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How many cores are reasonable?

Posted , 6 users are following.

ES28567
ES28567

I have a PSA of 18.5. I insisted on having an MRI done before I would agree to a biopsy. The MRI came back showing two areas with a PI–RADS 5 (very likely cancer) One area with a PI-RADS 4 (very likely cancer), One area with restricted diffusion and abnormal signal One area with restricted diffusion and abnormal signal ADC. Originally, the urologist wanted to do a 12 core random biopsy ( this was before I insisted on the MRI) Now he wants to do two cores for each suspicious area PLUS the 12 core random biopsy.

My original plan was if there were no areas of concern, and I would not move forward with the biopsy. Unfortunately, there are several areas of concern based on the MRI. So, my next plan was to just have him do targeted biopsies only in the areas of concern.he said that the T3 MRI could have missed some areas that may contain cancer and so he wants to do 12 random cores plus two biopsies in each of the areas of concern. That's going to be 18 to 20 biopsy Cors!

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  • craig84609
    craig84609 ES28567

    Posted

    There is a lot of info on this. I was under the understanding that they are trying to guide the needles to the site of the cancer that is suspected. The MRI gives them this info to do a guided biopsy. If other areas don't show on the MRI I would be apt to believe these areas don't posess any significant cancer cells. So I would disagree with him if it were me. I am not a doctor so do what you feel is important. I have heard the reason for the MRI is to cut down on biopsy cores by directing them to the trouble spots. If it were me I wouldn't have any more than was really needed. Get a second opinion. This is the best thing to do. If two doctors say the same thing then it is probably needed, however saturation biopsy defeats the purpose for the MRI. Really get a second opinion. 
  • ES28567
    ES28567

    Posted

    Sorry, I accidentally hit send before I was finished. So here it is again...

    I have a PSA of 18.5. I insisted on having an MRI done before I would agree to a biopsy. The MRI came back showing two areas with a PI–RADS 5 (very likely cancer) One area with a PI-RADS 4 (very likely cancer), One area with a PI-RADS 2 (less potential of cancer) and one area with restricted diffusion and abnormal signal ADC. Originally, the urologist wanted to do a 12 core random biopsy ( this was before I insisted on the MRI) Now he wants to do two cores for each suspicious area PLUS the 12 core random biopsy.

    There is no history of prostate cancer in my family. So, My original plan was if there were no areas of concern, then I would not move forward with the biopsy. Unfortunately, there are several areas of concern based on the MRI. My "plan B" was to just have him do targeted biopsies in only the areas of concern. However, my urologist said that the T3 MRI could have missed some areas that may contain cancer and so he wants to do 12 random cores plus two biopsies in each of the areas of concern. That's going to be at least 18 to 20 biopsy Cores! I don't want to tell the urologist how to do his job but, i'm concerned that the more cores the more damage to my prostate, the longer the recovery time and the more potential for side effects.

    Is it reasonable to ask the urologist to limit the biopsy to only do 12 cores (which include the areas of concern) or am I being negligent by not letting him be thorough in the biopsy procedure by possibly missing some areas of cancer not detected by the T3 MRI. (I'm also wondering how true it is for a T3 MRI to miss areas of concern.)

    Any help is greatly appreciated. (FYI my MRI is scheduled for this Monday so quick replies are appreciated.)

    • craig84609
      craig84609 ES28567

      Posted

      It is your body and you decide what you are willing to endure. Again I say a second opinion is in order and totally normal thing to do. The fewer cores taken the less chance for damage and if they have suspicious areas to target then I don't get why the doctor would want to do so many. Everything I have read about the 3T MRI has stated the biggest advantage to it is the ability to target suspect areas and be able to biopsy those with fewer cores taken. If it were me and it maybe real soon I would get a second opinion and ask my doctor what he would do if it was him going in for a biopsy.
    • stewarta
      stewarta ES28567

      Posted

      Having recently been through the same procedure, a Transperineal Fusion Biopsy is the way to go. Be prepared for a biopsy result that gives a Gleason Score that indicates a need for action based on PI-RADS 4 or 5.

      You will need to arm yourself with many questions for each profession you see to get the full picture.

      I decided on a a Robot-Assisted Prostatectomy. Now some three weeks later, I am happy.

    • stewarta
      stewarta

      Posted

      I wrote this in another forum, and I think it may help here.

      i really do understand how you feel. I am a youthful 69, and I was heading in a completely different direction towards a PAE until the pre-op MRI results gave a fateful reading - PI-RADS 4.

      I decided that while those posting here mean well, like all forums, the best advice comes from qualified professionals. But each has to be consulted and asked some serious questions. I did this before making my decisions: "How do you know you got it all?; "What if the PSA rises again?"; " Can I have a Prostatectomy after radiation therapy, if the radiation (whether beam or brachytherapy) doesn't work?"; "If I have a full body Scan and there is no PCa spread to the bones, how do you know it hasn't spread to (say) the lymph nodes?"

      I got the answers to these eyeball-to-eyeball with the various professionals, then made my decision.

