I have been "told" to get a biopsy of my prostate. However, as I have never had any kind of surgical procedure performed on my body, I am very worried, and apprehensive of the RECTAL invasion and possible consequences; even thought prostate CANCER is something to worry about! My age, 63

Do it! My doctors kept putting off even mentioning this test. I’m now 66 and hope to see 67. For over ten years and three doctors, one finally said my PSA was high enough to have a biopsy done. Like you I was apprehensive about having my rectum invaded like this. It turned out to not be as bad as I expected, not something I care to do regularly.

My PSA in 1995 was 4.2 and my doctor gave me antibiotics to see if it would come down. It did and everytime my PSA went up, here came the antibiotics. Last year, I went on Medicare and my PSA was again 4.2. This doctor said it’s not high enough to worry about yet.

I changed insurance and doctors in January. When my PSA came back at 4.3 in February, my new doctor insisted I have a biopsy. This was done in a Urologists office with no drugs. I was relived when it was over. Now came the hard part, waiting for the results.

Out of all the cores they took, my cancer was in 85% of them. My Gleason score is 9 (4+5). The only scores worse than that is 9 (5+4) and 10 (5+5). I have a very aggressive form of prostate cancer. My only treatment is to have 42 extrernal beam radiation sessions over an eight and one-half week period. While they are burning my rectum, I’m also having hormone shots to block my testersone, that’s what makes you a man. In three months I’ll under go another biopsy, to see if I will need to have radioactive seeds implanted in what’s left of my prostate. At this point removal, for me, is not an option.

Removal is the desired treatment since removing the prostate cancels any worry of cancer if the cancer has not spread beyond the prostate. If it has, you must continue on with radiation. With the prostate gone your PSA will now be Zero.

As Larry, the Cable Guy says, "Get R Done"

Additional thoughts: I attended a seminar on Prostate cancer treatments to hear a doctor mention he had a 42 year old patient with a PSA of 2.5 and a Gleason score of 10. PSA isn’t always the answer, the Gleason score, can only be found with a biopsy, is the answer.

While PCa at your age is rare, it’s hardly unknown. You have an significantly elevated risk due to the fact that your father had it.

PSA is not an indication of cancerous tissue, it’s produced by both normal and diseased prostate tissue. The absolute number turns out to be fairly meaningless, as "normal" could be anywhere from .5 to 8, mostly depending on the size of your prostate and general health. It’s best to have regular PSA tests, and to keep a chart of your results. A rapid increase in PSA is more concerning than a high absolute number.

Free PSA is the percent of PSA which isn’t attached to protein. If it’s very low, there is a higher chance that your PSA reading is caused by cancer.

A DRE can only detect cancer when it’s extensive enough to be palpable. In parts of Europe, adoption of PSA testing has been slower than in the US, and DRE is still a preferred detection technique. But DRE will miss cancer in it’s earliest, most treatable stage. In the US, the overwhelming majority of men are diagnosed with biopsy following abnormal PSA readings, and never reach the stage of having a positive DRE.

If I were in your place, I would take the biopsy. Although biopsy isn’t the most pleasant experience, it’s the only way to find peace of mind. If it’s negative, I would continue being vigilant, and have PSA tests every six months, charting the results. Given your family history, it pays not to take chances.

What you can expect from the biopsy is a few minutes of discomfort, followed by a month of bleeding. It’s not the worst thing that can happen to you.

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