Recently, a patient wrote to me asking for advice. He has a strong family history of several types of cancer and has been diagnosed with bladder cancer in the past. His doctors have discovered a nodule between his prostate and his bladder. After numerous diagnostic tests and biopsies, the results have been ambiguous. Although the latest test showed some basal cell hyperplasia , there have been no definitive diagnoses with regard to this mass. In addition, the patient’s PSA has risen significantly, obviously causing concern to the patient who is relatively young.
My advice to this patient is to have his latest biopsy results reviewed by an expert uropathologist. If this still does not yield a positive result, I recommend a transperineal ultrasound guided biopsy. Assuming his previous biopsies were done through the rectal wall, it is difficult to know if the nodule is reachable with this approach. If it is located more anterior in the prostate, then a biopsy such as we do here at Chicago Prostate Cancer Center would give a much higher likelihood of accurate diagnosis. We have performed well over 1500 of these biopsies in men who have had 1-3 previous negative transrectal biopsies of the prostate and found cancer in approximately 40% of patients with a higher percentage in the anterior prostate. This area is not easily reached by standard transrectal biopsy. If this type of biopsy comes back negative, then he can be much more confident that it is a “true” negative.