Prostate...MRI or Biopsy?

Posted , 19 users are following.

hello all...

If an MRI is the be all/end all in determining prostate cancer...why do I need a biopsy...???...why can't I just go right to the MRI...???

Background: 67 years old. My PSA was at 5.5. My urologist performed a cystoscopy; & said that everything was normal, but wanted to keep an eye on my PSA. It went up to 8.2, so he ordered a biopsy. He tells me that if the biopsy comes back clean, but my PSA remains high (or goes up)...then I will need an MRI.

So...why do I need to put myself thru such an invasive technique, if an MRI can fully determine prostate cancer. Biopsy side effects range from blood in the urine to not being able to urinate & a bunch of other scary things.

please help...thanx,

mark4man

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  • Posted

    You're asking the right questions. If I were you, I would avoid the biopsy, and go for a 3T MRI first.

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  • Posted

    It is my understanding that a 3T MRI can see lesions but not the grade. There is no substitute for taking actual tissue samples and sending them to the lab for grading. The goal is that someday imaging will be all that is needed, but we are not at that point yet. A rising PSA if often a symptom if BPH, enlarging prostate size. It is not always a reliable indicator of cancer. My PSA was 4.6 and I had a 12 core biopsy and cancer was found. I had a second 12 core a year and a half later and that showed "progression" so I decided to have treatment. I am not a fan of the biopsies - but, you can always refuse to have one and then live with the uncertainty that accompanies that decision.

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  • Posted

    3T Mri first then biopsy ..

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  • Posted

    your answer. get the MRI if a lesion is observed by a specialized Interventional radiologist then you have a focal single needle biopsy of the specific lesion . urologist do not typically do this or have the ability to do it so they do not mention it or sell it it is the way to go . MRI first then make a decision as to whether you need a single focal needle biopsy

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  • Posted

    You can get the MRI CD disc and if you want it read by the best, send it to Houston via his web site and send it to him. He does not charge and has a portal setup on the site.

    Dr. Karamanian

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  • Posted

    You can get the MRI CD disc and if you want it read by the best, send it to Houston via his web site and send it to him. He does not charge and has a portal setup on the site.

    Dr. Karamanian

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  • Posted

    It's prostate laser center. Look it up you have his name now. And then call.

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  • Posted

    When I was suggested biopsy I asked for MRI. After MRI it was obvious that there is no cancer and thus no need for biopsy. BTW, my PSA was 24 - other factors beside prostate size play factor, like autoimmune condition that can cause inflammation throughout of the body.

    What your urologist is saying is that he will do sample from 12 different places in prostate and if you are "lucky" he will hit the cancer spot. However, in case he misses , and the PSA still goes up, then MRI is needed to find the reason.

    Bottom line biopsy is blind collection of samples from prostate. If cancer was NOT found that does not mean you don't have a cancer. After MRI, if there is any suspicious area, then TARGETED biopsy will be performed , Much better way to go.

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  • Posted

    Good question. Have the 3T MRI first. if that shows one or more suspicious areas,then have a targeted biopsy. I believe there is an area if the prostate that the MRI cannot see, so if you need a biopsy, you can have a targeted biopsy along with a random biopsy if that particular area.

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  • Posted

    I would get a 4K, PCA3, or Select MDX test first, followed by a 3TMRI. If those look suspicious, you can then go to a targeted, ultrasound-guided, or fusion (not random) biopsy. Biopsies have a lot of potential hazards, so should be a last and not a first resort, although they are quite definitive.

    Best of luck,

    Fred

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    • Posted

      Light1,

      These are excellent suggestions you've given.

      The MiPS test developed at the University of Michigan measures PCA3 and another genetic marker (TMPRSS2:ERG). It's a good test.

      Also, PHI (Prostate Health Index) was created by Dr. William Catalona in Chicago. It provides a score and a cancer probability.

      One or more of the above and the 4K or Select MDX would provide a man's urologist with additional information before proceeding to biopsy.

      But by all means, EVERY man should have a multiparametric MRI on a 3T machine BEFORE even considering a blind 12-core needle biopsy.

