TRUS biopsy happening sooner than expected
Posted , 8 users are following.
My partner was being put on his consultants NHS list to have a biopsy carried out in early march, to confirm that the MRI scan was correct in saying all was clear. He got a letter today, however, giving him a date 2 weeks from now. It's probably because someone cancelled but he thinks it's because the consultant thinks something is seriously wrong with him! Anyway, I just wanted to check if this biopsy is a good idea while he is feeling pain from the prostate? He is getting it every day, like a dull throbbing. I think that taking random biopsies from an already enlarged, painful prostate is asking for trouble. I have told him we should contact the urologist on Monday and make sure he is aware of the symptoms. I am so worried that he will either end up with an infection or urinary retention, or both. Has anyone had an ok experience with TRUS biopsy, I mean without a lot of pain during procedure and no real side effects afterwards?
0 likes, 35 replies
craig84609 caz11527
Posted
I don't understand the need for the biopsy if the MRI came back clear. I would get a second opinion. It is possible that he has prostatitis and that can be damaging to have a biopsy done if he has it.
harveybronx caz11527
Posted
I agree with Craig. Remind me, was the MRI an mpMRI? If so, what was the PI-RADS score? If it wasn't an mpMRI, then I have no opinion, because I would have no idea what a clear MRI means. In any case, the mpMRI has made random biopsies obsolete. And biopsies are not risk free. Is it a crime under the NHS to not show up for a procedure appointment? If hecancels, will they arrest him? Is it possible to get a second opinion under the NHS? I have not really fully understood what was going on from the beginning. There is obviously a problem with pain and a dull throbbing. How does he know it's coming from the prostate? How will a random TRUS biopsy determine the cause of the pain? Certainly, I would want answers to these questions before getting such a biopsy.
?Harvey
craig84609 caz11527
Posted
I don't understand the medical system in your country. You shouldn't have to have a biopsy if you don't want one. If the MRI was a 3t MRI then it should show cancer if it is present. So if it was clear, then I don't understand why they would force him to have a biopsy. A biopsy is a bit risky and at the very least painful. In the USA there are no laws about canceling a proceedure if you change your mind. I think you raise a lot of unanswered questions. All of which are prudent and need to be addressed before consenting to a biopsy. My doctor said that she would want to do a biopsy on me if my PSA is high, but I told them I don't really care how high it is. I will not allow a biopsy to be done on me without first having a PCA3 test done and depending on those results, a 3T MRI to follow. If a tumor is found during the MRI then a guided biopsy can be done, with less punctures. That way it cuts down on the damage done to me and they will get the tissue from the site of the tumor. That way a better assesment of the severity of the cancer can be done. I have it all planed out for me, because I curently have symptoms of an enlarged Prostate and I can bet that my PSA will be elevated. I am having my PSA test this week and my previous test was at age 43 and it was a little elevated then at 1.3. Now I am 48 and having symptoms so really scared what it will be. In my case though I will not have a biopsy done. In his case he has to decide if he thinks it is the right thing to do and he needs to have his questions heard by a doctor that can help him decide if it is the thing to do. If you can have him get a second opinion and for sure get his questions answered. Stabbing needles into an infected gland can't be good for it. I wish you both luck and hope that all of this will be behind you soon. Take care.
Waffalobill craig84609
Posted
What I was thinking. I thought the MRI was to check for cancer. If it shows none, why the biopsy? If it doesn't show what needs to be seen, then why did they do it to begin with? Think it's time to get tough and ask what is going on. I have no problem with being sure when it comes to cancer. But doing tests or procedures that they know won't give answers ?
craig84609 Waffalobill
Posted
It needs to be a 3T MRI in order to get enough detail to check for a tumor. I would agree that if it wasn't then what is the point of it. High definition MRI is very useful in finding an area of concern or to figure out if a biopsy is even needed. If they find something, then a targeted biopsy can be done with less pokes. This is a good tool. 3T MRI is fairly new and may end up being the new standard in the future. I would have a hard time with having a TRUS biopsy done. For me it is super risky. I have active Crohn's disease and I am on Prednisone currently to treat it. Prednisone weakens the immune system and increases the likelyhood of sepsis, even with antibiotic prophylaxis. So in my case I have to be careful. As Derek76 states below, even if you get through it there are still problems that can arise such as lasting pain. Another person on this blog had saturation biopsies done and had permanent damage as a result. Biopsy is nothing to take lightly, we must weigh the pros and cons of it and one must decide if it is the right thing to do. In my case, probably not. This week I have a PSA test and I will likely be facing this decision myself. My last PSA was done 4 years ago at age 44. It was 1.3. That is low, but not really low for someone who is 44. I thought it would have been under 1.0. So with the symptoms I am having, I would imagine that it will be higher. I hope that it is under 3.5.
