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Time from MRI to Fusion Biopsy

CMO2021
Posts: 11
Joined: Feb 2021

Dear All,

 

I am a 55 year old man whose PSA went from 0.9  ng/ml to 2.8 ng/ml in a year Primary Care suggested follow-up  PSA in 6 months which then was 4.1 ng/ml with Free PSA 0.8 ng/ml (2.0%).   Urologist couldn't see me until December 23rd.  Where he noted a subtle difference in prostate testure on DRE.  He schedule a TRUS Biopsy for Feb 17 but I insisted on a  Multiparametric MRI  before biospy which was perforemd January 28th and showed PI-Rad 5 with concern for localized extra prostatic extension.  I have done a lot of  reading and know this is highly suspect for aggressive disease.   Now I am being told the earlies a Fusion Biopsy can be done is March 29th, I am concerned this is too long as I want to be able to move forward with treatment as soon as possible.  It will be almot a year since the initial elevated PSA if I wait tile March 29th.  Not sure if I should just go ahed with the TRUS biopsy or am ok to  wait an extra 6 weeks. I appreciate others experiences.

Clevelandguy
Posts: 658
Joined: Jun 2015

Hi, 

Sounds like the Fusion biopsy is more accurate than the Truss but both types could find cancer.  It's your choice, Prostate cancer is usually slower growing than other types of cancers.  One of the main purposes of the biopsy is to grade the cancer to see how agressive it is. Both types of biopsy should provide you the info needed to move forward. A PET scan is also a good tool to see if the cancer has spread outside of the Prostate.

Dave 3+4

hopeful and opt...
Posts: 2304
Joined: Apr 2009

An MRI guided biopsy is the state of the art. This biopsy is superior to a random 12 core biopsy. This biopsy finds more aggresive cancers than the random. Also with a PIRAD of 5 that indicates that a significant cancer is very likely, you" really"  want  that area targeted. Prostate cancer is very slow growing so the March 29 biopsy date will be appropriate. (Note: you can ask the doctors office to let you know if there is a cancelation for an earlier appointment.

PS As a man who is has been in an active surveilance protocol for 12 years and has had several fusion biopsies, some not exactly on time, there was no concern by my doctor or myself. It worth the short wait for excellence.

During this time continue your research. Keep on asking questions

CMO2021
Posts: 11
Joined: Feb 2021

Thank you for you responses its is nice to have a place to ask questions.  I feel a better about waiting for the Fusion and I did exactly as you suggested and  told the clinic that I am available if an earlier date becomes available due to a cancellation.  Preparing for the worst but hoping for the best as I continue my research regarding the disease and treatments.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3609
Joined: May 2012

CMO,

The wait is a sound choice.  PCa is usually slow-moving, except when it is not.  But this wait is not unreasonable, especially in the current environment.  Your Vector, or Doubling Rate, is of concern.

I was diagnosed with advanced, bulky, Stage 3 lymphoma in 2009, and it was three months thereafter before before my first chemo infusion.  "Waiting" is something the medical industry has perfected.  They have not perfected anything else however -- just waiting.  And, medical administrators, accountants,  and insurance carriers continue to ever-refine and lengthen waiting, still today.

 

I recommend to nubies Dr. Peter Scardino's The Prostate Book.  It was recently updated (2019 edition).   Scardino is former Chief of Surgery at Sloan Kettering Cancer Center, NYC.  He reviews basically every aspect of prostate disease and all therapies.  I do not find him to be biased toward surgery at all in the book, and he reviews R.T., Photon, Active Survellence and H.T. in great detail.  He uses the technical 'verbology,' but then explains all of this in Layman's terms.   It has been a NYT Bestseller forever, and is always available at Amazon or Barns and Noble.

CMO2021
Posts: 11
Joined: Feb 2021

Max,

Thank you for your  note and your suggestion of Dr. Scardino's book.  I will  get a copy of it.  Yes I am concerned about my doubling rate and velocity and is how I got here today after follow-up PSA, Urologist visit in December and a my request for a Multi-parametric MRI and Fusion biopsy vs the TRUSS Biopsy.  The result of the MRI are worrying for me given the potential for Extraprostate Extension.  Trying to take it day by day but hard to get out of my head sometimes.

