they just miss it, because the major flaw inherent in using a biopsy to search for cancer is that it only samples a very small percentage of the prostate tissue.  It’s also possible that there was no cancer originally and it developed after the first biopsy.  In fact, some studies indicate that prostatitis, BPH or atypia may increase your risk of future cancer, so being diagnosed with these means you need to keep a close check.  There are also apparently some areas of the prostate that are difficult to sample during a typical transrectal ultrasound (TRUS) biopsy. 

Fortunately, there are newer techniques for prostate biopsies other than the random 6 or 12 sample method done in in a typical urologist’s office.  Like the targeted MRI/TRUS fusion biopsy I had, there are also saturation and “mapping” biopsies that use more samples or some type of specialized imaging to improve the coverage and reduce the chance of a false negative.  Some of these are transperineal, meaning they are done through the skin, rather than through the rectum.  A biopsy like these might be considered by higher risk patients who have had a negative biopsy in the past.  Continue reading Negative Biopsy but High PSA: What Happens Next?

My Prostate Biopsy Pathology Report is In. Good News!

Great news!  My biopsy was negative for cancer.  I’m also very glad it only took a little over a week, as I was told it could take 2-3 weeks.  The waiting is not fun; it’s on your mind very frequently.  Now, I get to put it out of my head for at least 6 months until my next checkup!

I temper my relief a little bit, because I know that there are a lot of false negatives with prostate biopsies.  This was one of my main concerns about having a biopsy in the first place.  While a biopsy can confirm the presence of cancer, it cannot rule it out completely.  In fact, a single, standard biopsy may not be all that much better than a PCA3 test or a 3T MRI for ruling out small, less aggressive tumors of the prostate.  Also tempering my great relief was a finding of an “atypical gland” in 2 of the 16 core samples.  This is basically a warning to keep close check on my PSA and have a regular DRE.  I’ve had a handful of suspicious moles removed in the past.  While none have turned out to be cancer, a couple did come back as “atypical”.  So, I also have a dermatologist check my skin at least once a year, too.

I am still very relieved.  Combined with my PCA 3 test and my 3T MRI results, the negative biopsy hopefully means I do not have prostate cancer at all and almost certainly means I don’t have any large or aggressive tumors.  Amen.

MRI Images Fast!

After I got home from my trip to the NIH, I faxed in the form needed to get a copy of my MRI results.  Three business days later, I received a packet in the mail with a paper copy of my MRI report, X-ray report, blood tests, urine tests and other lab results (the biopsy pathology report can take 2-3 weeks). 

The best part?  A custom labeled DVD with almost 1400 images from my MRI exam, complete with an included viewer.  This is what I expected from my $950 ultrasound, but ended up with 5 still photos that almost completely failed to document the “3D/4D” ultrasound I was supposedly given.

I can’t interpret the MRI images any more than I could interpret the ultrasound images, but at least I have them for reference if I ever need them.  As I expected, the limited ultrasound images were not very helpful to the urologist or radiologist at the NIH.  So, for anyone considering any type of prostate ultrasound (colorflow, color doppler, power doppler, 3D, 4D etc) or  MRI (MRSI, MRIS, spectroscopy, diffusion weighted, contrast enhanced, T2-weighted, 3T, etc), be absolutely sure to ask what types of images you will receive.  If you aren’t happy with the response, you should probably look for another physician, especially if you are paying for the service up front.

Anyay, for as much flak most government agencies get in regards to efficiency and customer service, I am pretty impressed with the NIH.

Clinical Trials with Advanced 3T Prostate MRI

The prostate MRI like the one I had is not unique.  I mentioned in an earlier blog that a urologist in Florida does 3T MRI screenings for a fee, some of which is paid by insurance.  This is also an area with clinical research, such as the study I entered at the NIH.  I was told that I was somewhere around the 75th patient in this particular trial.  I believe this is the link for the trial I entered, but it may be a related trial and not the exact one where I participated:

http://www.clinicaltrials.gov/ct2/show/NCT00182624

Other major centers are doing similar research, notably, the MD Anderson Cancer Center in Houston, Beth Israel Deaconess Medical Center at Harvard and Memorial Sloan Kettering Cancer Center in New York.  These are all among the top research institutions for prostate cancer.  You can search for such trials at www.clinicaltrials.gov.  Here’s a few I found that might be similar:

http://www.clinicaltrials.gov/ct2/show/NCT00588679

http://www.clinicaltrials.gov/ct2/show/NCT00429338

http://www.clinicaltrials.gov/ct2/show/NCT00831142

These are just a few active studies I found that appear to be recruiting participants.  These may vary from the study I entered in important ways, so you would need to read about the details and contact the researchers to make sure the study applies to you.  For example, some may have age limits or require that patients have a positive biopsy result for prostate cancer.  There may also be other studies I didn’t find in a quick search, or those that are still open but not actively recruiting.  It doesn’t hurt to email a researcher if you find one like this.  Clinical trials aren’t for everyone.  They may or may not help in a diagnosis or treatment.  You have to do a lot of your own research to determine if one is right for you.  Remember that not only might a clinical trial help you in the short term, but they will help others in the long term by advancing the technology for detection and treatment of prostate cancer.