prostate biopsy

Great really don't want one. did yours all go ok

I had a TRUS biopsy, and a MRI guided biopsy. They are invasive, the TRUS boopsy wasn't too bad. But the MRI guided biopsy was the worst, because they took more cores out.

If it saves your life get a biopsy.

If the mri tells me i have cancer and what stage it is, i can't see the point in the biopsy.

Lol my 12 core PCR fusion biopsy was alarming but not painful. I agree with your point "if it saves your life" but it is only now mainly a tool (an important one) for decision making. In the past it was key to diagnosis but now only to how fast you must act. The mpPCR will at least give you the answer to PCa or no PCa along with the staging of it

You would want to know your Gleason score, and find out if the PCa is agressive or non aggressive. You can find this out with genetic testing, using your biopsy remains. That is what I did, I had mine genetic tested. In my view a Gleason score is important to have. I i

So a multiparametric mri will also tell me if i have cancer ? that's if they will give me one. i just don't want to risk getting an infection from the biopsy because i have Emphysema

They should in any case do an mpMRI before going ahead with any biopsy in order to do a fusion biopsy (using the PCR data to map where to go along with Ultra Sound guidence).

In fact the risk of in fection is low but it is present. So much depends on the skills of the team - these seem to vary hugely.

Ok but they told me they want to do the biopsy first ? doctor told me he can't feel sulcus and the prostate felt uneven.

What a strange way round. A biopsy without MRI guidence is just as likely to be negative even if you are positive just because it has a good chance of missing any tumour cells.

I would ask for a second opinion and go to a unit with mpMRI like Brighton.

They said when you first arrive they give you an antibiotic to take and the biopsy is done with ultra sound ? i have told them i don't want one and not taking any tablet until they have done other tests and give me some idea if they think it's cancer or not first. I am driving to hospital and on there letter it says make sure you got someont to take you home, so hopefully me driving will put them off doing my head in over the biopsy.

It's called One stop biopsy clinic

I've just checked their website. They are out of tune in their approach with all the top urologists. What more can I say. Ask for a second opinion somewhere where they are a little more up to date.

Don't have it done. A TRUS (trans rectal ultra sound) guided biopsy is just used to guide the needle to 6 or 12 points in the prostate in the hope of finding tumour cells if they are there. Many times they miss them in people with PCa. If mpMRI is done first and PCa identified, the biopsy can be targeted to where the tumour cells are.

Ask for a second opinion.

Which website is that ?

Sorry John, I'm in Taiwan just now and rather jetlagged - The PDF file posted on the One stop biopsy clinic site...

Glad you decided against withour first having a 3T mpMRI.

Lucky you wish i was miles away  

You are in what I felt to be the hardest phase. A phase where you have to make a lot of tough decisions - even tougher when the professionals are not well informed or have chosen to take a simplistic view. You'll look back on this in a year's time and be glad you asked all the right questions. Hopefully it will all be behind you by then

Seems to be every year i am in this place with cancer scare

Sorry mate. That's tough.

A 3T MRI can certainly indicate if you are likely to have PCa. But only a biopsy is definitive.

if your e worried about infection I suggest you opt for what I had: an ultrasound guided transperineal biopsy.

ultrasound is guided by the images from the 3T MRI and transperineal as opposed to the over uses transrectal approach has far less risk for infection.

Yes it is a ultrasound is guided biopsy but without having a MRI done first

Then I believe you're not going for the most accurate biopsy.

An u/s guided by what the MRI finds is targeted to take samples of the area suspicious for  PCa.

If a biopsy is not guide pad by a MRI then it is not as accurate bemused it samples the whole prostate rather than focus on the area most likely to have PCa present.

I can't make them do anything or tell them what to do. i am going to tell them what i want and if they don't do it i will walk out but not sure i will ever get help if i do ? plus if it is cancer and i just leave it i have no hope.

True you can't make them do anything they don't want. But you can go elsewhere to find a urologist who will perform the biopsy in a way that gives you the least chance of infection (sepsis) and the best possible diagnosis of what looks suspicious.

Does that have to be in your area ? or any hospital in UK

Hi John, Barney is on the nail and no, a second opinion can be anywhere. I recommend that you find places where the urology department is up to date and find the closest one to you. Then ask your doctor for a second opinion at that hospital (best to look up the team and name the senior consultant). As I said earlier, Brighton (E Sussex) is one option.

