How to avoid a biopsy to test for prostate cancer

[R123]

http://www.telegraph.co.uk/science/2017/01/19/prostate-cancer-could-ruled-simple-mri-scan-prevents-25000-biopsies/

 

A couple of years ago doctors in Pattaya were trying to persuade me to have a biopsy as my PSI level was high/above the norm. I did some research including on this forum and found a well respected doctor in Bumrungrad who recommended an MRI scan, which  showed simply an enlarged prostate but no evidence of cancer.

The scam was paid for my insurance company.

Since the time of my scan my PSI level has fallen to not so far from normal.

I am posting this simply to tell my own personal experience as everyone is different.

But lessons from my experience may benefit others.

 

[chiang mai]

Since when is an MRI conclusive proof of cancer, surely a biopsy is the gold standard test?

[R123]

19 minutes ago, chiang mai said:

Since when is an MRI conclusive proof of cancer, surely a biopsy is the gold standard test?

I made my post (and link) in the hope it might benefit others. Not to enter a debate as to what can conclusively prove or not prove cancer.  I followed the advice of one of the top urologists in Thailand and he is confident the MRI is as far as humanly possible sufficiently conclusive.

Read the Daily Telegraph article which in effect supports my doctors advice.

If you are a prostate specialist then let us know your credentials.

[lopburi3]

Actually this reports says that MRI can be very effective in finding and rating the cancer as it covers the whole area rather than a biopsy which only gets cells from specific spots.  Obviously it would have to be read by an expert and if cancer found suspect biopsy might also be done prior to operation.  I know CT scans w/contrast are a standard check for cancer spread and MRI is even more detailed than most CT scans so appears to make sense to me (layman).  

[chiang mai]

1 minute ago, R123 said:

I made my post (and link) in the hope it might benefit others. Not to enter a debate as to what can conclusively prove or not prove cancer.  I followed the advice of one of the top urologists in Thailand and he is confident the MRI is as far a humanly possibly sufficiently conclusive.

Read the Daily Telegraph article which in effect supports my doctors advice.

If you are a prostate specialist then let us know your credentials.

 

No need to be snotty, I simply asked the question, if you don't know you don't know!

[chiang mai]

2 minutes ago, lopburi3 said:

Actually this reports says that MRI can be very effective in finding and rating the cancer as it covers the whole area rather than a biopsy which only gets cells from specific spots.  Obviously it would have to be read by an expert and if cancer found suspect biopsy might also be done prior to operation.  I know CT scans w/contrast are a standard check for cancer spread and MRI is even more detailed than most CT scans so appears to make sense to me (layman).  

 

And as a layman also, my understanding has always been that MRI (with contrast) is a useful diagnostic tool but that it's not definitive, the article posted seems to suggest a biopsy is used where the MRI shows a positive result hence my question earlier.

[Orac]

Since when is an MRI conclusive proof of cancer, surely a biopsy is the gold standard test?

Oddly i was listening to my local radio here 30 mins ago which has a live feed connection to BBC World News and they had a report on a breakthrough by UK doctors published in The Lancet whereby they had used MRI to significantly improve discovery of prostate cancer so maybe new developments on the horizon.

[Orac]

Oddly i was listening to my local radio here 30 mins ago which has a live feed connection to BBC World News and they had a report on a breakthrough by UK doctors published in The Lancet whereby they had used MRI to significantly improve discovery of prostate cancer so maybe new developments on the horizon.

Edit: oops - just noticed link in OP!

[Naam]

27 minutes ago, chiang mai said:

Since when is an MRI conclusive proof of cancer, surely a biopsy is the gold standard test?

no, it's not! an MRI can rule out cancer, a biopsy cannot. no need for a biopsy if the MRI is "negative". but if cancer is detected an MRI cannot determine the kind, a pathological examination based on biopsies (always plural) can.

[chiang mai]

So the MRI is the gold standard for detection whilst a biopsy remains the gold standard for identification, that makes sense.

[soalbundy]

53 minutes ago, chiang mai said:

Since when is an MRI conclusive proof of cancer, surely a biopsy is the gold standard test?

This was in an English newspaper today stating that an MRI scan could replace biopsies, which can also cause problems themselves. What did the scan cost? 

[Spaniel]

Can you name the "well respected doctor" at Bumrugrad?

[R123]

12 minutes ago, Spaniel said:

Can you name the "well respected doctor" at Bumrugrad?

Dr. Viroj Chodchoy at Bumrungrad   

 

And to address another poster my recollection was that the MRI cost was @ 40,000 baht; my insurance paid it.

