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From: piker on 2 Apr 2008 08:26
Why 18 cores instead of 12?

Hi all,

Im going in for a prostate biopsy in 2 weeks or so.
The Urologist says he wants to do 18 sticks. Most people
I have spoken with have never had more that 12.

So far as I know, there is nothing special about my
presentation: 55 yo male, enlarged prostate X 15 years
PSA rose form 2.4 in 2001 to 5.25 in 2008, no symptoms,
no nodules or tumors on DRE.

Why the extra cores?

The doctor sort of made a half joke that as long as he's
in there, there's no difference between 1 stick or 18.
GMAFB. I'm a paramedic and I know very well what the
difference is. I'm not happy with that kind of answer.

He also put me on Avodart for a month before the procedure.
Anybody ever heard of that?

1) Are there any extra complications from the extra sticks?

2) Are there any studies showing more cancer is found from
18 sticks as opposed to 12?

TIA

From: Leonard Evens on 4 Apr 2008 12:19
piker wrote:
> Why 18 cores instead of 12?
>
> Hi all,
>
> Im going in for a prostate biopsy in 2 weeks or so.
> The Urologist says he wants to do 18 sticks. Most people
> I have spoken with have never had more that 12.
>
> So far as I know, there is nothing special about my
> presentation: 55 yo male, enlarged prostate X 15 years
> PSA rose form 2.4 in 2001 to 5.25 in 2008, no symptoms,
> no nodules or tumors on DRE.
>
> Why the extra cores?
>
> The doctor sort of made a half joke that as long as he's
> in there, there's no difference between 1 stick or 18.
> GMAFB. I'm a paramedic and I know very well what the
> difference is. I'm not happy with that kind of answer.
>
> He also put me on Avodart for a month before the procedure.
> Anybody ever heard of that?
>
> 1) Are there any extra complications from the extra sticks?
>
> 2) Are there any studies showing more cancer is found from
> 18 sticks as opposed to 12?
>
> TIA
>

The more cores he takes, the more likely he is to find cancer if it is
present. At one time, six was considered sufficient. It is a question
of balancing the increased likelihood of finding the cancer against the
increased cost and possible side effects to the patients. Improvements
in technique have reduced the cost and risk of side effects. Urologists
vary in the number they use. Most do about 12, but it is not out of the
realm of what is considered acceptable to do 18.

Your urologist gave you a flippant answer, and you might insist on more
information. In particular, ask him if he regularly does 18 on his
patients or if there is some special reason in your case to do more.

My urologist took twelve samples and used a local anesthetic in the
rectal wall. I was happy when he was done, but overall the discomfort
was similar to that of a typical dental procedure. I had no significant
problems afterwards except of course th diagnosis of prostate cancer.


As you probably know, Avodart is used to reduce the size of the prostate
and decrease urinary obstruction due to BPH. Are you having problems
urinating? Again, you should ask him what connection it has to the
biopsy. Perhaps he ahs found his patients do better after biopsy with
such treatment. I haven't heard of anyone else having been given that
drug before a biopsy, but I'm hardly an expert in the subject.

You might post also to alt.support,cancer.prostate which is where you
are more likely to find such information.

From: piker on 5 Apr 2008 06:55
Hi Leonard,

Thanks for the reply.

I figured the 18 cores was just being more aggressive, but I haven't
actually heard of anyone else getting 18. They all seem to get 12.
This doctor is supposed to be a hotshot or something. That could be
good or bad. Dont know yet.

The doctor wasn't really trying to be a smartass (I dont think).
In retrospect, I think it was just a feeble attempt to put the
patient at ease. Kind of a stupid thing to say to someone
with a medical background, though.

He says he uses avodart to shrink the prostate before biopsy to
reduce bleeding. I'm not sure how much it works over a single
month though. No effect so far as I can tell.

Sorry to hear about the DX. Which treatment have you considered?
I'm still at the research stage, but there is almost TOO much
information. How to make a choice, should I need it, is beyond me.
>>
>
>The more cores he takes, the more likely he is to find cancer if it is
>present. At one time, six was considered sufficient. It is a question
>of balancing the increased likelihood of finding the cancer against the
>increased cost and possible side effects to the patients. Improvements
>in technique have reduced the cost and risk of side effects. Urologists
>vary in the number they use. Most do about 12, but it is not out of the
>realm of what is considered acceptable to do 18.
>
>Your urologist gave you a flippant answer, and you might insist on more
>information. In particular, ask him if he regularly does 18 on his
>patients or if there is some special reason in your case to do more.
>
>My urologist took twelve samples and used a local anesthetic in the
>rectal wall. I was happy when he was done, but overall the discomfort
>was similar to that of a typical dental procedure. I had no significant
>problems afterwards except of course th diagnosis of prostate cancer.
>
>
>As you probably know, Avodart is used to reduce the size of the prostate
>and decrease urinary obstruction due to BPH. Are you having problems
>urinating? Again, you should ask him what connection it has to the
>biopsy. Perhaps he ahs found his patients do better after biopsy with
>such treatment. I haven't heard of anyone else having been given that
>drug before a biopsy, but I'm hardly an expert in the subject.
>
>You might post also to alt.support,cancer.prostate which is where you
>are more likely to find such information.
>

