Random Prostate biopsy

[Sevenomma]

I am trying to find the cost of random Proste biopsy. I cannot find it online. I dont want to use private hospital. Anyone did this or know the price in Government hospital in or near Pattaya?
 

[Sheryl]

"Random" prostate biopsies are now pretty much a thing of the past, you may have trouble finding anyone willing to do it, involves more excision sites so more bleeding risk, and less accurate.

 

And there is still  chance of missing a cancer even if one is present.

 

The standard these days is what is called an "MRI fusion" biopsy where both MRI and rectal ultrasound are used to pinpoint where to biopsy.  This is done under general anesthesia and involves at least 1 night stay in hospital (may be more if you have trouble urinating immediately afterwards). Currently some private hospitals in Bangkok are offering package of 120,000 baht, does not include the pre-op checks and consultation, and assumes just 1 night in hospital.  I would guess cost at government hospital to be about 1/2 to 1/3 that.

 

At a bare minimum (and less desirable/accurate) a  biopsy needs to be done with ultrasound guidance.

 

Performing a multi-parametric MRI beforehand, if you have nto already had one,  can often eliminate the need for biopsy. Of course, if it indicates biopsy is necessary, then cost will have been more, so a bit of a gamble but can be worth it if it prevents unnecessary biopsy, as it often does.

 

I do not think any government hospitals in Pattaya itself have the capacity to do this.  There is some chance -  but no guarantee- that  this could be done at the Burapha University Hospital in Bang Saen . They do have urologists, as shown in this schedule (open in chrome for English translation)

https://buh.buu.ac.th/doctors/schedule.php?dm_id=26

 

In addition, the larger university affiliated government hospitals in Bangkok (Siriraj, Chulalongkorn, Ramathibodhi) can do this.   You would start by consulting a urologist at one of these places. Siriraj levies a 20% surcharge on foreign patients, and is less conveniently located, so you might prefer one of the latter two. You can consult a senior urologist through the "after hours" clinic at Chula https://spcweb.kcmh.or.th/users/users/searchDoctor

Also possible to go through the public channel for the initial consultation but will take much longer (as in, multiple visits) , involve queuing at the break of dawn, and your interactions will be with doctors in training. May also be long wait lists. Consulting via the "Special clinic" does not preclude performing a procedure through the public channel.

 

Ramthibodhi (which excels in urology) also as an after hours clinic called the Premium Clinic but it seems not to have a urology section.  Could call and ask, though. https://www.rama.mahidol.ac.th/qsmc/th/service/premium_clinic-th

 

 

[scubascuba3]

Could try a Urologist at Queen Sirikit, I saw one at Pattaya International hospital who i think is head of Urology at QS, a golf friend saw the same man for bladder cancer at QS

[Sevenomma]

2 hours ago, Sheryl said:

"Random" prostate biopsies are now pretty much a thing of the past, you may have trouble finding anyone willing to do it, involves more excision sites so more bleeding risk, and less accurate.

 

And there is still  chance of missing a cancer even if one is present.

 

The standard these days is what is called an "MRI fusion" biopsy where both MRI and rectal ultrasound are used to pinpoint where to biopsy.  This is done under general anesthesia and involves at least 1 night stay in hospital (may be more if you have trouble urinating immediately afterwards). Currently some private hospitals in Bangkok are offering package of 120,000 baht, does not include the pre-op checks and consultation, and assumes just 1 night in hospital.  I would guess cost at government hospital to be about 1/2 to 1/3 that.

 

At a bare minimum (and less desirable/accurate) a  biopsy needs to be done with ultrasound guidance.

 

Performing a multi-parametric MRI beforehand, if you have nto already had one,  can often eliminate the need for biopsy. Of course, if it indicates biopsy is necessary, then cost will have been more, so a bit of a gamble but can be worth it if it prevents unnecessary biopsy, as it often does.

