saturation biopsy

[Art Smith]

getting a free/total psa tomorrow(3-4-09)...urologist says next step would be a "saturation biopsy"..I was wondering if anyone had one of these and any thoughts/comments/information they could share...thanks

[E. Michael D. ("Mike") Scott]

Dear Art: I have NOT had either a saturation biopsy or indeed any other form of prostate biopsy, ever. (Full disclosure!)

You state on your page that your PSA rose from 0.4 to 4.4 ng/ml in 1 year, and then again rose to over 5 ng/ml. You were referred to a urologist and who gave you a six-core biopsy that came back negative. You then had another PSA 6 months later with a result of 7.1 ng/ml. Yes? (Want to be sure I am getting my facts right.)

QUESTION 1: Have any of your doctors ever tried giving you an antibiotic or other form of treatment for possible prostatitis and then monitored your PSA? Do you have any physical signs or symptoms? Assuming you have had at least one DRE, was it positive or negative?

QUESTION 2: Did you urologist tell you what he meant by a "saturation" biopsy? For a urologist who normally gives a six-core biopsy today, a saturation biopsy could mean a mere 12 cores. But many urologists now consider a 12-core biopsy to be standard practice and would consider a "saturation" biopsy to require 20+ cores.

The free/total PSA test result will help to differentiate between risk for BPH and risk for prostate cancer, but is not absolutely definitive. The other thing that you could ask about before you have the saturation biopsy is availability of a color doppler ultrasound test. This test MAY be able to assist in identification of areas in your prostate at high risk for prostate cancer, although you might have to travel to get such a test done.

[Art Smith]

Hey Mike,
No, I did not go through a course of antibiotics but several years back(5-8 years ago) I had prostatitis and was treated w/antibiotics...my primary physician and urologist both did a DRE and said it felt normal..they did not feel any lumps/nodules...just normal...I do not have any symptoms such as: blood in the urine/semen, frequent urination, pain, hard to stop/start urination...a normal flow...I also have no family history of PC...he just said that it would provide biopsies from many different angles for a saturation biopsy not just the back of the prostate like the one he did..I think the free/total psa result will tell me a lot and I'll go from there...I do appreciate you responding and I will definitely ask about the color doppler ultrasound test...are you familiar with that procedure and what it entails? Again, thanks Mike and I hope to hear from you again...Art

[E. Michael D. ("Mike") Scott]

Art:

The color doppler transrectal ultrasound is, as far as I am aware, very similar to the ultrasound experience that I assume you went through when your doctor gave you your prior biopsy procedure. It just uses a more sophisticated package of equipment.

Mike

[Steve Z]

Art,

I had a type of saturation biopsy called a transperineal 3-D mapping prostate biopsy. They go in between the scrotum and rectum using a 5 mm grid similar to what's used to deliver brachytherapy seeds - at a 90 degree angle from a transrectal one. It took 51 needles to cover my 34cc prostate.

This is more to deal with than your usual 12 needle transrectal biopsy, and there was a bit of discomfort for the first 24 hours afterward. It's done under sedation and most men are catheterized for a day afterward. I had a little blood in my urine for the next couple of days and still showed a little brown in my semen after 5 weeks, but feel confidant that I would have fully recovered. Like any procedure, it entailed risk, mostly voiding problems afterward that might have caused me to need to be recatheterized; also, like other saturation biopsies, scar tissue that grows after the procedure may make surgery more difficult for those who go that route subsequently.

Our situations seem very different. I was low pretty stable PSA with some urinary symptoms, and my initial 10 needle biopsy had shown two 5% PCa cores. The mapping biopsy was a prequel to the focal cryo procedure I opted for.

Antibiotics and ultrasound make sense at this point. You might also want to consider a new test for prostate cancer called PCA3.

Good luck.

[Richard L.]

Art, my history is very much the same as Steve's, and part of my diagnosis was a 40-needle saturation biopsy as he describes, with 2 cores showing less than 5% PCa. In addition I had the PCA3 test (not that common to find the laboratories who specialise; at least, here in Europe) which led to the biopsy.

One factor to consider would be whether you had made any decisions on possible further treatment. In my (limited) experience (my interest is focal therapy) specialists in Cryo / HIFU / Brachytherapy are keen to dictate precisely the biopsy mapping procedure, preferably with a professional they work with on a regular basis. This could prevent having the biopsy repeated.

