How many cores are reasonable?

​The reason I am stating this is that patients often believe they are doing the right thing but due to a lack of communication/skill/budget or whatever, the Urologist still ploughs on with a saturation biopsy anyway. 

​Good luck for tomorrow!

First, do not get a biopsy based ONLY on a PSA score. There is nothing wrong with having a PSA test done if you have symptoms or concerns. However the evidence suggests a PSA test is NOT an accurate guide by itself to warrant a biopsy. If you PSA is high or increasing, I would recommend getting a PCA3 test which I have read is much better at predicting the presents of prostate cancer and the type.

Second, if the PSA and PCA3 test are at a suspicious level then insist on an MRI and get the results back before agreeing to a biopsy. Also, the MRI is a great way for the urologist to know WHERE to biopsy. In the words of my radiologist, his logic/analogy was...a bank robber "goes where the money is" so at least biopsy the areas of concern notes on the MRI.

Below is a recap of my journey so far...

Originally the urologist was going to do 12 blind cores based on the PSA score of 18.5. My goal was to avoid doing a biopsy so I insisted on an MRI first to see if there was more evidence to support doing a biopsy because the DRE (by two different urologists) did not indicate any abnormality and as we all know the PSA by itself is not a good indicator of cancer. So the T3 MRI was performed and came back showing two areas level 5 (high probability of cancer) one level 4 (very likely probability of cancer) and one level 2 (most likely benign). And to make matters more alarming, in the radiologist report, the areas of concern are against the prostate wall with concern that the cancer may have already breached the prostate.

I talked to Sperling cancer center and they could not comment directly to my situation but they only target the areas of Concern. However they said depending on the experience of the radiologist and the quality of the images, he may or may not miss something on the MRI. And then (of course) they encouraged me to come to their center for the biopsy. I talked with the radiologist who did the reading. He suggested focusing on the areas of concern because he felt very likely that will be where they will most likely find issues that need addressed. I also talked with my contact at the cancer center of America. She said she would be inclined to do both the targeted and random samples so more likely nothing is missed.

After getting everyone's opinion, I felt that probably only doing the areas of concern would show us if I had cancer. My final conclusion was that the whole purpose of the biopsy is to see if there is cancer, where it is located, and what type. The more I know about my prostate the better I can make an educated decision. Knowledge is power (and since we are doing the biopsy anyway) having a general idea of how the rest of the prostate is will give me a better idea of how to proceed with whatever treatment is necessary.

I'm not saying my decision to allow the urologist to do more cores than the areas of concern is right for everyone. It was just the right decision for me at the time with the information I had available. Maybe explaining my thought process will help others with their decision.

One last note regarding the biopsy. My original goal was to avoid or only agree to a biopsy if there was enough evidence to support it. I took a conservative approach and even insisted on a PCA3 test before allowing the biopsy. Unfortunately when the MRI came back with such bad results, I didn't see a reason for the PCA3 test. To my urologist credit, he was very agreeable to all my requests and never tried to talk me out of the MRI or PCA3 tests I only wish he was the one who brought up those options when we were determining a plan of action.

Always go in with as much knowledge as possible.

I went to the hospital records dept. and got my results from pathology. FYI, you don't have to wait until you revisit the urologist to get your results. I don't fully understand every nuance of the report but I did google everything and have a basic understanding. The worst was one Gleason score of 3+3 = 6 out of 22 cores. 3 areas of small acinar proliferation. And the rest no malignancy found. Also, no perineural invasion identified. So, I have cancer but is not as aggressive as other types. I know there is a lot of debate about doing biopsies but looks like it was the right choice for me. Now I need to figure out how to proceed with this new information.