caret icon Back to all discussions

Should I get a biopsy?

Hi folks, I have a family history of prostate cancer (father & two of his brothers); had a recent ultrasound that revealed a 8mm nodule on prostate; my latest PSA is 2.5 with no real trend (it bounces around but always below 4).
I'd welcome any thoughts on whether a biopsy seems appropriate - my urologist says it's an option but isn't pushing it; seems to be leaving it up to me.

  1. Has your urologist considered doing scans? This can tell you whether a biopsy is indicated and provides a target for the biopsy.
    A biopsy is a series of 12 coring needles shot into the prostate to take tissue samples. Without imaging the needles may or may not hit a cancerous area, particularly if the cancer is located on the anterior.

    1. Yes, an MRI. There are other scans, but maybe for more advanced situations. I'll have to let others comment on that until I am up to speed.

      Have your providers offered an MRI? Insurance companies sometimes require a biopsy first, which I see as wasteful as a second uncomfortable/painful biopsy will then likely be needed. I was not offered an MRI until I asked for one to determine the cancer's location. This was to help decide on treatment. Question was whether it was in a location favorable to surgery. It was not.

      I see your comment on nodules. They don't necessarily show cancer, but are one of several items to watch. I had nodules, PSA went from 2.7 to 3.1 in 6 months and the urologist suggested a biopsy. The nodules were a great target for the biopsy needles, making it less random.

      Guy B. Meredith, moderator.

    2. My urologist hasn't yet suggested an MRI - at this point he's just said to come back in 3 months for another PSA check & probably DRE. I haven't checked with my insurance company yet about whether they'd cover an MRI as a diagnostic prior to a biopsy, but think I'll do that. Thanks Guy.

  2. Unfortunately with prostate cancer there are a lot of unknowns. If you have a family history you are at a higher risk level than someone who did not have that family history .
    A PSA of 2.5 may be due to am enlarged prostate, recent exercise, sexual activity or who knows what. A guided biopsy is probably the way to go as Guy noted – especially if a node has been identified and you decide to move forward.

    My PSA prior to diagnosis was also 2.5.

    In my case the biopsy revealed an aggressive cancer that was contained. I underwent surgery in 2013 and 5 years laster needed radiation due to a continued but slow rise in PSA.

    It is good your urologist is not pushing you ... at the same time a PSA test is not a test for cancer - only a biopsy can give you the needed information. If you are diagnosed with PCa do not be surprised if the urologist asks you what treatment you want vs suggesting one or the other. They really tend to leave this up to you.

    From here on ... it is up to you to ask questions, do some research get second opinions and follow your instincts on best next steps. Please keep us posted here

    1. Hi Dennis, just curious, you mentioned your PSA was only 2.5 before your diagnosis. Being relatively low at 2.5, what then led to your diagnosis, which I assume came from biopsy?

    2. A low PSA and an aggressive cancer can happen at the same time - I am one of those cases. To the only way to tell what is going on is some addition testing - There are liquid biopsy options Urine test etc as well as a guided biopsy. Again the PSA blood test is not a test for cancer - As Richard pointed out a steady PSA is good

  3. Hi . It is a good sign that your PSA has been steady, but, as discussed in this article, the history of prostate cancer (PCa) in your family raises the odds of you getting it considerably: A biopsy is certainly the most definitive way to diagnose PCa and, as Guy was mentioning, an MRI guided one is much more effective. Short of a biopsy, there are urinary tests that can help to further determine the likelihood of PCa. Your doctor should be able to provide additional information. Wishing you the best and please feel free to keep us posted on how you are doing. Richard ( Team)

    1. My doc's office didn't have or do the Michigan test, but they did offer a test called SelectMDX, which apparently screens for aggressive PCa. My result came back "very low" risk. I'm due for another PSA check in a couple weeks. Assuming that comes back steady with recent levels, and with the good result from the SelectMDX test, I'll hold off on biopsy until anything changes.

    2. Hi . Good news on the test results. I thought you might be interested in this write-up of research done on SelectMDX through Johns Hopkins: The lead researcher notes that "The results were very promising." Best, Richard ( Team)

  4. Definitely push for an MRI before anything else is done. An MRI isn't 100% accurate for presence or absence of PCa - but if it shows something it's then time to move on to the biopsy, now called a "Guided Biopsy" since it will target whatever was found in the MRI.

    If your insurance won't cover it - talk to the MD and find out what Medicare reimburses the radiology group for doing one - then start dickering with them. Tests that are billed at thousands of dollars are usually reimbursed by Medicare at a tiny fraction of that cost - more in the line of $100-200. At that point you have to ask yourself if it's worth that much to find out what's happening and stop worrying. I know what my answer would be.

    1. I will say Medicare covers has been impressive especially when combined with my own coverage - Worth checking and hope you did

Please read our rules before posting.