 

I do not think any government hospitals in Pattaya itself have the capacity to do this.  There is some chance -  but no guarantee- that  this could be done at the Burapha University Hospital in Bang Saen . They do have urologists, as shown in this schedule (open in chrome for English translation)

https://buh.buu.ac.th/doctors/schedule.php?dm_id=26

 

In addition, the larger university affiliated government hospitals in Bangkok (Siriraj, Chulalongkorn, Ramathibodhi) can do this.   You would start by consulting a urologist at one of these places. Siriraj levies a 20% surcharge on foreign patients, and is less conveniently located, so you might prefer one of the latter two. You can consult a senior urologist through the "after hours" clinic at Chula https://spcweb.kcmh.or.th/users/users/searchDoctor

Also possible to go through the public channel for the initial consultation but will take much longer (as in, multiple visits) , involve queuing at the break of dawn, and your interactions will be with doctors in training. May also be long wait lists. Consulting via the "Special clinic" does not preclude performing a procedure through the public channel.

 

Ramthibodhi (which excels in urology) also as an after hours clinic called the Premium Clinic but it seems not to have a urology section.  Could call and ask, though. https://www.rama.mahidol.ac.th/qsmc/th/service/premium_clinic-th

 

 

 

[Sevenomma]

I asked for Random prostate biopsy. I know there are other ways to do this. Banglamung can do this. I took PSA some days ago and I was so surprised when the doctor told me about my PSA level so I dont remember what he said about cost. He recommended Biopsy and gave me choices. I have appintment in february and try to learn about transperineum biopsy, MRI and so on. So I still have time to choose random or targeted biopsy. 

[Sevenomma]

Queen Sirikit is a good tip. Thanks a lot 🙂

[Sheryl]

1 hour ago, Sevenomma said:

I asked for Random prostate biopsy. I know there are other ways to do this. Banglamung can do this. I took PSA some days ago and I was so surprised when the doctor told me about my PSA level so I dont remember what he said about cost. He recommended Biopsy and gave me choices. I have appintment in february and try to learn about transperineum biopsy, MRI and so on. So I still have time to choose random or targeted biopsy. 

 

 

Biopsy is NOT usually indicated based on PSA alone. I don't think you were well advised.

 

What exactly was your PSA? And did doctor perform a digital rectal exam?

 

A parametric MRI might preclude the need for biopsy. But Banglamung is nto the place for this. Nor the place to have any sort of biopsy, even if they offer to do it. It is a fine hospital for many things but not something this specialized, you need an experienced senior doctor.

 

Strongly urge you to consult senior urologist at Burapha.

[CM4Me]

From my own experience, I think Sheryl is providing excellent advice

[sidjameson]

Yes, take her advice.

I did hundreds of hours of online research and everything she says is spot on.

[Sevenomma]

On 12/29/2024 at 5:04 PM, Sheryl said:

 

 

Biopsy is NOT usually indicated based on PSA alone. I don't think you were well advised.

 

What exactly was your PSA? And did doctor perform a digital rectal exam?

 

A parametric MRI might preclude the need for biopsy. But Banglamung is nto the place for this. Nor the place to have any sort of biopsy, even if they offer to do it. It is a fine hospital for many things but not something this specialized, you need an experienced senior doctor.

 

Strongly urge you to consult senior urologist at Burapha.

Thanks for your advice. I want to get a second opinion. Maybe from Chonburi hospital. I had an ultrasound also that showed my prostate is bigge than normal. The urologist I met gave med three choices. 

Can I ask if you are a doctor or educated in medicine?

[Tropicalevo]

On 12/29/2024 at 3:35 PM, Sevenomma said:

I asked for Random prostate biopsy. I know there are other ways to do this. Banglamung can do this. I took PSA some days ago and I was so surprised when the doctor told me about my PSA level so I dont remember what he said about cost. He recommended Biopsy and gave me choices. I have appintment in february and try to learn about transperineum biopsy, MRI and so on. So I still have time to choose random or targeted biopsy. 

 

Listen to Sheryl and  I recommend go MRI's and targetted.

A doctor friend of mine said - do not do random biopsies - they put 'wounds' in the prostate. Also, if you do have cancer, the wounds help it to spread more quickly.

He recommended MRI's on a regular basis. (I went once per year.)

When they spotted an 'irregularity' they did a targetted biopsy.

[Sheryl]

An enlarged prostate is quite common in men  starting from age 50 and usually benign.  In a younger man, more of a danger sign but even then can be due to inflammation (prostatitis) rather than cancer.

 

OP how old are you?

 

Although there will be at least 1 urologist at Chonburi hospital, you may get a more senior one if you go through Burapha after hours clinic.

