Prostate Biopsies Can Be WRONG! - Dr. Ahdoot Explains Prostate Cancer Diagnosis

When men are found to have an elevated PSA or are at risk for prostate cancer, the first step in the diagnostic work up is often a prostate biopsy. However, recent advances in the field of prostate cancer diagnosis has lead to a big change in the way prostate. biopsies are performed. The traditional ultrasound guided 12 core biopsies actually have a very high rate of missing cancer! Newer technologies like MRI targeted biopsies however can diagnose cancer better. In this video we discuss the scientific studies about traditional and MRI targeted biopsies. We explain which is better and how to choose.

Our goal at Cancer Better is to provide people with the best possible information to help them make the right health decisions. When it comes to big decisions like cancer treatment, you should know the facts so you can be in control of your health.

Creating these videos takes many hours of research by experts in their field.

[firebearva]

On my third transrectal biopsy I developed an infection and sepsis. I spent a week in the hospital on IV antibiotics, so cancer is not the only thing you have to worry about. In a week I will have a prostate MRI which will be a determining factor on any future biopsy.

[remmymafia]

I had a steadily increasing PSA for almost fifteen years. (1999-2014) Given my age in '99, (44) I began regularly having my DRE and PSA level checked. The DRE never indicated any unusual characteristics during this time. (44 yrs- 59yrs) At 44, my PSA was 1.6, then after years (13 ) of incremental increases, in proportion to my age, I experienced in one year's time, in one's year's time (2012-13) at the age of 57-58, my PSA went from 5.1 to 8.1. At this time, I decided to see a different urologist, so as to get a second opinion as to what might be behind this increase. Neither urologist, at any time, mentioned anything in regards to preventative measure I might take (diet, over the counter testosterone supplementation etc.) I mentioned over the counter testosterone supplementation, because like many males my age, I was experiencing the natural decline of testosterone. The research I did, and by the way, I NEVER explicitly searched on the subject of over the counter supplementation of testosterone on the prostate, but instead would read up on the basic topic of 'decreasing testosterone in middle aged men, and it NEVER mentioned the possibility of the affect of testosterone supplementation on the prostate of middle aged men. So, with this increase in my PSA, my urologists, said not to worry, and to check back for my yearly DRE and PSA check. Well, in another year, (2012-13) at the age from 57 to 58, my PSA increased from 5.1 to 8.1. It was at this point that I engaged the opinion of a urologist at UCLA, who also said to wait, and possibly get an MRI. After relaying this MRI suggestion to my urologist back home, he ordered one done, which according to my urologist, indicated nothing abnormal. So, after going another year, (2013-2014) from age 58 to 59, my PSA increased from 8.1 to 10.0. Despite this high number, the advice was 'watchful' waiting'. During this period ('99- 2014) my urge to urinate increased, but never to a point to where it was concerning, especially given my age. Given the actions taken so far (DRE's, PSA testing and one MRI) and my urologist seemingly unconcerned, I got out of my confort zone and pushed to get an biopsy done. Okay, this took place- 12 plugs, no cancer. Three months later my PSA decreased from 10.0 to 8.0. I still was concerned and asked for another biopsy, as my urologisty said with 12 plugs taken, there's always a chance that a cancer could be missed. Again, 12 plugs, no cancer. Three months later, a PSA test shows a jump from 8.0 to 9.1. Again, I demand another biopsy, and this time 'Eureka'! 12 plugs and one plug was showing 'pre-cancer'. After waiting for the required three month recovery period (biopsy), we did our fourth biopsy, which of course no was re-biopsying the pre-cancer area from the biopsy before. "Eureka, Eureka"! The area had now turned into cancer. Watchfull waiting? For two months, then after getting the first person accounts of successful biopsies of three co-workers, from the same surgeon, I decided to undergo a prostatectomy. Successful- no lingering effects. For the next six years at six month intervals, my PSA was registering ay less than zer0. which is supposedly no active cancer cells. Then in Sept. '21, at my six month interval for my full blood labs, that SHOULD have included my PSA, it was omitted erroneously by the doctors office, and as such when reviewing my results a week later, I discovered that they didn't do my PSA. I asked why, and the doctor said that my insurance (Medicare Advantage) only covers it once a year. I was a bit miffed, because he knows from my file, and maybe more importantly, the previous six months blood labs, that per my urologist, I need to be tested every six months. He glossed over it, saying out of his hands was the reason for the omission, and went onto say that "besides, you've tested less than zero now for six years, I'm sure it's the same". At that point, I should of again gotten out of comfort zone and demanded that I be tested I didn't. Sure enough, when the next lab work rolls around, (six months) my PSA has now registered 1.6. Whaaaat? What was it six months ago, when I SHOULD have been tested? Still zero? .03, 1.0, .1.6? Needless to say, I was hot, and told my primary as much. Longer story longer, (lol) I see my urologist (surgeon), and he says to go get radiation. I go consult with the radiologist and he gives me these testosterone suppressors to start taking, and to set up my initial appointment to get 'measured', and begin my radiation treatments. Five days a week, 15 min per day for eight weeks, all while staying on these testosterone suppressors for a year. WhaaaaT? I then tell the radilogist that obviously testosteron isn'y good for the prostate, and he says there's evidence of such. (study's) I said there has to be ample evidence, for anyone undergoing radiation treatment for the recurrence of prostate cancer, that ANYTHING testosterone, whether it's the bodies natural generation of such, or a persons ingesting over the counter supplementation, that TESTOSTERONE is a no-no. I look back, and think of the on and off again, (semi-regular) ingestion of testosterone supplementation by me, from probably the age 45, to literally after I became aware of my PSA measurement of 1.6. I was unknowingly feeding cancer! Wow! naturally in 2020, there's no shortage of online videos that tell you such. Obviously not enough damning evidence, to make it a priority for the urologists to pass along this simple preventive measure, to their middle aged patients. By the way, after weighing everything, I've decided to forego ingesting the testosterone suppressors, ($2500 per month) and of course ceasing the ingestion of any testosterone supplementation. On top of that, I'm atleast initially NOT taking any radiation, after my PET scan showed no cancer in the obvious areas. I'll be getting a PSA done next month, and I'll go from there. I understand that I might be wrong in not taking the testosterone suppressors, and radiation, but given the now realized proof of the culpability of testosterone's harmful effect on the prostate, I'm going to see if my ceasing of ingesting (albeit irregular) a testosterone supplement, has a positive effect on my situation.

