Prostate Biopsy: How many snippets?

[Lost Sheep]

I had a biopsy on my prostate (rectal instead of perineal because of the risk to my implant) and the surgeon took what seemed to be two dozen samples.

I am starting to wonder if he was being extra thorough or if that is the usual. And today I got not one, but two phone calls (from an office that usually makes none) and they got me an appointment tomorrow to discuss the results.

So, even though I am not a worrier, I wonder if I should prepare for a round of treatment.

Over the past decade, my PSA has been climbing and prostate enlarging but my PSA has for most of my life been low and the digital exam a couple months ago (before scheduling for the biopsy) I had was pretty near normal. I am 74.

Anyone have any advice on questions to ask?

[ftwabeck3533]

Over the past decade, my PSA has been climbing and prostate enlarging but my PSA has for most of my life been low and the digital exam a couple months ago (before scheduling for the biopsy) I had was pretty near normal. I am 74.

Anyone have any advice on questions to ask?

At age 62 (inJune of 2018) my PCP felt a lump on my prostate, and a week later my Urologist confirmed the lump with his finger. A biopsy was performed (12 samples) a couple weeks later.....

....and this is where you need to prepare yourself for questions. Each piece of tissue from your prostate is tested for malignancy and assigned a "Gleason" score. If they are all benign or have Gleason scores of 6, you are home free. If any score 7 or more, your Urologist will recommend "treatment". The 7 scores are a little tricky, because each score consists of two values. A "3+4" is less of a concern than a "4+3". I had a few tissue samples scored as "4+3".

Let's not get ahead of ourselves. We'll cover "treatment" options after you get your results. The good news for me, five years after being diagnosed with prostate cancer -- I am cancer-free (my PSA was checked last week, and it's undetectable).

LostSheep, feel free to PM me.

[Old Guy]

That doesn't sound good. Thankfully my prostrate is in good shape, so doc tells me. However, I just had two tumors removed from my bladder. Talk about hurt, never experienced such horrible pain as after that surgery.
It started with seeing blood in my urine. It got really heavy then quit. When it started the second time it had me worrying. So the tumors were cancerous, and I have to go through a treatment. Once a week for six weeks they will catheterize me, put some fluid into my bladder and I have to hold it for two hours. Six weeks after that's over it'll be the scope up the urethra again to see if there are any more tumors. I'm asking for the heaviest pain drug they got that time!

Guys it is very important to see your doctor if you see any amount of blood in your urine. Reading stories on the BCAN (Bladder Cancer Advocacy Network) one fellow left it go for one year. Had to remove his bladder and spread to prostrate.

[bldoink]

I had a rectal biopsy 3 different times over several years. He found the cancer on the third one. I don't remember how many snippets he took each time but it wasn't a lot. However I hear the protocols have changed and they do a lot more now. Maybe if my doctor had followed the newer protocols at the time he would have found the cancer earlier, so I think more snippets are better. Often I understand many do a guided biopsy now where imaging is used during the biopsy so it's more accurate.

I couldn't guess about the call. How soon after the biopsy did the calls come. As for the number of calls I wouldn't read much into that. There was probably a note to call you after the results came back and two of the girls saw the note at different times and weren't aware it had already been taken care of.

When I was treated, my doctor recommended surgical removal. He said if I got surgery they could do radiation later if needed but if I was given radiation first he couldn't come back and do the proctectomy.

My experience is 11+ years old and things have likely changed a good bit.

Good luck.

[Lost Sheep]

Thanks for the replies, guys.

The clinic does not have a reputation for diligent followup, so the fact that they called twice in one day is (to my mind) significant. The fact they gave me an appointment right away, also.

I am not particularly worried. No significant history of cancer in my family and I am not by nature a worrier. But my girlfriend is. And unlike my implant surgery, I am not well-studied on this subject.

The calls came 21 days after the biopsy (Mar 30 to April 20) and the Doctor told me 2-3 weeks for the results to come. So, no surprizes there.