[Art Smith]

Steve,
Thanks for the information..my urologist started me on Avodart...I got a psa test & free/total psa test which came back several days later..he said he would have liked the free/total to be a little higher and indicated that it wasn't definitive...but....the base psa had dropped from 7.1 to 4.1..?? I had only been on the Avodart for 6 days when this blood was taken..?? The information I've read says that Avodart could lower psa by 40-50% over a 4-6 month period...Dr. wants to continue with the Avodart for another month and take another psa at that time...Am I wrong? Avodart would lower psa if it is BPH ? It wouldn't lower psa if it was prostate cancer would it??
Thanks, Art

[Steve Z]

Art,

Check out -
http://prostate.emedtv.com/avodart/avodart-warnings-and-precautions...

"Avodart can lower your PSA levels. The PSA (prostate specific antigen) blood test is a common way to screen for prostate cancer (see Prostate Cancer Screening). Your healthcare provider will need to adjust your PSA test result (by doubling it) if you are taking Avodart. Or, your healthcare provider can use a slightly different blood test (the "percent free PSA" test) that does not need to be adjusted."

Apparently, Avodart can lower PSA regardless of the cause. Sounds like free PSA was a good way to go, and again, if you want more to go on, there is PCA3 as well.

You said "I do not have any symptoms". I'm no doctor, but why did your urologist say he was putting you on Avodart?

[Steve J]

The FDA-approved "label" information on Avodart (dutasteride) includes this:

"Effects on Prostate-Specific Antigen (PSA) and the Use of PSA in Prostate Cancer Detection

Dutasteride reduces total serum PSA concentration by approximately 40% following 3 months of treatment and by approximately 50% following 6, 12, and 24 months of treatment. This decrease is predictable over the entire range of PSA values, although it may vary in individual patients. Therefore, for interpretation of serial PSAs in a man taking AVODART, a new baseline PSA concentration should be established after 3 to 6 months of treatment, and this new value should be used to assess potentially cancer-related changes in PSA. To interpret an isolated PSA value in a man treated with AVODART for 6 months or more, the PSA value should be doubled for comparison with normal values in untreated men."

BUT: one thing that is too often overlooked is that Avodart's "label" use is tx of benign prostatic hyperplasia (BPH). The above warning is directed at those men who are being treated for BPH and I understand is intended to forestall failure to detect PCa in such men.

Even though PSA is not specific for PCa.

The reason the PSA declines is that the size of the gland is reduced, which is of course the purpose of the med.

Once a man has undergone primary tx of PCa, I understand that the PSA is then what it is and no adjustment is necessary.

[Art Smith]

Steve,
To be honest, he didn't tell me why he decided to put me on Avodart. And now knowing that it could lower psa that has risen because of prostate cancer now sorta worries me. I am scheduled for another psa in 2 weeks...I have some questions for him...thanks for the info....Art

[Steve Z]

Art,

Not to worry - some studies suggest that dutasteride may prevent prostate cancer or at least slow its progress.

I just think its important for patients understand what they are getting and why they are getting it before they are treated. It's the only way to make an intelligent, informed treatment decision.

Don't be afraid to ask your doctor questions -- any question -- or to call him back after the appointment if something starts to particularly worry you.

[Art Smith]

Hey Steve,
I haven't been on in a while...just waiting for the next PSA blood test...I got the results back today after a month and the baseline psa dropped to 3.8...month ago it was 4.1 and it appears to be going in the right direction...my free/total also rose and it appears to be going in the right direction also...my urologist wants to take another in 3 months and continue with the avodart...I asked him about why he put me on that and he said to see if it had an affect on psa....anyway, we discussed my history w/my prostate and psa over the past 1 1/2 years and feels we are on this...anyway, I appreciate your comments/info....I've really stressed about this the past couple of months but seeing the levels go down is reassuring to me...thanks,,,Art

[Art Smith]

Hey Steve,
Long time since I've been on...really only about a month..anyway, I returned to my urologist and the psa has gone down and free/total has gone up...both in the right direction..we have decided to stay on the Avodart for 3 more months and check it again...that should give us some direction...my guess is if it continues to go down we'll stay the course and if it doesn't change or goes up we'll go with the sat.biopsy...I appreciate your asking...please keep in touch....Art