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Anonymous
Subject:Prostate Cancer Diagnosis

Facing potential prostate cancer diagnosis. 53 year old white male. Good physical health, only symptom is decreased urine flow. PSA 12/94 @ 2.19; 2/95 @ 1.8; 8/01 @ 3.02; 5/04 @ 6. Independent PSA 5/04 @ 6 (dried sample vs. draw). Dual negative DREs. Awaiting additional PSA and Free PSA results. Review of literature indicates risk of metastasis due to TRUS biopsy which a doctor would suggest as a logical next step. Planning EBT scan of abdomen for prostate volume and localization of tumors if present.
Seeking suggestions on additional non-prostate-invasive testing that could be performed. I.E. molecular staging (PCR-PSA), prostate-specific antigen density (PSAD), bone scintigraphy, endorectal magnetic resonance imaging (MRI), etc. The choices seem endless. Thanks in advance.


Posted: 21 Jun 2004 11:24 PM
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Ann

Ann

Total Messages 63

Subject:Prostate Cancer Diagnosis

At this time there are only two ways to diagnose prostate cancer: (1) TRUS biopsy of prostate or (2) Biopsy of metastatic sites such as lymph node, liver lesions or lung lesions. The role of MRI imaging is currently under investigation and currently can not diagnosis prostate cancer. Bone Scan is unable to determine the cause of any areas of increased uptake. It can only suggests the presence of bone metastasis. With a PSA of less than 10 ng/ml the probability of discovering metastatic disease with CT scan, Bone Scan or MRI is less than 1%. At this time, there has been no link between TRUS Biopsy and metastasis. It would be of great interest to review the literature that has been alluded to in this question.

Todd Pickard, MMSc, PA-C


Posted: 22 Jun 2004 11:09 AM
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Anonymous
Subject:Prostate Cancer Diagnosis

Thank you for the posted response to my query on prostate cancer diagnosis. It was indicated in my text that a link might exist between TRUS biopsy and metastasis. The literature cited was "The Prostate Cancer Primer - It's Not a Disease just for Older Men Anymore". Author Dr. Nicholas R. Hild, PhD. and Dr. Patricia A. Pierce, ND. 2004. Pages 17 & 18. To paraphrase, "Good urologists will not prescribe a biopsy but rather suggest to the patient that it is his choice". "because biopsies (unbeknown to the patient) carry a risk - that of spreading cancer cells that are otherwise contained in the prostate.
Implantation Metastasis citations found during a Google search includes:
1. Implantation metastasis after percutaneous transthoracic needle aspiration biopsy. Acta Radiol [Diagn] (Stockh), 1976 Jul, 17:4, 473-80.
2. Implantation metastasis of head and neck cancer after fine needle aspiration biopsy. Auris Nasus Larynx. 2001 Nov;28(4):377-80. PMID: 11694388 [PubMed - indexed for MEDLINE].
3. Needle track seeding of papillary thyroid carcinoma from fine needle aspiration biopsy. A case report. Acta Cytol. 2002 May-Jun; 46(3):591-5. PMID: 12040660 [PubMed - indexed for MEDLINE].
The above citations although not prostate specific, indicate there is potential for "spill" of cancerous cells during the biopsy procedure but with a very low overall risk of metastasis.
This does bring up another question, that of the optimum number of cores taken during a TRUS. A minimum of six to a maximum of 21?


Posted: 22 Jun 2004 11:43 PM
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Ann

Ann

Total Messages 63

Subject:Prostate Cancer Diagnosis

The most common prostate biopsy strategy is the sextant biopsy. This includes the right base, right mid, right apex, left base, left mid and left apex. However,
at most large cancer centers the ten core biopsy is the new standard. This increases the sextant biopsy by adding two cores from the right anterior horn and two cores from the left anterior horn. While is it well known that some cancers can be "seeded" by biopsy, there is no data to show that this is the case for prostate cancer. If there are anecdotal cases, there are no published studies that indicate that TRUS biopsy of the prostate can lead to seeding of prostate cancer. The American Urological Association, The National Cancer Institute and The American Cancer Society have no reports or recommendations with regard to seeding of prostate cancer.

Todd Pickard, MMSc, PA-C


Posted: 24 Jun 2004 08:48 AM
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