[bkersfield]

Dr. Ahdoot, FYI: the subtitle throughout the video is code. Oh, and excellent presentation. It gave me more information for my second opinion appointment. I had the old ultrasound biopsy.

[daisuke]

I've had two MRI targeted and fusion biopsies. In both cases the MRI found a 5/5 PIRADS but in both cases it was negative.The second involved 42 samples/cores and caused bleeding in the semen and ED for over 2 months. In one other MRI was PIRADS 2/5. You will forgive my scepticism about MRIs. It caused tremendous anxiety.

[HuckToohey]

Very good presentation Dr. Ahdoot, thank you. I'm 68 years old. With my regular Medicare physicals being done, 6 years ago in 2018 at age 62, my PSA showed 1.6. Since then it has increased steadily the over the last 6 years. 2.0, 3.8, 4.4, and 5.4 on May 24th. I had a targeted MRI, plus ultra sound showing no enlargement. My urologist said while looking at my MRI, he detected a "shadow." He didn't say tumor or lesion, just shadow and recommended the Transrectal biopsy. Not being a fan of any procedure that is invasive to my body, I set out to lower my PSA naturally with diet, exercise, vitamins and herbs. I had a PSA check on 8-24-24. My PSA dropped from 5.4 to 5.2. Needless to say I'm pleased. My friend who has a PSA of 11 and it's been this high for several years, is on "awareness" but said his Transrectal biopsy made is incontinence worse while obliterating his ability to get an erection. My question: My PSA dropped .2 in three weeks of lifestyle changes. The drop in PSA a fluke? Or with maintaining these changes can I see another .2 or greater drop? I have a Transrectal biopsy scheduled on 9-29-24. Thank you.

[abdulmohd]

It is very clear and understable. Thanks for your short but precisley info keep doing many thanks

[AmberWhiskeyRGS]

Thank you, going through this/decisions right now.
22.5 PSA by two different labs and went to a third lab today as a final check.

[gregsettle]

Thank you! I am in the process of scheduling a biopsy and this video gives me good info to discuss with my doctor.

[elyclavel]

What can you say about the new prostate scan called PSMA? I believed it is fairly new came out in 2021. From what I understand is that this test or scan is so precise, the patient can have this scan and can tell if the patient has cancer, if the cancer is contained in the prostate, if the cancer moved out of the prostate and had it metastasized to the bone, lungs or other parts of the body. I am 78 years old, I had prostate MRI and was given a Gleason 8 score and was sent to for a PSMA scan and the result shows that the cancer is contained in the prostate. I was given hormone shots to contain the cancer in the prostate and I chose radiation therapy over surgery because I believed that radiation therapy today is much better than in the 1990’s and probably less complications than surgery for my age. At present I suffer some complications because of the hormone pills and radiation but I was told that after treatment, everything will be back to normal.