Thank you,

Chris

hopeful and opt...
Posts: 2304
Joined: Apr 2009

Chris

When we are diagnosed, we all have those negative feelings, Some strategies are to develop knowledge as you are doing. Another one is to surround yourself with upbeat postive people. For example if you attend religious services and the clergyman is not upbeat, change to another facility where the clergyman is upbeat...even if you have to change religions. lol

Clevelandguy
Posts: 658
Joined: Jun 2015

Hi,

Just remember you don't have cancer until the biopsy detects it and its graded by a lab doctor.  Once the results come back you and your doctors can formulate a plan on how to deal with the cancer if you have it.  Stay positive and try and put it out of your mind until you know.  Worrying about it won't make it better or worse.  We all have worring thoughts when our PSA starts to rise but you and your doctors will figure it out with a good sound plan you are comfortable with.  Have a brewski and chill out until  you know more.  Take it from a guy who has already been down the road and is climbing the hill on the other side.

Dave 3+4

CMO2021
Posts: 11
Joined: Feb 2021

Dave 3+4, 

Thank you for your reply it is helping me to keep things in perspective until I have a definitive answer. I'm working on staying positive;some days its  easier then others.  I am also  trying to keep busy so I am not just sitting and worrying.

ASAdvocate
Posts: 153
Joined: Apr 2017

I am seeing some confusion in this discussion of biopsy types.

There are two types of biopsies, transrectal (TRUS) and transperineal (TPUS).  Either can be done with no previous MRI (systematic), or using observed lesions from an MRI (targeted), or can have the MRI images superimposed on the biopsy ultrasound imaging (fusion).

But, "TRUS versus Fusion" is mixing apples and oranges.

CMO2021
Posts: 11
Joined: Feb 2021

Thank you, for your reply.  Originally my urologist setup a TRUS biopsy after my first exam. On doing research on my own I inquired about having a fusion biopsy done.  He noted that often insurance companies won't cover a Fusion biopsy for initial biopsy but he was willing to contat my insurance company and they agreed to the Multiparametric MRI with the plan to do a Fusion Biopsy. So the current pland is to have the TRUS with the fused MRI image on March 31st.  Hopefully this gives  some more information on how I got to where I am today.

 

Clevelandguy
Posts: 658
Joined: Jun 2015

Hi Cm,

Your doing the right thing, gather as much info as you can to make the right decision. Later on you will have confidence that you did your due diligence and made the right choice for you and your unique situation.  Good luck.......

Dave 3+4

CMO2021
Posts: 11
Joined: Feb 2021

After waiting  8 weeks for my MRI Fusion biopsy the results are in and not great mostly Gleason 9 (4+9) and one Gleason 9 (5+4).  Have Bone Scan and CT Thursday and Friday of this week.  Hoping it hasn't metastasized but concerned.  I have appointments set  up at Memorial Sloan Kettering with Medical Oncologis, Radiaiton Oncologist and Surgical Oncologist.   Trying to stay level headed and make the best decision, but need CT and Bone Scan results before I can really move forward but need to make a timely decision due to the agressiveness of the PCA. Any others here treated at MSKCC. 

PSA = 4.1
 
Gland ~ 4.0 x 2.7 x 5.0 cm.
 
Volume = 28.0 gms.
 
PSAD = 0.14
 
PSA2 = 20%

DIAGNOSIS

A PROSTATE, LL APEX; CORE BIOPSY: INVASIVE PROSTATIC ADENOCARCINOMA, GLEASON
SCORE 3 + 4 = 7, GRADE GROUP 2, (5% CRIBRIFORM GLANDS), INVOLVING ONE OF ONE
CORE; 9 MM TUMOR LENGTH (80% OF PROSTATE CORE); PERINEURAL INVASION PRESENT.

B PROSTATE, L APEX; CORE BIOPSY: INVASIVE PROSTATIC ADENOCARCINOMA, GLEASON
SCORE 3 + 4 = 7, GRADE GROUP 2, (5% CRIBRIFORM GLANDS), INVOLVING ONE OF ONE
CORE; 12 MM TUMOR LENGTH (90% OF PROSTATE CORE).

C PROSTATE, LL MID; CORE BIOPSY: INVASIVE PROSTATIC ADENOCARCINOMA, GLEASON
SCORE 4 + 5 = 9, GRADE GROUP 5, WITH INTRADUCTAL CARCINOMA, INVOLVING ONE OF ONE
CORE; 12 MM TUMOR LENGTH (85% OF PROSTATE CORE).