[al007]

Well many views let me share some of my experiences

 

I had an MRI with dye into the bloodstream, and contrast separately up the anus last week at Chula Bangkok a top cancer hospital in Thailand, cost 10,500, a big difference from 40,000 from R123

 

In September 2015 I had an MRI in Khonkaen and it showed no prostate cancer or other cancer

 

In October 2015 CT scan in khonkaen, no prostate cancer identified, or other cancer

 

In September 2016 I had Holep surgery for prostate in India

 

Biopsy of material removed showed prostate cancer

 

The prostate surgeon in India told me a biopsy normally done on the prostate can still miss cancer as it is only a sample of twelve needle samples, and the needle can miss

 

I have also had annual medicals for the last ten years, and always been told no problem

 

Due to following my instinct I had another colonoscopy and discovered colon/rectum cancer

 

I am currently undergoing treatment for both prostate and colon/rectum cancer, and neither were found on either the first MRI or the CT scan

 

Draw you own conclusions

 

 

[SantiSuk]

I also question (without pejorative thoughts!) the accuracy of R123's recollection of a ThB 40k cost for an MRI with contrast scan. We all know Bumrungrad can be expensive but even so I had a CT scan with contrast on my chest there 8 months ago and the bill for the scan itself was ThB 13.2k or ThB 25.5k fully inclusive. I don't think an MRI would be that much more expensive than a CT .... would it?

 

 

 

[ Quoting scan costs on a comparative basis is fraught with difficulties. I have seen people boast that their local private hospital CT scan cost only Thb 8k. Depends what basis you are quoting. The reason why I show two different numbers above is to make that point. My Bum CT bill (paid for it myself as far as they knew, so some 'insurer-creep' may have elevated 123's bill) breaks out as follows:

• CT scan 13.3k
• Medicine (contrast dye I presume, as no other meds were given) 6.3k
• Doctor's fee 2.0k*
• CT scan radiologists fee 2.5k* ^
• Nursing service/Facility/Laboratory Clinical/Others - all separately priced out on the bill - totalling 1.4k

*  Bum insist on a quick doctor talk and a radiologist's report - even if you tell them you are just 'buying a scan only' ie having it to send the disc to another  hospital's specialists - in this case my UK 's pulmonology specialists

^  I also asked to have a discussion on related matters with their immunologist, so the doctor's fee might have been as low as 0.6k had it just been about the scan  ]

[siam2007]

On 20/01/2017 at 7:53 PM, al007 said:

Well many views let me share some of my experiences

 

I had an MRI with dye into the bloodstream, and contrast separately up the anus last week at Chula Bangkok a top cancer hospital in Thailand, cost 10,500, a big difference from 40,000 from R123

 

In September 2015 I had an MRI in Khonkaen and it showed no prostate cancer or other cancer

 

In October 2015 CT scan in khonkaen, no prostate cancer identified, or other cancer

 

In September 2016 I had Holep surgery for prostate in India

 

Biopsy of material removed showed prostate cancer

 

The prostate surgeon in India told me a biopsy normally done on the prostate can still miss cancer as it is only a sample of twelve needle samples, and the needle can miss

 

I have also had annual medicals for the last ten years, and always been told no problem

 

Due to following my instinct I had another colonoscopy and discovered colon/rectum cancer

 

I am currently undergoing treatment for both prostate and colon/rectum cancer, and neither were found on either the first MRI or the CT scan

 

Draw you own conclusions

 

 

 

 

very interesting indeed and I would be interested to know if SHERYL is able comment on this

[ballzafire]

FYI, beware of the biopsy procedure. There is a high incidence of sepsis resulting from it, which has caused many untimely deaths...

Instead, focus on researching natural remedies to reduce an enlarged prostate, such as taking supplements or eating foods high in beta sitosterol (e.g. Saw Palmetto), and lycopene (e.g. tomatoes).

I also recommend taking a cranberry extract pill everyday, as this prevents bacteria from sticking to the lining of one's reproductive glands and urogenital tract (also helps keep your sinuses clear).

And include some garlic in your diet, too, as it contains natural antibiotic factors.

Excluding the beta sitosterol (don't need it yet) using the above regimen has enabled my PSA to stay the same for 15+ years now ( ~ 0.35). And absolutely NO symptoms of BPH (benign prostatic hyperplasia).

Hope this helps.

[Sheryl]

Biopsies are done when cancer is strongly suspected.  Nothing to do with BPH.

 

The incidence of sepsis due to prostate biopsy is not "high".  It is about 1-2%, and the risk can be brought down to below 1% with appropriate targeted prophylaxis.

 

Men suspected of having cancer of the prostate should not be discouraged against undergoing biopsy.