[yasserrofail]

MRI found type 2 prostate cancer 3+4 Glyson 7.. after reboot prostate surgery pathology found type 3 not type 2 and 4+3 glyson 7 !! Not 3+4!!
Any comments or concerns regarding my case please??

[jaimemarun]

Hello Dr. Ahdoot: I am PIRAD-2 with a big prostate (166 cc) and a PSA of 15 for a Prostate density less than 0.1. I will have a PAE (prostate arteries embolization), but first i will have a biopsy. I have the following questions: a. Probability of cancer? b. Probability of a significant cancer c. Is it necessary to have a biopsy before PAE? d. Is PAE a good option for me? According to this excellent video the best biopsy for me is the systematic... Is it right? Thank you in advance to your answer, I appreciate a lot you recommendations. Best regards

[arayt]

Sir I'm 58, had an exam 2 years ago was told PSA was elevated to see a Urologist. The urologist recommended a biopsy, it came back negative, PSA was 6 at the time. Had annual checkup again this year and PSA was 9, went back to the urologist and he ordered an MRI, I was told this is needed to determine / pinpoint location to do another biopsy. The MRI came back with no findings, should I have the 2nd biopsy even though the MRI came back with no recommended target areas? I appreciate the advice.

[LeinonenHannu]

I was asked if I want a MRI guided biobsy. I agreed. So doc found 3 targets. It was difficult to hit the targets with ultrasound help. Also he did 12 samples even though nothing was found on MRI on left side. Very good information for planning treatment!

[Jabotank]

Just had my PSA done for the 1st time ever after years of doctors telling me to wait until I was 45. It cam back at a 7.5. My doctor did the digital and said everything felt normal. He then suggested a biopsy. I had the biopsy and had to do some studying on prostate cancer. My primary care physician didn't ask if I had sex recently. I had a lot of sex and drinking up to 12 ours before my psa test, which I didn't know they were doing. I also had sex about 12 hours before my biopsy. Noone said not to. After researching, I am very afraid. I am 45 years old and wondering if I am missing something by what my doctors aren't saying. Waiting 2 weeks for my results.

[desertbluesplaylist]

Excellent information and advice, clear and concise - thank you very much. Your videos are invaluable and thank you for taking the time to make them. Much appreciated!

[orangeguy]

I got 20 samples pulled out my prostate. All were benign. My mri came out of a grade 2. My psa was a 7 also. Hope all this backs up no cancer. I going to have a holep procedure done in the next month also. The material pulled during the holep procedure. Will also go to the lab looking for cancer.

[danny]

Im a Gleason 6, , wondering if I should undergo surgery to take out prostate

[henryzamora]

Thank you Dr Ahdoot for the knowledge & insight to diagnostic options available for men. I'm 71 have BPH & my most recent was PSA 6.5 up from 4.5 from my last exam 5 yrs ago. At that time underwent MRI & Aphiny test/analysis not sure which kind. Radiologist did not find anything to raise concerns. I'm thinking of a follow up with a urologist. My understanding is that men with BPH will see a rise in PSA as they age. I want to be proactive with my health but don't want invasive exams unless completely necessary. My experience with urologists over last 20 yrs has been we need do biopsy etc. Your research & videos provide a wealth of up to date information for men with decisions to make. Thank you again.

[georgezorn]

I wonder if pet-scan could be reliable considering the presence of prostate cancer.
I appreciate a lot your time to let me me know, how you evaluate this decision making process.

[georgewashington]

I had a PSA done after a 4 year lapse and it came back 5.7. One year later it was repeated and came back 7.7. At that time the urologist asked if I wanted a biopsy. I replied yes, but after I have a 3T MRI to show if and where any lesions are located. The MRI came back PIRADS 4 with a 1.1cm lesion noted. I was never contacted by the ordering physician so I started looking for another urologist. The new urologist performed the biopsy sampling 20 cores of which 5 were positive for cancer and two of the cores were Gleason 4+4.
I was started on Lupron and two and a half months later I began Proton Therapy with 39 therapy sessions. No side effects of the Proton Therapy noted, it was completed only 4 days ago. I will continue with the Lupron probably with two more six month injections. As an aside my initial diagnosis was high risk/aggresive cancer but a genome test on the cancerous cells put me in the low risk category. From what I have read, the high risk category is a heterogenous class with varying patient outcomes.
As an aside, anyone going through this should read Robert Marckini's book, "You Can Beat Prostate Cancer and You Don't Need Surgery to Do It". I learned a lot from it and it was the time it took to read.
BTW, it has been 7 months since I had the MRI and the ordering physician still has not called me back with the results. That should be a lesson to everyone, no news from your doctor does not necessarily mean "good news".