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
0 likes, 34 replies
JerryR mark4man
Posted
Wrong, wrong, right, right, wrong! Donald?
Guest mark4man
Posted
I had PSA of 4.2 which went up to 7.11 so was referred for a biopsy, the uro decided to do a 3T MRI first and biopsy second on the basis that if the MRI showed anything he would know where to target. The MRI came back negative so no biopsy but showed I have a 60cc prostate. Suggest you ask for the MRI first.
MichaelVM7 Guest
Posted
Twiglet,
Your PSA density is still high: 0.119. It should be <0.10. But not alarmingly high, and it is likely due to BPH, as your MRI was clean.
Still, make sure you have regular DRE's. And it wouldn't hurt to have another test, such as PHI or 4K (see discussion above).
Definitely, ask for MRI before jumping to biopsy!
Michael
Supertractorman mark4man
Posted
Had 2 Biopsies one with Sepsis after, and in between a 3T scan which was inconclusive. In the end Prostate removed and was found to be far worse than any of the previous tests showed. Don't think the 3T is really the answer but who Knows ?.
Motto Supertractorman
Posted
What do you mean by far worse? Was it cancerous? That's really scary.
barney34567 Supertractorman
Posted
As I indicated elsewhere, 3T or 1.5T is not the question. The question is: do you have a highly experienced (in prostate reading) person reporting on the images?
MichaelVM7 Supertractorman
Posted
If your MRI was inconclusive, I assume you were given a PIRADS of 3?
In that case, it is indeterminate, and caution tends to lean toward biopsy.
If you're given a PIRADS of 1, or no lesions are seen, then I think it's safe to avoid biopsy.
The MRI on a 3T machine is more accurate than 12-core TRUS biopsy in terms of negative findings.
For PIRADS 4 or 5, definitely get the biopsy (fusion biopsy).
I'm sorry to hear of the complications from your biopsy. Infection is certainly a risk with that kind of procedure.
Michael
barney34567 Supertractorman
Posted
3T has the best resolution of any MRI. Maybe the problem is the lack of experience of the reporting radiologist? If so, get another to report on the images, if possible.
Supertractorman Motto
Posted
Yes , a lot more Cancerous than the Professor thought even after scans and biopsies.
Supertractorman barney34567
Posted
I don't think this was the case as the scanner is part of the University equipment used for research work, but gets used by the teaching hospital, and I was advised that it was more accurate but sometimes does not give all the answers.
Supertractorman MichaelVM7
Posted
Michael, The only advice I can give anyone going for a biopsy is ask before regarding A/B's. If not under anaesthetic you can witness them giving you them, but under anaesthetic nothing is seen. If after the biopsy in next 24 hours you have sweats, shivers, sickness, blurred vision or blood coming from your orifices, get someone to take you to the nearest A&E as your body is shutting down. They did not recognise Sepsis in me over the phone by NHS24 with all these things happening, but a friend who is a Nurse did and got me into the High Dependency unit with only less than an hour to live. I could not focus or read a car number plate on the way to hospital. Hope none of you ever have Sepsis.
David
barney34567 Supertractorman
Posted
Two points come to mind:
steve07664 mark4man
Posted
Every urologist who pushes a patient to have a biopsy before an MRI is committing malpractice. Anywhere from 4-6% of men who get biopsies will get infections including sepsis, and about 2% of them will die from it. Basically a prostate biopsy has somewhere between a 1-in-500 to 1-in-1000 chance of death. There is zero risk of dying from an MRI.
Get the MRI first. If a biopsy is then required, lower your risk by insisting that it be done in a hospital, in an operating room, with a medical team just like any regular surgery. Have a rectal swab done beforehand so that they can match the antibiotic they give you prior to the biopsy with your own biome. Do not get a biopsy in a doctor's office or some outpatient clinic. Insist that the doctor takes the absolute minimum number of core samples; don't let them do a "saturation" biopsy where they take dozens of core samples, which can leave you with permanent urinary problems.
lee56659 mark4man
Posted
When my PSA went from 3 to 11, I had a biopsy (the only painful part was the antibiotic shot) and it came back as prostatitis but negative for cancer. Six months later I had a TURP and 15% of the removed tissue showed prostate cancer (Gleason 6) so the 12 biopsy samples missed it. I guess that suggests the MRI may be better.
timothy81571 mark4man
Posted
I asked the same question after I had a biopsy, then MRI. Uro told me because insurance worked that way. I dont know, hopefully she wasn't lying to me.
tom86211 timothy81571
Posted
I had my first 12 core biopsy in 2012. MRI was not an option at that time, was never told about it, didn't know anything else was an option, not covered by my insurance. Your PSI goes over 4 (was never told the lab was taking it), my doctor called me and referred me to a urologist, who did a 12 core. Cancer was found, Gleason 6. This all came as a complete surprise to me. IF I had known about the MRI option and it was offered to me and was covered I would have done that. A 3T MRI is an advanced option and not normally done, so it's something you have to ask for.