 

 

[oxo1947]

I had a MRI done at Bumrungrad --8 weeks ago--full length spine---20K

Also while getting a 2nd opinion I was offered an MRI at a Hospital Sheryl had told me about--BNH,,,,15K but I had already committed to  Bumrungrad

[al007]

I would like to add some additional comments

 

The likely hood of the biopsy not finding the cancer can be reduced if a 24 sample biopsy is done

 

If my urologist had advised me  I needed a biopsy I would have had it done, and maybe not have the problems I have today, also instead of Holep surgery, when the inside of the prostate is removed, I would have had the whole prostate removed and hopefully the cancerous tissue as well

 

There are those with high PSA levels who do not have cancer, but this is more unusual than the norm, do not be lulled into a sense of false security

 

My urologists advice was always up to me, and I know he gives this same lackadaisical advice to others

 

My PSA was around 13.0

 

I had four previous annual medicals, with ultrasounds and all this was missed, and elevated PSA

 

I also put in writing I had been loosing blood through my anus, another sign all is not well

 

I actually believe my Urologist was negligent, and have a malpractice case running

 

I am not medically qualified I only can talk from my experience

 

I am happy to discuss my experience on the phone should anyone wish to, if so please PM me and I will give my tel no

 

Sheryls advice is some of the soundest you will find anywhere, and you should listen to her and rate her advice very highly, there is a lot good unqualified advice around, and some very bad unqualified advice, be choosy and check around, and hopefully you will not wind up in the mess I am in

 

I am also sorry to add;  just because a doctor tells you something, does not mean he is correct, a mistake I made, I trusted doctors maybe because it was the easy option, my fault !

 

My malpractice claim is against three yes three doctors, and a hospital who all missed warning signs

 

CANCER KILLS but if caught early can be treated, and with luck stopped, delay is life threatening, if in doubt double check

[Sheryl]

PSA's over 10 are very suggestive of cancer. Especially if they show a fast rise.

PSAs between 4-10 are more difficult to interpret as BPH will often cause elevations in that range.  For a PSA not above 10, provided the findings on digital exam are not suspicious (i.e. prostate feels even in shape, consistent with BPH) then a conservative approach of wait and see would not be unreasonable.

 

Beside absolute PSA level the rate if rise is important, in BPH is will not be rapid.

 

DRE findings are also very important.

 

And lastly, ruling out prostatitis which can cause rapid and steep rises in PSA (which will then drop once th4e infection resolves).

 

The decision to biopsy or not is complex.

 

[lopburi3]

There is another type of scan used to help rule out cancer - that being the PET/CT scan (combined PET and CT scan).  Not cheap at 63k baht at leading private cancer hospital would not expect to be cheap (they are handling radioactive materials).  

[chiang mai]

3 hours ago, ballzafire said:

FYI, beware of the biopsy procedure. There is a high incidence of sepsis resulting from it, which has caused many untimely deaths...

Instead, focus on researching natural remedies to reduce an enlarged prostate, such as taking supplements or eating foods high in beta sitosterol (e.g. Saw Palmetto), and lycopene (e.g. tomatoes).

I also recommend taking a cranberry extract pill everyday, as this prevents bacteria from sticking to the lining of one's reproductive glands and urogenital tract (also helps keep your sinuses clear).

And include some garlic in your diet, too, as it contains natural antibiotic factors.

Excluding the beta sitosterol (don't need it yet) using the above regimen has enabled my PSA to stay the same for 15+ years now ( ~ 0.35). And absolutely NO symptoms of BPH (benign prostatic hyperplasia).

Hope this helps.

 

Rubbish, post your proof that there's a high incidence of sepsis resulting from biopsies, and from a reliable well known medical source only.

[chiang mai]

5 hours ago, SantiSuk said:

I also question (without pejorative thoughts!) the accuracy of R123's recollection of a ThB 40k cost for an MRI with contrast scan. We all know Bumrungrad can be expensive but even so I had a CT scan with contrast on my chest there 8 months ago and the bill for the scan itself was ThB 13.2k or ThB 25.5k fully inclusive. I don't think an MRI would be that much more expensive than a CT .... would it?

 

 

 

[ Quoting scan costs on a comparative basis is fraught with difficulties. I have seen people boast that their local private hospital CT scan cost only Thb 8k. Depends what basis you are quoting. The reason why I show two different numbers above is to make that point. My Bum CT bill (paid for it myself as far as they knew, so some 'insurer-creep' may have elevated 123's bill) breaks out as follows:

• CT scan 13.3k
• Medicine (contrast dye I presume, as no other meds were given) 6.3k
• Doctor's fee 2.0k*
• CT scan radiologists fee 2.5k* ^
• Nursing service/Facility/Laboratory Clinical/Others - all separately priced out on the bill - totalling 1.4k

*  Bum insist on a quick doctor talk and a radiologist's report - even if you tell them you are just 'buying a scan only' ie having it to send the disc to another  hospital's specialists - in this case my UK 's pulmonology specialists

^  I also asked to have a discussion on related matters with their immunologist, so the doctor's fee might have been as low as 0.6k had it just been about the scan  ]

 

I agree that sounds way too high, unless it represents insurance company padding!

