Prostate Biopsy Alternatives

Man Using Laptop Computer
July 30, 2013 (Updated: August 16, 2018)
Lily Moran

Reggie had been a patient of mine for more than a decade, until he moved out of the area. So you can imagine how surprised I was to see him in the exam room one day. It turned out, Reggie had been having prostate problems, starting with a PSA test that had risen from 1.9 to 3.0, all the way up to 4.1 over a period of three years. As his doctor pointed out, this trend was not moving in a good direction. Although his physician seriously doubted that he had cancer, he did suggest a biopsy “just to make sure” everything was fine.

“That was last year,” Reggie explained, “and I went along with his suggestion because he’s the doctor! At that time, it never occurred to me to ask about alternatives or to question his recommendations. Who argues with doctors? You just do what they tell you, right? And hope for the best.”

Reggie was not at all prepared for the very unpleasant, uncomfortable experience of having a prostate biopsy. Nor was he ready for the downtime and bleeding afterward. But the results were easily the worst part of the experience.

“After all the hassle and discomfort, I expected that at least the lab report would make it all worthwhile and finally tell me whether or not I had cancer,” Reggie explained. “Instead, the results came back as totally inconclusive. When my doctor said that was not uncommon, I was speechless. Here I thought I was doing this to get a definitive answer and a little peace of mind. Instead I got nothing.”

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The doctor recommended Reggie wait six months and redo the PSA. That was when he showed up in my office. I explained that the PCA3 was a more accurate test and that we could also use the Color Doppler Ultrasound, if necessary.

But, as it turned out, Reggie had been doing some research on his own and made a few dietary tweaks during the six months between the disastrous biopsy and the current visit. With just a standard PSA test, we discovered that Reggie’s score had gone down to 2.5. Six months later, he returned and his test was even better, at 1.9.

“I wish more doctors would discuss options like this with patients,” he told me during his most recent visit. “The other doctor never talked to me about diet or exercise or anything, except more testing. From now on, if I’m in another doctor’s office, I’m going to make it a point to ask questions, instead of going along with whatever they say.”

As a physician, it’s frustrating for me to hear these kinds of patient stories when there are so many better options. But I was also happy that Reggie’s bad experience had a good outcome. Knowing what he knows now, Reggie is likely to be asking doctors questions for many years to come.

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