Waffalobill craig84609
Posted
Good luck Craig. Hope it's low. Couple years ago I thought this whole prostate problem thing was simple. After reading everyone's post the past 6 months I am floored at the amount of info on here. No wonder ppl get confused about what to do. It seems docs don't help with it much. They all seem to have a different plan as to how to test and treat problems.
derek76 Waffalobill
Posted
Much of the time thay are not sure if it is prostatitis. If it is Nonbacterial many UK Uro's deny that it can be prostatitis.
harveybronx craig84609
Posted
When you (Craig) mentions 3T MRI, I assume you mean a 3T multi-parametric MRI. It's the several different MRI images that show various tumor characteristics as distinguished from normal cells and show up on the MRI images that make it possible for its high negative accuracy in finding aggressive PCa, and its ability to illuminate likely non-indolent PCa..
?Harvey.
derek76 caz11527
Posted
Both my biopsies caused problems and why a TRUSS biopsy when they have a much better image from the MRI even if there was anything to aim at.
The pain of the actual biopsy is soon gone and one of mine was done without a local. It is the pain afterwards that is the problem!!
caz11527
Posted
PI-RADS score wasn't given as there were no lesions to score. that is a positive. The urologist did say he was equally happy to leave it three months or so and do another PSA. My partner is a worrier and keeps thinking what if there is something and I leave it three more months etc. I understand how he feels and as someone said previously, it's what allows him to sleep at night that will make his decision. He is worried about infection, pain during and after, retention etc but at the same time he is convinced that a biopsy is the only way they can tell for sure what is going on with his prostate. I, personally, think he has prostatitis or some type of inflammation in the gland. How a biopsy will affect this I don't know. He is going to speak to his urologist on Monday and go over every detail with him and if he feels at the end of that conversation that he isn't comfortable with a biopsy then he will cancel. He is taking an anti-inflammatory to see if that eases his symptoms, along with a painkiller every 4 hours. Oh, the scan was 3T MRI with diffusion weighting done by a centre of excellence in Dublin. Not the consultants idea, we booked it ourselves after I read on this forum how good it is at detecting Pca. It came back no areas of concern. According to the consultant there is a 10% chance of Pca upon biopsy and he would like to do the procedure to rule that out.
derek76 caz11527
Posted
He can really only base his decision on the experience of others and the urologist. Being the NHS they are not going to rush into anything as they have budgets to consider..
derek76 caz11527
Posted
caz11527 derek76
Posted
I don't know Derek. He said that sometimes a tiny spot can be missed as MRI only shows larger lesions. Something like that. His thinking is that there could still be something in there but without biopsy we won't ever know. How will he know where to target? he won't. Not ideal by any means. So to sum up, with a clear 3T MRI but psa of 7.7 he would expect to find Pca in 10% of cases. I can't begin to understand any of this, we just wish it was over but it looks like a long road ahead, full of uncertainty. You know, and I know, that anything there is likely tiny and won't cause any problems for a long time, if ever. My partner just wants to know if it exists and then he will see where he goes from there. I'm hoping the samples show inflammation and nothing else. it's a worrying time.
derek76 caz11527
Posted
I'm sure that like me others here will not follow the Uro's logic. It would seem that he has little faith in 3T MRI scanners.
Remember the stat that more men die with PC than from it.
harveybronx caz11527
Posted
As I understand it, there is always a PI-RADS score, as follows:
PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present)
PIRADS 2 – Low (clinically significant cancer is unlikely to be present)
PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)
PIRADS 4 – High (clinically significant cancer is likely to be present)
PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)
?If no areas of concern show up, then it's PI-RADS=1. Also, if I remember correctly, if all three of the parameters are determined by MRI image, and are negative, the accuracy of the negative significant PCa result is about 95% or better. I truly don't understand the insistence on a biopsy. If there are no areas of concern on the mpMRI, then there is nothing to target, and a random biopsy seems senseless to me, unless the consultant believes that the radiologist who interprets the mpMRI is incompetent, in which case you should find a different radiologist. BTW, can you get the MRI images?
?My own reading for my mpMRI performed in Jan, 2015, was PI-RADS=2, and I did not have any identifiable regions of concern for aggressive PCa; however, there was something about the images that are specified in the procedure for computing the PI-RADS score that led to my 2. I did not do a biopsy since there were no regions to target. As it turned out, a month later my PSA dropped back down from 14 to 8, where it was before, and still is, now.
You can get a copy of the complete PI-RADS process by searching for: PI-RADS v2 Prostate Imaging-Reporting and Data System, as published by the American College of Radiology, in 2015. It's an eye opener.
?Harvey