[al007]

MRI with contrast last week at Chula  Bangkok10,500, that was abdomen and lower abdomen, remember most MRI s charge according to how much body area is scanned

 

I would highly recommend Chulalongkorn, in fact very highly, but choose your doctors carefully

[al007]

On 1/20/2017 at 7:57 AM, R123 said:

A couple of years ago doctors in Pattaya were trying to persuade me to have a biopsy as my PSI level was high/above the norm. I did some research including on this forum and found a well respected doctor in Bumrungrad who recommended an MRI scan, which  showed simply an enlarged prostate but no evidence of cancer.

 

Maybe I am writing too much, but having both Prostate Cancer and Colon/rectum cancer, and thinking about it all the time, I have to add the following, to the original post

 

Both my MRI and a CT scan identified enlarged prostate, but neither reports suggested possible cancer, the downside risk of getting it wrong is awful, I wasted a full year before finding it, and the end result is far harder to treat.

 

No evidence of cancer, as quoted above, does not mean no cancer

 

I can only comment from experience learnt the hard way

[lopburi3]

Suspect it is writing by those involved that drives forum and knowledge of readers - we are lucky to have a professional giving her service to keep everything real but do not think you have written too much myself; know I have learned by your saga and thank you.

 

Believe prostate cancer is difficult to image - at least with PET radioactive method - from what I have read; but many cancers can be found with imaging/contrast and indeed questionable areas may be ruled out so it is very important - especially after cancer has been found or suspected due to symptoms.  But as with anything else the image has to be read and that is where several experts might well be worth the price - you get the scan video anyhow so probably worth the second opinion cost.

[chopin2]

On 2017-01-28 at 2:47 PM, Sheryl said:

PSA's over 10 are very suggestive of cancer. Especially if they show a fast rise.

PSAs between 4-10 are more difficult to interpret as BPH will often cause elevations in that range.  For a PSA not above 10, provided the findings on digital exam are not suspicious (i.e. prostate feels even in shape, consistent with BPH) then a conservative approach of wait and see would not be unreasonable.

 

Beside absolute PSA level the rate if rise is important, in BPH is will not be rapid.

 

DRE findings are also very important.

 

And lastly, ruling out prostatitis which can cause rapid and steep rises in PSA (which will then drop once th4e infection resolves).

 

The decision to biopsy or not is complex.

 

Having a first-degree relative with the disease increases the risk two to threefold. Something to remember when interpreting a PSA result.

[al007]

I write in open forum so hopefully others can learn from my experiences, and thank you Lopburi

 

I have made good progress over the last six months and a very big part is due to TV, and "S" who does more than keeping a watchful eye on us, and warns me about keeping out of trouble

 

One day I will write a lot more, but may need that post vetted legally first, just so I break no defamation laws !!

 

Lopburi makes an exceedingly valid point, the report is only as good as the eyes and knowledge interpreting the MRI and CT scans

 

I am pretty sure maybe my first MRI and CT scans were NOT properly interpreted

 

I do need to get an MRI and CT  discs reexamined, and a new report and second opinion on them, any ideas on where to do this would be very much appreciated, I am maybe going to try at the Udon Thani cancer centre

 

I am also expecting to pay a very fair price for this, or does anyone know a well qualified oncologist/radiologist who might be able to assist me

 

This thread has helped me again because I was trying to think of a reason to ask for reevaluation of those two discs, so simple just want a second opinion please !!

 

 

[chopin2]

33 minutes ago, al007 said:

I write in open forum so hopefully others can learn from my experiences, and thank you Lopburi

 

I have made good progress over the last six months and a very big part is due to TV, and "S" who does more than keeping a watchful eye on us, and warns me about keeping out of trouble

 

One day I will write a lot more, but may need that post vetted legally first, just so I break no defamation laws !!

 

Lopburi makes an exceedingly valid point, the report is only as good as the eyes and knowledge interpreting the MRI and CT scans

 

I am pretty sure maybe my first MRI and CT scans were NOT properly interpreted

 

I do need to get an MRI and CT  discs reexamined, and a new report and second opinion on them, any ideas on where to do this would be very much appreciated, I am maybe going to try at the Udon Thani cancer centre

 

I am also expecting to pay a very fair price for this, or does anyone know a well qualified oncologist/radiologist who might be able to assist me

 

This thread has helped me again because I was trying to think of a reason to ask for reevaluation of those two discs, so simple just want a second opinion please !!

 

 

the report is only as good as the eyes and knowledge interpreting the MRI and CT scans

 

Same goes for a biopsy. The eyes and knowledge of the pathologist.