From: Leonard Evens on 5 Apr 2008 11:54
piker wrote:
> Hi Leonard,
>
> Thanks for the reply.
>
> I figured the 18 cores was just being more aggressive, but I haven't
> actually heard of anyone else getting 18. They all seem to get 12.
> This doctor is supposed to be a hotshot or something. That could be
> good or bad. Dont know yet.
>
> The doctor wasn't really trying to be a smartass (I dont think).
> In retrospect, I think it was just a feeble attempt to put the
> patient at ease. Kind of a stupid thing to say to someone
> with a medical background, though.
>
> He says he uses avodart to shrink the prostate before biopsy to
> reduce bleeding. I'm not sure how much it works over a single
> month though. No effect so far as I can tell.
>
> Sorry to hear about the DX. Which treatment have you considered?
> I'm still at the research stage, but there is almost TOO much
> information. How to make a choice, should I need it, is beyond me.

I recommend reading Peter Scardino's "Prostate Book". Scardino is a
world renowned authority on prostate cancer. He is a surgeon, but he
works closely in his research with experts in all the relevant areas of
prostate cancer, so his book is a good starting point. It is well
written and keeps things as simple and straightforward as possible for
such a complex subject. I got it in paperback from Borders for about
$18, and most public libraries should have it. There is also Patrick
Walsh's "Guide to Surviving Proste cacer", which has a wealth of
information, but is a bit more polemical in places and sometimes less
clear. Walsh also, while a surgeon, works with many other experts. (I
emphasize that because sometimes you will be told not to pay attention
to urologists because they are surgeons and reject other approaches, but
that advice is highly misleading for both Scardino and Walsh.)

I am not a physician, so read anything I say, or for that matter
whatever else you find on the web, with more than a grain of salt.
Also, remember that what men tell you may be strongly influenced by
their experience. Each man is different, and prostate cancer varies
enormously. More so than for other diseases, there is not one single
approach which fits all men.

But I will try to tell you what I've gleaned from my reading and my
personal experience.

Most likely, you don't have prostate cancer. Remember that before
going on with what I say below.

If you do have prostate cancer, it very likely to be at a pretty early
stage. Before choosing a treatment, you will have to thoroughly
understand the diagnosis, so you should concentrate on understanding
staging, Gleason score, and the significance of the PSA. You basically
have to choose one of three alternatives: not doing anything at
present, surgery, or radiation, Both surgery and radiation would try to
cure to cure the disease. There is also hormone suppressant therapy,
but that should be reserved for men with evidence of advanced disease,
which is unlikely at present. You shouldn't worry about that. It will
just scare you and not be particularly helpful. There will be plenty
of time to consult a medical oncologist, the appropriate specialty, if
need be.

What you do next depends on a variety of factors: your age and health,
the specifics of the diagnosis, and perhaps special factors about your
case. Just waiting, also called expectant management or watchful
waiting, is primarily for men with an expected lifetime of less than 10
years or men in ill health who cannot tolerate more aggressive
treatment. Younger men with disease that is considered curable are
usually advised to choose surgery for a variety of reasons, but there
may be special reasons to choose radiation. Older men are often treated
by radiation. There are two choices for radiation: external beam or
implantation of radioactive seeds. For both surgery and seeds
(brachytherapy), the skill of the doctor is very important, both for
success in curing the disease and for avoiding side effects, For
external beam radiation, the skill of the doctor is not quite as
important, as long as an up to date method such as IMRT is used.

I was 67 at diagnosis. I was in very good health and, except for the
cancer, could expect to live at least another 15 years. I had a Gleason
7=3+4, T1C case (meaning the doctor felt nothing on digital rectal
examination) with PSA 4.5. My urologist suggested either surgery or
radiation. For various personal reasons, I chose surgery, but had I
been five years older I might have chosen radiation. Some men fear
surgery, but I didn't, and I just wanted the damn thing out, which is a
typical but not entirely rational response. My surgeon told me that at
my age with him doing the surgery my chances of being permanently
impotent were about 50 percent. Radiation couldn't do much better in
that regard at my age. The chances of being seriously incontinent were
much lower, so I didn't worry about that. Had I been five years older,
the chances of being permanently impotent would have been at least 75
percent no matter who did the surgery but only about 50 percent with
radiation. As it turned out, I am not incontinent, and I regained
erections after 18 months, with some help from Viagra. Before that we
used a pump and managed to continue our sex life at about the same
frequency as before surgery. I remain recurrence free today over 7
years later and my chances of ever having a recurrence are pretty small.
It could happen, but most likely something else will get me first, so
it doesn't make sense to worry about it. Of course, each year, I do get
a bit tense as I wait for my PSA test results.

I see you also posted to alt.support.cancer,prostate. You will probably
get lots of useful advice, but remember that it may be biased one way or
another. Also, the men who post there are more likely to have had
special problems, or, like me, they are medical junkies. As
statisticians say, the sample is skewed.
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