D PROSTATE,
L MID; CORE BIOPSY: INVASIVE PROSTATIC ADENOCARCINOMA, GLEASON
SCORE 4 + 5 = 9, GRADE GROUP 5, WITH INTRADUCTAL CARCINOMA, INVOLVING ONE OF ONE
CORE; 13 MM TUMOR LENGTH (90% OF PROSTATE CORE).

E PROSTATE, LL BASE; CORE BIOPSY: INVASIVE PROSTATIC ADENOCARCINOMA, GLEASON
SCORE 4 + 5 = 9, GRADE GROUP 5, WITH INTRADUCTAL CARCINOMA, INVOLVING ONE OF ONE
CORE; 12 MM TUMOR LENGTH (80% OF PROSTATE CORE).

F PROSTATE, L BASE; CORE BIOPSY: INVASIVE PROSTATIC ADENOCARCINOMA, GLEASON
SCORE 4 + 5 = 9, GRADE GROUP 5, WITH INTRADUCTAL CARCINOMA, INVOLVING ONE OF ONE
CORE; 13 MM TUMOR LENGTH (90% OF PROSTATE CORE).

G PROSTATE, RL APEX; CORE BIOPSY: INVASIVE PROSTATIC ADENOCARCINOMA, GLEASON
SCORE 3 + 3 = 6, GRADE GROUP 1, INVOLVING ONE OF ONE CORE; 1 MM TUMOR LENGTH
(10% OF PROSTATE CORE); PERINEURAL INVASION PRESENT.

H PROSTATE, R APEX; CORE BIOPSY: INVASIVE PROSTATIC ADENOCARCINOMA, GLEASON
SCORE 4 + 5 = 9, GRADE GROUP 5, WITH INTRADUCTAL CARCINOMA, INVOLVING ONE OF ONE

CORE; 3 MM TUMOR LENGTH (20% OF PROSTATE CORE); PERINEURAL INVASION PRESENT.

I PROSTATE, RL MID; CORE BIOPSY: BENIGN PROSTATIC TISSUE.

J PROSTATE, R MID; CORE BIOPSY: BENIGN PROSTATIC TISSUE.

K PROSTATE, RL BASE; CORE BIOPSY: BENIGN PROSTATIC TISSUE.

L PROSTATE, R BASE; CORE BIOPSY: BENIGN PROSTATIC TISSUE.

M PROSTATE, RO1 #1 LM AXIAL; CORE BIOPSY: INVASIVE PROSTATIC ADENOCARCINOMA,
GLEASON SCORE 4 + 5 = 9, GRADE GROUP 5, WITH INTRADUCTAL CARCINOMA, INVOLVING
TWO OF TWO CORES; AGGREGATE TUMOR LENGTH 20 MM (95% OF PROSTATE CORES).

N PROSTATE, RO1 #1 LM SAG BASE; CORE BIOPSY: INVASIVE PROSTATIC
ADENOCARCINOMA, GLEASON SCORE 5 + 4 = 9, GRADE GROUP 5, WITH INTRADUCTAL
CARCINOMA, INVOLVING TWO OF TWO CORES; AGGREGATE TUMOR LENGTH 22 MM (95% OF
PROSTATE CORES).

GeorgeG
Posts: 152
Joined: May 2017

i didn’t get treated there but I met a surgeon and radiation oncologist when I was deciding on treatment. It’s an impressive facility and my research indicated that they are among the most aggressive with radiation /brachytherapy. I think they are a top consideration, especially If you want to get aggressive.

I chose JH for surgery and Mayo for radiation But if I didn’t live in Florida MSK would have still been in the running.

 

George

hopeful and opt...
Posts: 2304
Joined: Apr 2009

Sloan Kettering  is a center of excellence. 
The medical oncologist is the most important member of your medical team,and will lead your medical team. You want the very very best. There are a few who only specialize in prostate cancer. 
At ucla where I am there is a newly developed pet scan, GA68 pet scan that is extremely effective, an improvement over other pet scans in finding spots of cancer in the body. I don't know what advanced pet scan is available at Sloan or adjacent hospitals in the nyc area. You want to seek the very best pet scan. There is a difference in pet scans. 
Things must be done in a intelligent coordinated way for success. 
Best

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