Biopsy scheduled - Questions

Jmar5

Had borderline PSA over the limit for a few years and finally high enough I was told I needed an in office biopsy or MRI.  I went with the MRI, which I guess was good because the Pi-RAD 4 lesion is in the anterior region and likely wouldnt have been caught.  I'm scheduled for an MRI guided transperinal biopsy mid December.  From what I read I have about a 62% chance of having cancer because of the PI-RAD 4, although I dont know if also having an additional PI-RAD2 ups that.

 

I wonder if I should stick with the upcoming biopsy with my local urologist?

If needed, I don't think I'd want to get treatment where I live now but would prefer to go to somewhere that specializes in prostrate cancer treatment.  (MD Anderson, Kaiser, Cleveland, ?)

This makes me question whether I should even have the biopsy here...or maybe it doesnt matter.

Chosing to stick with existing biopsy at least gets me an answer mid December.  Going elsewhere will require me changing my insurance Jan 1 to a PPO that would allow me to go out of my existing HMO network (which only covers the city I live in)

 

Included my test results below...any wisdom of thoughts are appreciated

 

*******************

Age 54

Impression

PI-RADS 4 lesion at the RIGHT prostate base.
PI-RADS 2 peripheral zone, possibly a sequela previous
prostatitis.

Narrative

MRI PROSTATE W WO CONTRAST

CLINICAL INDICATION: elevated psa

TECHNIQUE: Prostate protocol multisequence, multiplanar MRI
of the pelvis with and without IV contrast. Using a large
surface coil small field-of-view images of the prostate were
performed using high-resolution multiplanar T2-weighted
imaging, diffusion-weighted imaging and dynamic postcontrast
imaging. Post processing with DynaCAD software.

COMPARISON: None

FINDINGS:

Prostate size: The prostate gland measures 5.7 x 4.5 x 5.4
cm. 71.15 cc

Central gland: Changes of glandular and stromal hyperplasia.
There is a 1.5 x 1.0 x 0.7 cm lesion at the RIGHT prostate
base with indistinctness and smudginess. This demonstrates
moderate restricted diffusion. This is consistent with a
PI-RADS 4 lesion.

Peripheral zone: Mild diffuse T2 hypointensity with the mild
restricted diffusion consistent with a PI-RADS 2 lesion. No
focal area of avid restricted diffusion seen. There is mild
hyperemia.

Seminal vesicles: Normal.

Extracapsular extension: No neurovascular invasion.

Urinary bladder: Normal.

Lymph nodes: No lymph adenopathy in the visualized pelvis.

Bones: No marrow replacing lesions.

Other: No free fluid in the pelvis.

Old Salt

My thoughts

Assuming your urologist has significant exerience, I would stick with him. 

The insurance issue is complicated. The biopsy is scheduled for mid Dec, but you won't get the result right away. You can ask the urologist when to expect the result, but considering the holiday season, it could be early Jan. We hope of course that no treatment will be necessary, but if therapy is recommended, it will be next year, for sure. 

I do think it's smart to go to a center of excellence for treatment, if necessary. Which one will depend on the outcome of the biopsy and your own study of the issue(s).

ASAdvocate

Biopsy pathology takes one day

Salt, I'm not sure why his biopsy result would take weeks to obtain. For over ten years, all my biopsy pathology reports were written one business day afterward, with the report appearing in MyChart in three businrdx day.

Unless he is in a very remote location, he should be able to (or insist upon) getting his  report within a few days.

Jmar5

Thank

Thank you for the input, now just the waiting.

GoneWest

https://csn.cancer.org/discussion/324338/biopsy-scheduled-questions

I’m 8 weeks post RP surgery. But 4 years ago when my PSA was up over 4 advice given to me was to go to a facility associated with medical research (maybe that’s a “center of excellence”). Was an hour+ drive every time but well worth it I thought. Midway in that journey my urologist FIRST recommended the biopsy, didn’t find anything so we did an MRI as well (also came back clean). But PSA kept going up. Not too long ago we did the reverse order - did an MRI and it came back with a Pi-RADs of 5. Followed that up with a Biopsy that resulted in the 3+4 Gleason, Grade Group 2. Best of luck to you!