Checking for Cancer: MRI or Biopsy...???

Actually, mark4, you got some bad information somewhere.  Only a biopsy can prove a PCa diagnosis. By 'only,' I mean nothing else can or will, including an MRI.

MRIs have important roles in PCa (prostate cancer) treatment, but they cannot confirm a diagnosis.  Unlike green, I never had an MRI at any point in my prostate cancer journey.  My surgeon-urologist and a Radiation Oncologist both said getting one would be pointless.  MRIs give false negatives when viewing the prostate gland as often as they detect anyting. In general, all forms of imaging are close to worthless in spotting the tumors, which are often too tiny to be seen on MRI, CT, or PET scans.  When these tools are used, it is nearly always to look for metastatic or advanced disease, and CT and PET frequently cannot spot PCa, even then.  Everything I ever read anywhere has suggested that virtually all urologist would biopsy a man immediately for a PSA as high as yours, although PSA can waver a bit. But since an earlier lever was established above 5, the 8 may well be pretty accurate.

The side-effects of biopsy are actually very mild, and are usually all gone within a week or less. The bleeding is usually very minimal, when it happens at all. Serious infection occures in a very small percentage of men, but even that is readily treatable. Virtually all urologists give preventitive antibiotic beforehand and after the proceedure.

max

Clevelandguy said:

MRI first

Hi Mark,

MRI first to spot the probable areas and the biopsy to confirm the cancer in those probable areas.  Unless you will be going Active Survalence you should only need one biopsy to determine if you have cancer.  I had mine, very little discomfort and a little blood in the urine for a few days.  The biopsy is usually scarier sounding than it actually is at least in my case. Makes sense to me to do the MRI first to target the biopsy rather than just doing random core samples to hopefully find cancer.

Dave 3+4

After my first biopsy came back positive (<5% of two cores, Gleason 6), I had a 3T multiparametric MRI with contrast, and no lesions of concern were detected.  I have had two subsequent biopsys that were also positive with small amounts of Gleason 6 tissue.  If I had relied on an MRI first, my cancer would have been missed.  Fortunately genomic testing confirms that my cancer is very low risk and I'm follow Active Surveillence.  

Hi, Even though my cancer is related to blood disease,  I can understand the concern of Mark4man about the procedures. But MRI should not be stressful if the medical staff prepares the patient before entering the scanner. A biopsy is though painful, mine was. I am always sorry to hear patients speaking about their concern or pain when going through treatment. Blessings.

Well, I was told the definitive procedure for detrmining prostate cancer is a biopsy.  I had a 3 Tesla MRI prior to fusion biopsy (used MRI results to target suspicious areas).  My surgeon told me that a biopsy without that MRI probably would not have caught my cancer.  I had blood in my semen as a side effect of the biopsy for a while.  After my cystoscopy, my first pee had blood in it and burned.  Hope this helps.  Good luck on your journey.

Last Sept, despite normal DREs, by PSA was found to be 16.2.  My uro, young, top of class, residencies at Mayo, said, mpMRI 1st, as he had seen its value during his 4 years at Mayo.  Came back negative.  Decided to do biopsy.  I chose conscious sedation as I wanted NOTHING to do with the pain aspect.  Came back negative.  Did PCA3 came back 44 (positive cutoff is 35).  Waited 6 month post 1st mpMRI and repeated.  This time a 7-8mm lesion was spotted on the right anterior apex PIRADS 4.  On looking at the location, my uro and his associates all agreed that they would have NEVER found it with ANY systematic biopsy and even knowing where it was, it required active guidance (ie fusion) to direct the biopsy needle successfullly.  Biopsy came back positive, GL 7 (3+4) no other prostatic involvement, no bone, no lymph, no extra capsular indicated.  Retzius Sparing prostatectomy scheduled at KU Med in KC for Aug 30.  We caught mine just before it likely would have involved the external sphincter as well as going extra capsular all due to locatioin.  The mpMRI saved me!

Clevelandguy said:

Opposite results

Hi,

I had the exact opposite than Tech70.  Had the Mri which highlighted probable cancer areas and the biopsy confirmed.

Dave 3+4

The biopsy confirmed the cancer.  The MRI identified suspicious areas.  As I have said before no 2 cases are alike.  So many options.  Looks like Tech 70 is doing fine with his journey with Active Surveillance.  I think that is great.  Looks like you and I are doing fine with our RP's, so far in our journey.  RP's goal is to be curative in nature.  AS approach is based on the facts presented, why nuke or gut the prostate if the Gleason score is less than 6.  Let's monitor the cancer in the hope that it will not spread.  Looks like to me AS is a viable option.  If I had had a Gleason of 6 or less, I probably would have taken that option.  So with that said, best of luck to Tech 70.  Best of luck to Clevelandguy and me.  We gutted ours.  We have undetectable PSA's and are dealing with the side effects.  It is what it is, deal with it. 

Hi.

My humble opinion would be that the Urologist should be able to read the MRI and determine where to take the biopsy samples.  I had a regular MRI with contrast dye and my Urologist used that to sample my biopsy under local anesthesia In the doctor office.

Dave 3+4

I had a biopsy  and , aside from being painless, showed evidence of cancer in only 2 samples. This didn't jibe with my PSA of 45 so an MRI was schedueled. Whole different story.  The MRI showed that the horse was getting ready to leave the barn. Hadn't left yet but was looking around. Had  a meeting with DaVinci and nearly 2 years later and after shedding a few pounds  I remain cancer free and only have minimal stress incontinence. ED is here to stay , but there's moree than one way to skin a cat. I have found that you need to go with the flow and make the best of every day.