I am on my way to the appointment right now. I will report back in a few hours.

[SteveD]

I can offer this from my experience with prostate CA from biopsy to surgery to implant:

- Read the free patient guide literature from the Prostate Cancer Foundation <pcf.org> It will help with many questions, suggest conversations to have with the Docs about 1) watchful waiting, 2) surgery, 3) radiation (and different kinds), and combinations of both. There are obviously risks and benefits to all the approaches. Yes - tamp down the emotional quotient and 'think through the options' being presented.
- Re: biopsies: I had CT/MRI scans of the prostate that identified a tumor - with that info, and by blending the images with an ultrasound view - the Urologist did only 4 biopsies. All 4 were positive for CA - any biopsy that is positive is what matters. Historically - about 12 biopsies was the norm, sometimes more.
- Re: treatment decision: ensure you (and the Docs) know where the CA is located, e.g., prostate only, or invasion to the lymph nodes. Treating the prostate with radiation while excluding the nodes may not be your desired outcome.
- At 67 when I had my RP surgery ED was not a concern - thankfully never experienced any issues before surgery. 2 years after my RP (not an enjoyable period of time) an implant returned erectile function that was 'all but gone.' And - as so many have said before me - thank you Lord for a supportive, caring wife!!

You have a long road ahead - it gets easier to travel the more you learn about the route options.

[Old Guy]

Wow guys, your stories make me feel lucky. Prostrate cancer is something most have heard about but don't know the destruction it does to the body. I sure didn't. Survival rates are better these days, thankfully.
Lost Sheep, let us know the follow up. Hope it's a good report.

[tomas1]

I've had 3 bouts of prostate biopsies. The first 2 each showed Gleason 3+3[6.
Strangely, the last 12 specimens showed no cancer. That makes me wonder how accurate these biopsies are.

My doc was overjoyed, but I guess I'll take it.
I have heard the biopsies are likened to sticking a needle into a blueberry muffin and occasionally not hitting a blueberry. I might try for an MRI if doc wants more biopsies. I guess a lot will depend on whether my PSA goes up.

[Lost Sheep]

Thank you for the support.

My surmise was correct. The urgency I inferred from the phone calls and swift appointment was accurate. Gleason 7 (4+3) on most of them.

There were only 7 samples taken (but it felt like twice that many - I lost count during the procedure - ouch). The hospital (USAF Hospital courtesy of the Veterans Administration) is being VERY responsive. 9:45 appointment with my Urologist who recommended a pelvic CT Scan and head-to-toe bone scan to search for any metasitization. (metastasizing? metastasis?) The lab took blood sample, bumping me to the top of the heap and the CT Scan tech came and found me in the lobby (where I had gone to get cell phone service to call some friennds). Bone scan is scheduled for Monday (today is Friday).

edit: there were 17 or 18 samples taken from 7 locations in the prostate.

I have followup with my Urologist on May 4, less than two weeks from now.

Surgery of some kind seems inevitable. Prostatectomy was mentioned first, but he said only because he is a surgeon. Internal radiation (the pellets they insert into the prostate) was next. Radiopathy and cryotherapy seems like a less-likely recommendation. We will know more after the imaging comes back to see if the cancer has spread beyond the protstate.

What does seem certain is there will be testosterone suppression (also known as castration), either by orchiectomy or by chemistry. Fortunately, I already have an implant, so ED is not an issue. I wonder about how low T will affect my libido, though. And whether or not our experimenations with prostate massage will come to an end before we discovered the "magic spot". But I am REALLY not looking forward to incontinence.

Again, thanks for the information and encouragement. First prognosis is that there is 83% survival rate at 15 years out from where I appear to be at this point. But I am not ready to put a clock on my life expectancy yet.

[bldoink]

I'm sorry you're having to go through this. But you can do it. The incontinence will be a temporary. You do have a hard row to hoe but you'll get through it.