If MRI shows 2 large lesions, report says malignant neoplasm, PIRAD 5, why biopsy?
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They use MRI during RP so why biopsy what they already know is there??
In cases where malignant neoplasm is seen in the MRI scans, by a good radiologist, why reinvent the wheel? cellularity within lesions is mostly what determines how malignant they are; vascularity, arterial enhancement, if all indications are visible in the scans, what earthly good is biopsy?
0 likes, 12 replies
MK51151 rich22
Posted
Only acceptable confirmation of prostate Ca diagnosis is thru biopsy so you are not diagnosed with prostate Ca until it is confirmed by biopsy where core samples are examined by pathologist under microscope.Very often PYRAD 5 turns to be either low grade Ca or something else. Never heard that MRI findings could be substituted for biopsy
MK.
rich22 MK51151
Posted
thanx for input - i know established protocols dictate biopsy as the ONLY acceptable proof of PCa. That's why i created this thread; in some cases, like mine, i believe the size and details of the lesions seen on the MRI scans are enough.
"histologic correlation recommended" is the last line in the MRI report, which is tech talk for biopsy. i can see how biopsy is indicated IF the lesions were unclear, or very small, etc. Mine are half the size of my entire gland and "extra-prostatic" enlarged lymph nodes are present. My ejaculate has been entirely gel, no seminal fluid at all for a few years now... meaning my prostate gland has probably shut down production a long time ago... i need to consult with top urologists in top hospitals here in the U.S., because one can only get limited info online.
i see now that biopsy is the most definitive for presence of PCa, but again, in some cases, just a waste of time and money, when RP is easily indicated by MRI. I sure hope i'm wrong, truthfully. would rather find other alternatives to BOTH biopsy and prostatectomy. hormone-based chemo and focused ultrasound treatments look very promising.
richard98806 rich22
Posted
rich22 richard98806
Posted
barney34567 rich22
Posted
Hi Rich
As mentioned, only a biopsy confirms PCa. That said, it is wise to have the biopsy performed by the urological surgeon you trust the most to operate on you if you decide an operation is the way to go. This is because few urologists will trust the biopsy performed by another physician.
As to all the alternatives to surgery, you must compare them in your particular situation and not make a general comparison. Also note that some treatments applying initially, eg radiation, preclude surgery in the future if that is what you'll want down the line. Whereas surgery as the first line will allow all treatment options at a later stage.
rich22 barney34567
Posted
thnx for your reply. i've decided i want HIFU for either RP or focused neoplasm removal. The latter i'm guessing isn't even viable, because fairly certain the c cells have saturated the transitional zone and metastasis may already have occurred, as lymph nodes are enlarged nearby. the only doctor in this area who does HIFU told me to send him biopsy and MRI reports, no offer to do the biopsy so i'm seeking doctor and facility that does MRI-guided biopsy only.
barney34567 rich22
Posted
1. Ultrasound/MRI guided biopsy is the most effective biopsy possible. I had that in 2016. Don't bother with anything else;
2. I would think you need at least two concurrent therapies eg hormone+IMRT.
3. I know nothing about HIFU, but do know that if a biopsy reveals extra prostatic extension and perineural invasion and the tumour is classed as T3, then I doubt RP is a worthwhile option.
rich22 barney34567
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lesions/neoplasm not confirmed tumors yet. just looked up perineural invasion and ya, that would mean i'm cooked, time for hospice care. acckk!
barney34567 rich22
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Don't be too downhearted.
Even if you have Perineural Invasion (PNI) and T3 it isn't time for a hospice!
It may well be time for heavy duty therapy.
I suggest in addition to a MRI guided biopsy you get a PSMA PET CT scan, which is a scan that specifically picks up signs of PCa
rich22 barney34567
Posted
thnx for the encouragement but i ain't in the PNI ballpark... yet. and i'm fairly certain i've had it with supposedly low-dose radioactive tracers in my already-cancerous bloodstream. i have an MGUS and MDS-anemia, so i watch VERY CLOSELY what i put in my body these days. had a recent scan where a "harmless dye" was indicated, which the doctor assured me i wouldn't even feel. ya, for three days afterward, i didn't feel rooms tilting on me, didn't feel my thoughts coming from outer space, didn't feel any of that. ya, thnx for the assurance, Doc. that's why i'm kinda desperate to find an HIFU practitioner willing to take on what i'm already sure is metastasized PCa. HIFU is already 10 years old, yet is not catching on, for reasons i cannot fathom. it's focused ultrasound burning! clean, efficient and precise. blows my mind that hardly anyone has even heard of it.
barney34567 rich22
Posted
specific areas of prostate cancer (focal HIFU).
Hence a scan like a PSMA PET CT is vital to establish if the PCa has spread within yr system. If so, then
HIFU will not help IMHO because it is not a systemic therapy.
Other than hormone therapy, chemo therapy or radiation you could try new drugs that look very promising.
rich22 barney34567
Posted
absolutely correct... was just told that by urologist in PA. going by MRI report and 4K score (with a PSA 16.3), since i haven't gotten the biopsy yet, i'm fairly certain there is extra-prostatic involvement, kicking my gleason up to 8, maybe 7 if i'm lucky. may be starting 3 month course of lenalidomide to kill bone marrow cancer diagnosed before i knew about the PCa... and they're tied, neck and neck... who will kill richie first? don't ya just love the challenges life presents? frankly sick of it all, barn. but i will not go gentle into that good night.