Prostate Biopsy

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What does calcification in DRE and TRUS indicate?

Query: Hello doctor, Prostate biopsy was prompted by rising PSA over several years (20%-25% per year) reaching over 4 this past year (spiked at 7.3 which I think really is why they wanted the biopsy but I expect it to come down since then). 12 core came back benign, but I do not understand the implicatio...  Read Full »

Dr. Vandana Andrews

Family Physician, General Practitioner, Internal Medicine Physician

Answer: Hi, Welcome to I have studied your reports and consulted with my pathologist. (attachment removed to protect patient identity). As per her advice and mine too, your reports are normal, the biopsy changes are age related. In the biopsy no carcinoma is identified. Doing DRE (digital r...  Read Full »

Why is there brown discharge while emptying the bowel after prostate biopsy?

Query: Hello doctor, I had a transperineal ultrasound-guided prostate biopsy approximately four weeks ago. As a result of the biopsy, I have been getting a discharge of fluid from my penis when I empty my bowels. This happens usually with a hard stool. The color of the discharge is brownish. Is this a no...  Read Full »

Dr. Gajanan Bhat

General Surgeon, Urologist

Answer: Hello, Welcome to Anatomically prostate is located just in front of the rectum. The biopsy procedure would have caused some micro trauma with resultant bleeding. So, when a hard stool passes through the rectum, it puts pressure on the rectum thus causing the collected old blood to com...  Read Full »

Please enlighten me on non-invasive procedures to detect prostate cancer.

Query: Hello doctor, I am a 79 year old male. Excellent health, take no medications with the exception of an occasional Viagra. In a recent DRE, my urologist discovered two small nodules on my prostate. A PSA at the time was 6.3. Over the years, I have ranged in 2's and 3's. He suggested a biopsy of the p...  Read Full »

Dr. Karthik Rajan

Urologist, Andrologist

Answer: Hi, Welcome to I have gone through your query. I concur with your urologist in the need for a biopsy. Any PSA (prostate-specific antigen) more than 4 or abnormal findings on DRE (digital rectal examination) needs evaluation to rule out prostate cancer. None of the non-invasive te...  Read Full »

My PSA is 5.7 and MRI negative. Should I get prostate biopsy?

Query: Hello doctor, I had a 4.4 PSA and had an MRI that was negative. Six months later my PSA is 5.7 and even though the MRI was negative it is suggested that I should have a prostate biopsy. I am a 73-year-old male. I am certainly not that excited to have a biopsy. Any thoughts?  Read Full »

Dr. Gajanan Bhat

General Surgeon, Urologist

Answer: Hi, Welcome to I can understand your concern about undergoing an invasive investigation without any symptoms. Let me explain you what does PSA suggest. Basically, PSA is secreted by the prostate as well as some other body tissues. It does not reach circulation and hence remains low in...  Read Full »

Had a prostate biopsy as the PSA level was high. What does the report say?

Query: Hi doctor, The patient is a 59-year-old male with whose weight is 52.3 kg and height is 166 cm. His PSA was 247.5. He had a TRUS guided biopsy, and the report is as follows. 1. Moderately differentiated adenocarcinoma.2. Gleason grade 4+4.3. Perineural invasion present. What does the biopsy repor...  Read Full »

Dr. Raguram Ganesamoni

Andrologist, Urologist

Answer: Hi, Welcome to I am sorry to know about the problem. The biopsy report says that prostate has a cancer disease. Since PSA is very high, it means that there is a chance that it has spread outside the prostate. The next step will be PSMA PET scan to find out the areas in the body affec...  Read Full »

I am concerned about my PSA and free PSA values. Kindly guide me.

Query: Hi doctor,On a recent visit to the doctor, my PSA was 4.7 and free PSA was 0.78. The prostate was swollen on the right side, but no bumps or nodes felt. I had another PSA test three weeks later and the result showed PSA 2.5 and free PSA 0.60. Under what percentage do the 0.78 and the 0.60 values fal...  Read Full »

Dr. Raja Ramesh

Andrologist, Urologist

Answer: Hello, Welcome to Free PSA (fPSA) and %fPSA (free-to-total prostate specific antigen ratio) are called as PSA derivatives. There is no fixed normal range for fPSA. For your age, in the case of PSA above 4 malignancy or cancer needs to be ruled out by doing a biopsy. The %fPSA helps to d...  Read Full »

There is high PSA level but no symptoms. Is biopsy really necessary?

Query: Hello doctor, My husband needs help. He is a 68-year-old male with a high PSA level of 8.65. It has gone from 5.3 to 8.65 in a year. Now, let me give you the facts. We believe at his age, he might have an enlarged prostate, but none of the two doctors he has seen in the past one year has told him s...  Read Full »

Dr. Karthik Rajan

Urologist, Andrologist

Answer: Hi, Welcome back to I have gone through your query and would like to know the size of his prostate on the ultrasound scan. An increase from 5.3 to 8 in a year is significant and so is a nodule in the prostate. A free PSA (prostate-specific antigen) test can give an idea of the possibi...  Read Full »

Why is MRI required even after a normal prostate biopsy?

Query: Hello doctor, I am 64 years old and I just had my first prostate biopsy. Out of 10 samples, only one contained cancer. Gleason 6 (3+3). DRE normal. PSA 4.4. PSA has gone up and down over four years with 4.5 the highest, 3.75 lowest. Recent 4K score 9%. Recent PCA3 17%. I was relieved with biopsy, b...  Read Full »

Dr. Shahil Khant

Andrologist, General Surgeon, Urologist

Answer: Hello, Welcome to Yes, you require an MRI (magnetic resonance imaging). Your urologist wants to keep you on active surveillance. So it is better to make sure that there are no other suspicious lesions or foci which may be missed on biopsy. If no foci then you do not require anythi...  Read Full »

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