      If the MRI picks up a suspicious lesion, the doctor can overlay the MRI imaging to provide better targeting when inserting the needle (fusion biopsy).

      I had an elevated PSA (4.2) in the Fall of 2015 and then an MRI gave me a PIRADS 3 score, so I had a fusion biopsy of 16 cores. The pathology report showed no cancer and no PIN.

      But......................my PSA has never come down since that biopsy.

      Last Summer, my PSA shot up to over 11. My doctor wanted to do a repeat biopsy. I had a negative MRI before that (no lesions seen; no PIRADS assigned). I decided to wait. I did the 4K score and it came out low (3%).

      I had two more negative 3T MRIs. My PSA came down to 5.2.

      My prostate is large: 130 cc. My PSA density is very low.

      I'm glad I took the steps you suggest above. It saved me another biopsy. And, very likely, my PSA spiking again.

      For my two cents, biopsy is the LAST resort, and only if the 4K or MDX or other test looks bad. Your advice will save a lot of men needless biopsies and infections (that only drive up PSA and lead to more biopsies - a vicious and unpleasant cycle).

      Thank you,

      Michael

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    • Posted

      Thanks, Michael,

      I wanted to add that a color doppler ultrasound is an excellent diagnostic tool in the hands of an experienced doc who knows how to read and interpret the results. And it's not really that invasive. I've been having them 2X per year since 2007. That, combined with the results from MRI and 4K, PCA3, or Select MDX test (or similar) give a pretty good diagnostic picture. I finally agreed to a 2nd biopsy earlier this year during my pre-surgery (REZUM) investigations to be sure that we weren't going to be covering up anything active. But is was an ultrasound-guided, one-stick biopsy. Came back negative by the way.

      Best wishes,

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  • Posted

    Get a 3T MRI and remember sex and bicycle can raise your PSA.

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  • Posted

    Biopsies can lead to cancer ... called ' needle tracking ' cancer .

    PSA tests are like chemotherapy ... just quackery ... money making by misguided medical doctors.

    High PSA can be the result of recent sex amongst others such as infections .

    My one time supervisor had a PSA of 19 , had a biopsy , which showed NO cancer.

    Apparently the only real way to check for cancer is the good old digital rectal examination .

    I suspect that many men have their crown jewel mutilated by doctors who allege cancer due to high PSA results / or the doctor does the procedure anyway , to be 'safe' ... its a case of who will ever know the truth... even the doctor.

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    • Posted

      With all due respect, you are peddling false information here - not everything you said, mind you, but part of it.

      The DRE is not "the only real way to check for cancer." Studies have shown that DRE is excellent for palpating the apex of the prostate. However, in only about two-thirds of the time can the urologist reach 1/2 of the prostate, and he/she can reach 3/4 of the prostate less than 25% of the time.

      So, for tumors in the apex region, yes, DRE is a terrific tool. And I do recall reading that most cancers begin there, though certainly not all, which is why DRE is very good but not infallible. I will agree 100% with you: every man needs to have a DRE, certainly from age 50 and beyond, and sooner if a strong family history of PCa.

      Therefore, DRE is limited, and especially so for men with large prostates, and has to be used with other methods.

      PSA is a useful tool, but it needs to be used with other tools, and it cannot be a stand-alone decision-maker. Certainly, multiparametric MRI imaging of the prostate and more sophisticated blood and urine tests (see discussion on this thread) gives better information to both doctor and patient.

      As far as I know, no man has his prostate removed (mutilated, to use your word) "due to high PSA results." In the US, a urologist cannot surgically remove the prostate without a pathology report showing cancer. Maybe it's possible for a wealthy man to demand his prostate be removed if his PSA is elevated and he pays for it out of pocket, but insurance will not pay for radical prostatectomy absent a confirming pathology report.

      I would say, and this would agree with your position in part, that in the past, doctors were surgically removing the prostate too often, as in the case where Gleason score was 3+3 and did not present a life-threatening cancer that would metastasize.

      I think there's good to the PSA but it is not Gospel truth.

      Michael

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