[Sevenomma]

4 hours ago, Sevenomma said:

Thanks for your advice. I want to get a second opinion. Maybe from Chonburi hospital. I had an ultrasound also that showed my prostate is bigge than normal. The urologist I met gave med three choices. 

Can I ask if you are a doctor or educated in medicine?

My PSA was 9,9. Rising from 6 one year ago. I am 65 years. 

[Sevenomma]

19 minutes ago, Sheryl said:

An enlarged prostate is quite common in men  starting from age 50 and usually benign.  In a younger man, more of a danger sign but even then can be due to inflammation (prostatitis) rather than cancer.

 

OP how old are you?

 

Although there will be at least 1 urologist at Chonburi hospital, you may get a more senior one if you go through Burapha after hours clinic.

I am 65. I will check out Burapha. I have a phd in biology. So I know a little about anatomy an psysiology. But no clinical experience.  You did not answer about your qulafications in medicine?!

[Sheryl]

Just now, Sevenomma said:

My PSA was 9,9. Rising from 6 one year ago. I am 65 years. 

Definitely warrants further investigation, but a multiparametric MRI would be the preferred next step, before proceeding to biopsy.

 

Also if not done already, a fractional PSA  (fPSA) is helpful (but not definitive) in differentiating elevations due to BPH (benign enlargement) and cancer.

 

I have also sent you a PM

 

 

[Will B Good]

I shelled out 150,000 Baht.....but not sure now if that included the MRI???

 

 

Bumrungrad.

[Lacessit]

8 minutes ago, Will B Good said:

I shelled out 150,000 Baht.....but not sure now if that included the MRI???

 

 

Bumrungrad.

IMO that would include the MRI. Charging 150K baht for a biopsy and subsequent pathology would be daylight robbery.

[Will B Good]

1 minute ago, Lacessit said:

IMO that would include the MRI. Charging 150K baht for a biopsy and subsequent pathology would be daylight robbery.

 

I was hoping and praying someone would come back and say that......5555

[PJ71]

18 hours ago, Lacessit said:

IMO that would include the MRI. Charging 150K baht for a biopsy and subsequent pathology would be daylight robbery.

ok, if insurance is paying tho...

[Sheryl]

23 hours ago, Will B Good said:

I shelled out 150,000 Baht.....but not sure now if that included the MRI???

 

 

Bumrungrad.

 

If for biopsy, it will have included MRI/US fusion guide. Would not have included a stand alone MP MRI. (Or it could have included MP MRI but not biopsy. Will not have been both).

 

Due to the anatomy, and the need for advanced imaging to guide sample selection, a prostate biopsy is not such a simple matter  and certainly not comparable to many other types of biopsy. General anesthesia, at least 1 night stay in hospital (often longer if urinary retention an issue) and use of advanced  MRI equipment all involved.

 

Prostate biopsies are also not without risks: bleeding, infection, urinary retention on top of usual risks of anesthesia. Which is why it is often preferrable  to first do  a MP MRI - it reduces the number of unnecessary biopsies (i.e. biopsies that prove negative) considerably. But at a cost as it requires a special, new type of MRI machine and specially trained technicians etc.

[Will B Good]

1 minute ago, Sheryl said:

 

If for biopsy, it will have included MRI/US fusion guide. Would not have included a stand alone MP MRI. (Or it could have included MP MRI but not biopsy. Will not have been both).

 

Due to the anatomy, and the need for advanced imaging to guide sample selection, a prostate biopsy is not such a simple matter  and certainly not comparable to many other types of biopsy. General anesthesia, at least 1 night stay in hospital (often longer if urinary retention an issue) and use of advanced  MRI equipment all involved.

 

Prostate biopsies are also not without risks: bleeding, infection, urinary retention on top of usual risks of anesthesia. Which is why it is often preferrable  to first do  a MP MRI - it reduces the number of unnecessary biopsies (i.e. biopsies that prove negative) considerably. But at a cost as it requires a special, new type of MRI machine and specially trained technicians etc.

 

You hit the nail on the head re: infection risks.......that was very unpleasant.......also had two nights in what was a 5* hotel room.

 

All done and dusted now though......classed as a non-cancerous lesion ???