      Best wishes.

    • Greebo64
      Greebo64 stewarta

      Posted

      Hi Stewart

      Regarding your prostatectomy, were you given a choice of techniques ? & was it on the NHS ?

      By the way my GP told me there were no scans in the UK to find or locate any signs of prostate cancer, he said the only way was biopsy, which he did not recommend at this stage  [ my PSA was 7.2 ]

      i see a urologist next month the 14th April.

      i am just preparing myself, so any advice would be greatly appreciated.

       

    • david41094
      david41094 Greebo64

      Posted

      Your GP is telling porkies. I was given the same nonsense but I insisted on an MRI prior to biopsy. The MRI has two main benefits: it helps to determine whether you need a biopsy at all and it enables you to have a targetted biopsy, if necessary.
    • Greebo64
      Greebo64 david41094

      Posted

      Dave

      I a not suprised with your reply about my GP,

      its not the fist time i have had porkies from him, they are more concerned about their budget than patent care.

      This prostate stuff is all new to me,i am not sure if i should be alarmed or not at the 7.2 PSA reading , Any suggestions what to questions to ask when i see the urologist.

    • craig84609
      craig84609 Greebo64

      Posted

      I am not sure what Porkies means, but if the Uro makes more money the more biopsies taken and that is the reason behind it then that is super unprofessional. It isn't about the doctor making money it should be about patient care and well being. I find that really alarming that a doctor would put their budget over the patient care. I would seek a new doctor.
    • Greebo64
      Greebo64 craig84609

      Posted

      Craig

      Porkies is slang for lies. 

      I have change GP's before, but they all seem to be the same.

      This GP also told me that the Biopsy is very painfull...

      ps....Moderatrors.. i am having great diffiiculty typing here

    • stewarta
      stewarta Greebo64

      Posted

      I am in Australia. My GP is as big a tool as yours. He didn't know what a PAE is. Only one Interventional radiologist in Oz was doing the PAE, so I flew 800/Kms to Sydney where I had the MRI as part of the pre-operative process.

      The MRI gave a PI-RADS 4 result, and showed a suspicious area in one line. This result led me to a urologist, who used the MRI for a guided Biopsy (Transperineal Fusion Biopsy) which I had done under a general anaesthetic. That gave a Gleason score (4+4) 8. It was shown to be 9 after pathology tests on the extracted prostate. I had a full body Scan and path tests on the lymph nodes which showed the PCa to be localised.

      My urologist case managed the situation. He did Radical Prostatectomies, but I wanted to talk with a Radiologist and with the best urologist doing Robot-Assisted Prostatectomies. That last one was my chosen path.

      The only advice I can give is to arm yourself with question after question for each professional and then make your decision. The other thing is that my PSA was 2.4 to 3.5 over a decade, and I had digital rectal examination - none of which indicated a problem. I self-diagnosis a PAE was needed, and got it wrong. But as my operating RA urologist stated to me .... If I hadn't and that PCa escaped beyond the prostate, I would have been in seven kinds of sh*te.

    • craig84609
      craig84609 Greebo64

      Posted

      I can tell you I am happy with my Uro as she has not mentioned the biopsy word to me and or PSA testing. I think she believes I have prostatitis as I do. I wouldn't ever get a saturation biopsy as they seem to be kinda harsh and even if they don't cause permanent damage to one person they can easily in the next. Targeted biopsy is really the best way to go. If one is having the 3T MRI you can count on it being very accurate from what I have read. I would trust the MRI. But that is what I would do and maybe not what someone else would do.
    • stewarta
      stewarta Greebo64

      Posted

      As others have stated your GP is either ignorant or telling "pork pies".

      I am in Australia. Here, Medicare covers a lot, and one's private health insurance covers a bit more (if you have it). An MRI costs the patient $500 with nothing from Medicare or health insurance. It will show the likelihood or not of PCa, and determine the need for a biopsy.

      I have written a longer reply that awaits moderation.

    • Greebo64
      Greebo64 stewarta

      Posted

      I am in the UK using the NHS [not private] & when i asked my GP about a Scan,he said he had not heard of one hear in the UK that detects protate cancer,

      so is that it does not happen hear in the UK ?..i appreciate your reply Stewart, but i also need to hear whether anyone in the UK knows if this T3 MRI Scan is available.

      Any advice very welcome

    • andrew64174
      andrew64174 stewarta

      Posted

      hi i was diagnosed last week gleason 6 psa 5.4

      mri was clear i had transperenial biopsy 40 cores biopsied 1 core right of prostate tiny bit 3.5% cancer found. classed as low grade mri used was 1.5t and then my cae was looked at by mdt and they said mri was staged at t2c no cancer onleft side but biopsy picked up high grade pin. dont know what my pi-rads are infact dont know what they are never discussed anything bout this.

      they have said active surveillance best option as very slow growing and i am 44 so delay side effects for as long as possible. i thought i would be staged at t2a have not got a clue why im t2c with cancer only on right side.

      ​if anyone can ellaborate on this that would be great

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