Biopsy or not?

I’ve been reading about this in detail. There’s a ton of conflicting information. I called my Urologist today and making an appointment for a biopsy. The VA and my private Doctor are telling me to relax and let’s watch it. The Pi-Rad 3 is disconcerting. I’m just gonna get it done and pull the trigger. I’m inclined to get on this fast and go aggressive.

I stay on top of this constantly. I’ve tracked it for 15 years. I’ve had prostatitis numerous times with the BPH. I’ve always thought someday there’s a good possibility I’d have it.

Peterj116, I had SBRT almost 5 years ago, 9/2000, and had the "spacer" put in so your comment of "that they now put a "spacer" between the bowel & the area getting targeted by radiation" isn't representative of what has been going on for at least 4+ years.

No I am not very helpful to this discussion. I have been questioned by the experts on this site why I reached the decision i did. I also have regrets on the decision that I made. I just didnt ask questions from this group until years later. I went to the Dr in dec 2019 with an uncomfortable urge to urinate. Constantly. A physical exam showed a slightly enlarged prostate. Urologist recommended a biopsy as a first step. My PSA was 1.0. which was normal for me. Biopsy revealed 1 out of 12 samples with cancer. At that point, I panicked. I could not live with knowing I have cancer in me. Dr suggested we do active surveillance. I requested removal. I just wanted it out. No other testing . nothing. I had robotic assisted surgery. Feb 2020. No cancer since. Post op revealed cancer with clean margins gleason 3+3. I suffer from incontinence and ED. My point to you was I had normal PSA . Although I did have cancer

I had 28 sessions of EBRT with a True Beam machine. I had fiducial markers embedded in my prostate to help with targeting the radiation, and I had a SpaceOAR gel pack injected between my prostate and rectal wall to create some separation between prostate and rectum to reduce collateral damage to my rectum.

About mid-way through my treatments, I started to experience greater urgency and frequency of urination, and some discomfort getting the urine flow started. I also noticed that I began having a couple of bowel movements a day rather than my usual one - so I guess there must have been some irritation there. None of this was a really big deal, but for a stretch there, I didn't like to find myself too far from a restroom. I did not experience any incontinence, urinary nor bowel.

30 days post-treatment, the side effects persist, but have eased off considerably.

The 28 trips to the treatment center, plus a couple of setup visits, got to be a bit of a drag, but manageable (I'm retired, so I wasn't trying to squeeze things in around work). I live about 20 minutes from the treatment center and the treatments themselves are quick (< 10 minutes), so I was usually there and back in an hour.

@tuckerp
I tried to post a reply but I clicked something and lost it. So if you get duplication that is why.

I too had a normal PSA but with diagnosis had prostate cancer. Having (per my R/Os, urologist, PCP) a normal PSA does not mean you don't have cancer. Having an abnormal PSA does not me you have cancer. That is why testing is so important if something seems to be a problem to see what that problem is.

On MCC we are not prostate cancer experts. We are not medical experts. Some have had extensive experience and some with a lot of information from studies etc. and want to share with others.

Nothing can replace the expertise of a medical professional especially like those at major medical institutions like Mayo, Cleveland Clinic, John Hopkins, and many others.

The purpose of MCC prostate cancer forum is to share our experiences with prostate cancer, diagnosis, treatments, side affects, etc. , and be inspirations to others. We learn a lot on this journey and can help those by sharing our journeys.

Your biopsies showed cancer and you discussed with your medical experts the treatments and you chose what you wanted for you. That is a pesonal decision on what you personally wanted to do.

It appears your post op revealed prostate cancer was confined to prostate which is great news. The side affects of removal of prostate are for some what you posted.

What you decide is your personal decisions. You did discuss with your medical professionals and chose what you wanted personally. What is important to you and what you wan to do after your learned you had prostate cancer may not be the same for another and is why it is a personal decision.

Good luck and enjoy your life!

If you decide to do the biopsy I URGE you emphatically to do a TRANSPERINEAL one.
With your history of infections you are begging for a whopper if you go with the rectal option. The VA is not known for using the most effective, up to date procedures in my opinion.

I would suggest that you get a second and third opinion read on your MRI. Make sure you have a consistently correct read. PIRAD-3 mean equivocal.........can't tell one way or the other. Your PSA is well within the normal range. If you have a biopsy make sure it's an MRI fusion biopsy so that you have available to you the most accurate targeting you can get for the region of interest to be sampled. You do not want the standard systematic 12 core random sampling (2 cores each from the 6 zones of the prostate). If whatever was found is truly PIRAD-3 I would expect that you have plenty of "safe" time to watch this to see what develops if anything. Make sure you're basing your decisions on the most accurate information/data you can have and that requires second and maybe even third opinions given from centers of excellence. Too much of this MRI interpretation depends heavily on the experience and competence of the radiologist reading and interpreting the MRI images.............and that varies widely. I've lived this inaccuracy first hand. Be sure you've got good reliable assessments.

I hope my comment was not taken offensively. I have become very apprehensive with some medical advice. Various reasons. I think this group offers a very comprehensive look at individual treatments. I have referred to this group as experts as I truly believe that the MCC site offers a much better education than what I receive from the medical field. I do wish I would have used the site more prior to my decision. I may have very well followed the same path but I think I would have asked different question. Keep up the excellent feedback that you provide. It does make a difference.

Hey all, my Urologist gave me some kind of urine test to detect possible cancer before they do a biopsy. I’ve opted for biopsy. I have a single lesion on the transection of the prostate 1.1cm. It’s rated PiRad 3. My PSA is still 2.3, and only minor symptoms. I don’t even get up at night to urinate unless I drink water before bed. My kidney function is great btw. Typically good stream when urinating. I have chronic prostitis and BPH. I’ve requested the new biopsy method you all recommended. I’m hoping this is an early warning and get ahead of this thing.