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

mark4man
Posts: 2
Joined: Jul 2019

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

greenteaguy
Posts: 35
Joined: Feb 2019

I had the MRI first which showed a high probablility of cancer, leading to a biopsy to confirm, which I believe is standard procedure.  Your doctor's order sounds strange to me.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

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
Posts: 456
Joined: Jun 2015

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

Tech70
Posts: 53
Joined: Nov 2017

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.  

Clevelandguy
Posts: 456
Joined: Jun 2015

Hi,

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

Dave 3+4

lighterwood67's picture
lighterwood67
Posts: 207
Joined: Feb 2018

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. 

Shinaid's picture
Shinaid
Posts: 3
Joined: Sep 2018

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.

Damp
Posts: 17
Joined: Sep 2017

I had gone through a boat load of tests and proecedures to determine the reasons for my incontinence.  I had green light surgery over 10 years ago which helped, but only for a short period of time.  It was then decided to do a biopsy, wich determined a gleason score of 6.  I was then give the usual alternatives for treatment.  Since, I was done with all the proding and probing, I elected for the prostatectomy which also included a diverticiulotomy.  I had numerous diverticula one about the size of a grapefruit.  That is when it was decided to do the MRI.  I was glad they did becasue the gleason then went to 7.  My incontinence continues, but I'm cancer free as of over 2 years.  We are all different, and urologists approach each of us to obtain as much information as possible to determine the best course of action.

lighterwood67's picture
lighterwood67
Posts: 207
Joined: Feb 2018

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.

Steve1961
Posts: 245
Joined: Dec 2017

 My thoughts I had a urologist to didn’t know what the hell he was doing unfortunately I had two very painful biopsies. I wish I would have known about an MRI might’ve saved myself those two biopsies because of the pain I waited about an extra six months to get checked which I now regret. My GP told me  my PSA arose and I was told to go see another urologist this urologist numbed the area and the biopsy really was painless make sure you get numbed. But most definitely coming from the top surgeon at UCSF Dr. Peter Carol look him up definitely an MRI comes first and remember  get numbed before the biopsy 

dtidmore
Posts: 1
Joined: Jul 2019

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!

Tech70
Posts: 53
Joined: Nov 2017

Regarding some of the comments about painful biopsys, a urologist is doing something wrong if one experiences significant pain during a biopsy.  I have had three: the first two were essentially painless and the third only a very few "pinches".  If a urologist can't properly place a periprostatic block, I would be very skeptical about any more involved procedures they might undertake.

mark4man
Posts: 2
Joined: Jul 2019

well...

[first of all...thanx for all the knowledgeable replies...first time basck since my original post; & had no idea there would be so much info posted from so many nice folks!]

my prostate MP 3T MRI scan results came in (went that route); & indicate "suspicious lesions".

my frickin' (old-school) urologist seemed to be reading me the riot act over the phone, telling me "I NEED A BIOPSY!" (as if to suggest I shouldn't have messed w/ the MP 3T MRI in the first place...similar to what max suggested). He was however open minded enough to suggest another urologist, who performs an MRI guided biopsy procedure, in the hospital, under general anesthesia.

so...I'm pretty damn apprehensive at this point...the new uro needs me to come in for an appointment/consultation first...so as to establish myself as his patient (but doesn't have an opening until the end of the month). Don't like the delay...but unless I learn something different about this entire process...I guess I'm going that route

mark4man

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

Virtually all biopsies in recent years are at least ultrasound-guided, so the notion that without an MRI the urologist has no guidance in doing the proceedure is false.  Even a "blind" or "matrix" biopsy is designed for very high statistical liklihood of hitting any tumors present.  "Artemis" is a popular biopsy option worth asking about also.  It combines MRI and ultrasound imaging in one computer-blended image for an advance 3-D effect.

Good luck in your progress toward diagnosis, which I know all here still hope is negative (i.e., no cancer).

 

Clevelandguy
Posts: 456
Joined: Jun 2015

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

jeffman
Posts: 25
Joined: Oct 2017

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.

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