I never knew you could pick any hospital in the country, but brighton is 250 miles so bit far. Only 2 hospitals here and one of them as a bad record and been on watch.

I guess you either need to look up on line hospitals/urologists that do MRI-TRUS fusion prostate biopsy or MRI-targeted prostate biopsy and check out their urology teams. (Eg Cambrige University Trust comes out well and in particular Tev Aho of Addenbrooke’s NHS Foundation Trust) - That will take time and effort. Or you could start a thread here asking wich hospitals/urological teams practice MRI-TRUS fusion prostate biopsy or MRI-targeted prostate biopsy (both descriptions refer to the same thing). Hopefully you will get a list from current participants.

PS I see that Plymouth Hospitals NHS Trust also advertise that they do "Ultrasound-MRi Fusion for Targeted Diagnosis of Prostate Cancer"

On the letter it says i will have a the biopsy will involve a digital rectal examination, followed by transrectal ultrasound guided prostate biopsies if deemed appropriate

Well, you have a choice:

1. To go ahead with that

2. To ask for a second opinion

I am asking for an mri and nothing else, if i have to pay private i wll.

You won't have to pay if you get a second opinion at a urology department that specialises in mpMRI along with the urology team. Many in this discussion (Barney, Ayman, Husni, Craig, Roger2Dodger and I'm sure I left some out) have indicated that:

1. mpMRI is useful for 2 reasons - to determine whther a biopsy is needed or not, and if needed to enable an accurate and useful biopsy.

2. Good specialist imaging experts (they used to be called radiologists!) do this and offer their service to their urological team,

These situations are difficult, I appreciate. Grit your teeth and make a decision. This disease forces you to make severa tough choices.

This is my third cancer scare in 3 years plus got told my lungs are damaged only last year. But i will find someone if these refuse to one for me, i am stoborn and will never give in when i ame my mind up.

Good man. If you research and make a decision based on that and can stick to your guns you'll never look back and wish you had done something else because you gave it your best shot.

Good luck whatever you do.

Thank you and sorry about my bad spelling on the last reply

Update went to hospital they asked me questions and checked my prostate and said it's fine and does not even feel enlarged ? So why did the doctor tell me (can't feel sulcus and the prostate felt uneven) the specialist when i told him what the doctor said told me none of that is on the notes from my GP

I am at loss with all this and not sure who to trust. I did call the doctors to speak to him but he was not there so will try next week and ask him to explain why he never told them what he told me.

Same thing with a mole i ahd on my leg doctor sent me to specialist at hospital and he just said it's an harmless something and picked it off without asking me. and i can't see where it was now but it itches where it was but i can't even find it all i get is bit's of dry skin i pick off from that area where it was.

Interesting. It sounds a bit like me. The GP said she felt my prostate wasn't 'right' so sent me to the urologist (and took PSA which was barely raised at 4.6 at that time). The urologist said it felt normal but would recommend an MRI. The MRI showed it to be a positive tumour with an extra capsular extension.

The GP seems not to fully annotate what's going on, but neither did your 1st opinion urologist!!

Without communication, it's difficult to get it right. I'm sorry you have such a poor team.

I am going to tell them what i think of the service i have had so far, because you can't go worrying someone then send them to hospital for htem to say it's fine ? same thing happened with my liver 3 months of worry and the got told it's fine.

The problem is that unless it is really clear cut, it comes down 'opinion'. Different professionals are entitled to their opinion. If they were two different urologists then you need to ask for an MRI to clarify. If one of the Drs was your GP then you have to bow to the opinion of the urologist, though again you can ask for a second opinion. If you are leaving it, I would ask my GP for regular PSA monitoring for a year or two so that you can see if there is any shift. If there is you need referring again.

The specialist said he wants me to be checked in 6 months and monitor me every 12 months.

That sounds right. Your PSA is not high, but what is important is how it is changing over time. If it stays the same or moves only slightly all is ok. If there are significant jumps then you have a strong indicator....

Good luck to you. I do hope for you that it was a false alarm.

And me thank you for all the information and advice.

It's a pleasure John. That's what we're here for. To give back a little to the group from whom we benefitted.