First radiologist said Pi rads 4&5 second radiologist said Pi rads 2
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I mentioned this on the tail end of another thread but maybe I should start a fresh one. I had a 3T prostate MRI in Columbus Ohio a month ago which the radiologist interpreted as Pi rads scores of 4&5. I had a 3T MRI prostate MRI a year ago in Columbus which came up with Pi Rads scores of 3 so I did not do anything at that point. However I could not ignore the new Pi Rads scores of 4&5 and agreed to a fusion biopsy last Friday. However I have been taking Humira for psoriatic arthritis which suppresses the immune system and I was concerned about the real possibility of infection and sepsis so I cancelled that biopsy. At that point I forwarded the MRI to the urologist I had seen at the Cleveland Clinic for a second opinion. His radiologist came back with Pi rads scores of 2. My Cleveland Clinic urologist actually called me this afternoon and spent half an hour answering my questions but the end result was that he still wanted to do a biopsy but not a fusion biopsy. This surprised me is I would much prefer a fusion biopsy due to its increased accuracy and ability to pinpoint specific possible lesions. But I guess their protocol is that pi rads 2 do not merit a fusion biopsy. I toyed with the idea of going ahead and having the Columbus team do a Fusion biopsy but then I thought if the urologist doing that was in the same league as his radiologist who scored me as Pi rads 4&5 that maybe it was a bad idea. Another factor that my Cleveland Clinic urologist brought up was that my PSA levels have bounced between 7 and 3 for the past year-and-a-half. We left it that I should get another PSA done and if it was less than 4 than a biopsy was not indicated. If it's greater than 4 I guess I'll give it my best shot to ask Cleveland to do a Fusion biopsy anyway but failing that settle for their regular 12-core random biopsy. Tempting but probably a bad idea is to confront the Columbus team and ask why their urologist found Pi Rads scores of 4&5 while the Cleveland Clinic only found Pi rads level 2. I guess I might be burning my bridges with the Columbus team if I did that. I am thankful to the person who suggested that I get my MRI results re-examined by a radiologist with more prostate experience. complicating the issue is that I began having severe pelvic pain for the past two and a half years which I initially thought was just another bout of infectious prostatitis. I was having eight and nine level rectal Pain by the end of the day everyday until I found a competent internal physical therapist who lowered that to a four or five. My puborectalis, coccygeus and Levitor ani muscles were tight as steel bands initially. I do not know whether this was caused by a prostate issues or prostate issues were created by the tight muscles. This is one of the reasons that I am extremely reluctant to undergo a rectal prostate biopsy is that an infection or sepsis might make my rectal pain even worse. But I guess my final decision will be then if my PSA is over 4 i will have to get a transrectal blind 12 core biopsy. That's why I would prefer to get the fusion biopsy if I have to go through it at all. Sorry for the length and rambling but if that person had not suggested that I get a second opinion I might have made a less-informed bad decision. Thoughts?
0 likes, 10 replies
auntiebeanie rolf61809
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Hi Rolf wow you have certainly had alot to thimk about. I was lucky that at the weekly discussion held by teans at two different hosputals. The surgeon upgraded my husbands MRI scan even tbough first biopsy showed cancer low grade in a small area.targetted biopsy came back with more cancer in same half and awkward to treat so unable to have any treatment other than removal of prostate. Cancer was in the whole of prostate had it not been for surgeon we may be in a different posistion. PSA was 12 then 9 gleason was 3÷4 tumour was graded T1 T2a and finally T3c. I would ask the colunbus doc to review findings. Just dont regret leaving it too late. They can give you antibiotics when they do tge bioosy.
anne05147 rolf61809
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I understand that there is more risk from a rectal biopsy than there is from a perineal biopsy, if your main concern is infection.
rolf61809 anne05147
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anne05147 rolf61809
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rolf61809 anne05147
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Yeah my local radiologist had my Pi RADS at 4 and 5 well the Cleveland Clinic radiologist only had them at 2. Cleveland urologist suggested that I go ahead with the biopsy anyway if my PSA was above 4. Well it came back yesterday and it was 3.7 so I guess I'm on the watchful waiting check your PSA every few months list. it does suck that they don't offer the perineal biopsies.
anne05147 rolf61809
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Yes it does suck. I understand that a perineal biopsy also takes more samples. However, if the rectal biopsy is targeted from the MRI hopefully they know where they are going to take the target samples from. I hope it all works out well from you. It's all a very worrying time and sometimes knowing what is best to do is hard to know. All best wishes. Anne.
anne05147 rolf61809
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Also just to clarity, last year my husband had an mri done without contrast due to his higher psa levels, they didn't want to use the contrast dye as he takes a medication they said was not advised to use contrast and the score for that MRI was '3 equivocal' which was explained as meaning it was unclear and suspicious. My husband then decided against the rectal biopsy as another doctor at another hospital said there was nothing 'exciting' to see but then my husbands psa went up a bit and they said they wanted to do the rectal biopsy. We then said we were going to pay to have a 3T MRI and the hospital offered to do it instead and he had one done with a contrast dye which gave much more definition and were told there was nothing suspicious at all but they still wanted to go ahead with a trans perineal biopsy as it was part of a research programme they were doing but it was then my husband decided to go with the option of regular psa monitoring instead. Both MRI's he had done and a rectal ultrasound show an enlarged prostate which the consultant said for his age, 60, is normal but not causing him any symptoms.
rolf61809 anne05147
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And just when I thought it couldn't get any weirder the Cleveland Clinic urologist informed me that they don't do Fusion biopsies for Pi RADS of 2 or less. It's maddening - if I do finally opt for a biopsy I would rather get the most accurate one available. It seems that for Radiologists, interpreting a 3T prostate MRI is more an art than a science. The Columbus radiologist sees fours and fives and the Cleveland Clinic radiologist sees twos. If I bring this up with my Columbus urologist I can't imagine what he'll say but I don't expect it'll be 'Merry Christmas'.
anne05147 rolf61809
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As I understand it they don't do fusion biopsy here unless you have a MRI score of 4. It's really difficult putting a case forward that is alternate to what the doctor proposes but stand your ground and get the best information you can so that you can make an informed decision about the best way forward for yourself. My husband's consultant said there are risks to having the biopsy done and risks to not having it done, ultimately one has to decide what they think is best for them based on all the information to hand. A good doctor wouldn't mind what you bring up as everything should be open and honest between a patient and doctor. They can offer you the best advise based on what they know, between your concerns and their knowledge it should be a collaborative approach.
charles61038 rolf61809
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You certainly should take antibiotics before and after a biopsy. I had a rectal biopsy and my doctor had me on antibiotics prior to the procedure and for several days after. He also had me do a Fleets enema the morning of the procedure to clean me out. I think that is also a good idea to be as clean as possible when the do it. Don't wait too long if it means it will narrow your treatment options. There are many that will work for you. Good luck to you on this.