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TRUS prostate biopsy, or not?

Oboe
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Hi Everyone

I have a nodule on my prostate, found by DRE 18 months ago. I have had a large hemorrhoid, recently removed. This, I understand, could have caused a prostate nodule.

I have BPH, which was diagnosed by cystoscopy a few years ago. This may be raisng my level of PSA. Just over a year ago it was 3.7, it is now 2.0. However I have been on Finasteride 5mg for a year and I believe that may account for the PSA falling. The consultant wants me to have a TRUS biopsy targetted at the nodule. However I have doubts.

I am a 72 year old Caucasian who has never smoked and only ever drunk alcohol lightly. My diet for over 40 years would be described as healthy with no red or processed meat and plenty of vegetables. (My hemorrhoids are caused not by diet but by increasing age according to my consultant.) Apart from the prostate issue, I have no serious health problems. On the other hand my sister died of breast cancer (but it is not known if she had the suspect cancer genes that can also cause PCa in her brothers, sons etc.)

I have read that the chance of a prostate nodule being cancer is 15–20%. I'm not sure if my ethnicity and the lifestyle choices mentioned above have the effect of decreasing that percentage in my case or if once one has a nodule all other risk considerations become irrelevant. Can anyone help me with that?

Knowing that most PCa is so slow growing that sufferers are far more likely to die with the cancer than because of it, I'm leaning towards refusing the TRUS. The potential gain seems to be outweighed by all its risks, including the often lethal Sepsis. At the moment I'm thinking of asking for regular PSA tests and only taking further action if it goes above 6.5 (the 'safe' limit for my age group).

I'd be grateful for your thoughts on the above.

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    Hi Oboe. Welcome to the forum.

    I should start out by saying that I have no medical qualifications but I have been through the prostate cancer mill back in 2010. I had a Gleeson 3+4 (later downgraded to 3+3) prostate cancer, PSA 5.7.

    The confusing factor here is the effect of the Finasteride. It's great for shrinking the prostate and allowing you to pee freely (Simpson's reference there). That's good, but in shrinking the prostate it also lowers the PSA. If there's a cancer there, then Finasteride won't slow it down, but the lower PSA might lull you into a false sense of security, possibly letting an undetected early stage cancer progress to an advanced cancer.  That's the dilemma.

    So, it's really a question of playing the odds. We each have a point where the risk of something is too high to tolerate. For me, that level is something like 1%, so for me, the 15%-20% risk of nodule cancer is too high.  There is also another factor to take into account.  If you do have have cancer and it's missed, then there will be a long period of self-recrimination where you'll be saying to yourself "if only"...

    If you decide you can accept the uncertainty then I would still set the PSA level well below 6.5, because of the confounding effect of the Finasteride.  I think 3.5 to 4.0 is far more realistic value for triggering a biopsy.

    But I must emphasise my lack of qualifications. Whatever you decide must be in consultation with your medical team. 

     

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