Great questions.

My insurance at the time would not cover anything but a standard 12 core US guided biopsy and my knife happy urologist at the time didn’t have the training and facility access for a Fusion MRI guided biopsy. I sought care with another urologist at the same care center who was also a radiation oncologist that performed a 24 core stereotactic US guided transperineal mapping (grid type) biopsies. Insurance wouldn’t pay for that either so I paid the ~$1k difference out of my own pocket to have what I believed was a superior biopsy to the standard 12 core. The pathology found Gleason 6 in one of four cores in the right anterior apex, 5mm discontinuously involving 25% or the submitted tissue. (It’s believed now that the needle “skimmed” the margin of the 1.6 cm PIRADS 4 lesion shown on the pre-biopsy MRI and missed significant high risk disease).

Active surveillance was mentioned as an option but was never recommended over treatment. Focal brachytherapy was recommended with the belief that I’d never have to worry about PCa again. Since my PSA had doubled in 6 months and I was blissfully unaware of the aggressiveness that often accompanies short doubling times I agreed to the procedure. My PSA nadir was only 2.21 and while I expressed concern to my doctor that it didn’t drop lower and almost immediately started rising, I was only assured that I had been “cured” and not to worry. My requests for subsequent MRIs and biopsies were ignored. When the doctor ceased practicing due to medical reasons I sought care elsewhere and was independently advised by no less than 5 doctors at two different centers of excellence that it was their belief that I was under diagnosed and under treated.

Friends have suggested that I consider a malpractice lawsuit against the doctor and the care center that he worked for. I’m undecided.