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Pi RADS score of 4 & 5 and biopsy?

Posted , 5 users are following.

rolf61809
rolf61809

I've had acute rectal pain going on for about 2 years which I initially thought was prostate related but my prostate wasn't sore with the digital examination. My Pi RADS a year ago was 3 and the one I just had last Friday was four and five. I guess I finally do need a biopsy but unfortunately no one in Ohio offers the trans perineal approach. And my urologist claims there is no difference in post-procedure infection haha. I have seen a urologist at the Cleveland Clinic and I just called and they do do Fusion biopsies which I would greatly prefer. I'm waiting to hear back from my urologist at Riverside Methodist Hospital in Columbus Ohio whether they also do Fusion biopsies. In either case I'm going to have to settle for the transrectal biopsy unfortunately. I'm really afraid of post-procedure infection as I already have enough pelvic pain to deal with. Any advice appreciated.

0 likes, 8 replies

8 Replies

  • Pepasan
    Pepasan rolf61809

    Posted

    I’ve had two transrectal biopsies without any problems. First was a sampling of 12. Second was 36. I was given preventive antibiotics. I would do it again if my urologist asked me to.

  • Davey22
    Davey22 rolf61809

    Posted

    If you felt like going down to Florida, to either Sperling Prostate Center or Scionti Prostate Center, they perform those biopsies at both locations. Look them up on the internet.
  • charles61038
    charles61038 rolf61809

    Posted

    I went through the transrectal biopsy just fine. I was also given preventative antibiotics prior to the procedure and continued the antibiotics for a few days after. I was also given the instructions for a Fleets enema to clean out the colon which also probably helps. it is not a pleasant experience, but it is tolerable. And at least you will find out what course of action needs to come next. Clean yourself out, and take the antibiotics. That will help prevent any infection.

    Good luck - and let us know how you do.

  • cjc99
    cjc99 rolf61809

    Posted

    Curious to find out what you ended up having...my hubby is scheduled for consult after PI RAD 4 scan, and I believe they are planning rectal approach.  I would prefer perineal as it seems to be so much more accurate and obviously less likely to cause infection.  
    • rolf61809
      rolf61809 cjc99

      Posted

      Actually met the urologist that would be doing the transrectal biopsy a couple weeks ago. Didn't really get a satisfying answer as to why my local urologist's radiologist read Pirads of four and five while the Cleveland Clinic only read Pirads of 2. But he did confirm that the chances of infection or sepsis are much higher with the transrectal, which I made sure to mention when I saw my regular urologist a week ago. He's the one who had been telling me for the last year that the infection rates are the same. But I actually haven't made the decision about when to get the biopsy. Until today I thought I had to get it done by the end of the year since I had met my deductible but with my new insurance plan I only have to meet a $500 deductible for the year so I'm not in a hurry to get it done. The urologist I saw who would actually be doing the biopsy told me that he didn't think it was prostate cancer because it's showing up in the intermediate Zone and not towards the outsides of the prostate. But after two and a half years of incredible rectal pain I'm finally to the point where I'm willing to take the chance of a serious infection to rule out prostate cancer. Because early-stage prostate cancer isn't supposed to hurt. But everybody's different so possibly it's putting pressure on some nerve somewhere thats causing my pain, I don't know. But the infuriating thing is that last year my insurance coverage would have been in network for a doctor who does transparaneal biopsies. And my urologist knew that but decided not to tell me. Instead he tried to feed me this b******* line about how the infection rates were the same. So yes I am going to have the transrectal biopsy in the next month. But when you catch your urologist out-and-out lying to you and two different radiologists reading vastly different Pi rad scores you really start wondering who to believe... But the pain I've been in for the last two and a half years has changed my demeanor in that well I consider myself still quite rational I'm also rather angry with the medical infrastructure in place to deal with pain patients. Sorry for such a long answer to a short question.

    • rolf61809
      rolf61809 cjc99

      Posted

      And what I probably should have suggested is that possibly you should get another radiologist to read the 3T MRI scan. In my case the first one found four and five while the second radiologist only found twos. You really need an expert in reading prostate biopsies and not just a run-of-the-mill radiologist it appears. He
  • cjc99
    cjc99 rolf61809

    Posted

    Thanks for your reply.  That stinks about your Urologist.  I am finding that the best doctors, or the ones that specialize in these newer procedures seem to be involved in clinical trials.  The doc we have been referred to is running one on rectal bx technique, so hmmmm......would stand to reason that he will STRONGLY push that approach.  It will be interesting.  

    As far as the scan, I am told that the doc who read it is a specialist in this area (he is at Yale New Haven) so not sure about having it read by someone else - it can't hurt, can it?

    • rolf61809
      rolf61809 cjc99

      Posted

      The most frustrating and infuriating part of my experience was that even though one radiologist read it as four and five and the other as two the local urologist was unwilling to go back to the his radiologist to justify why he scored it so highly compared to the radiologist at the Cleveland Clinic. I mean we're talking about a procedure with a 3-5% chance of infection requiring hospitalization and a significant chance of sepsis which could even lead to death. I have yet to meet a doctor who reacted well when I questioned any information he had given me because I had found contradictory evidence on the internet. And it's not like I'm one of those people who goes searching for a disease and convinces themself that they have it. Oh well...

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