MRI fusion biopsy or nah?

Posted by vincenzo66 @vincenzo66, Oct 16 4:30pm

Hi - I posted earlier about a spike in my PSA over one month from 4.7 to 10.7. I had an MRI done and they noted a PI RADS 3 lesion without noted bone or lymph node pathology. The local urology group wants to biopsy it - and that’s fine - but doesn’t have MRI fusion technology. The clinician who is an experienced guy said there’s a paper out there that says that the incremental benefit of the fusion biopsy vs the traditional ultrasound transrectal biopsy done by an experienced practitioner is very marginal. Of course this is a little self serving. I can likely drive a few hours and have state of the art at a UC urology center. Is it worth the drive or is he generally correct?

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peterj116 | @peterj116 | Oct 16 4:45pm

Personally, I'd go for the MRI option.
Overlaying the MRI scan enables them to target areas of interest more accurately.
That's what I had done, anyway.
Mine was PI-RADS4. Your doesn't sound quite so bad, so it sounds like you have the luxury of choosing the best procedure.

But that's just me.
Here's some experts:
https://dailynews.ascopubs.org/do/transperineal-fusion-biopsy-superior-transrectal-approach-detection-high-risk-prostate.

jeff Marchi | @jeffmarc | Oct 16 5:27pm

Your PIRADS 3 lesion is marginal for being cancerous, But to hit it directly with at least three samples would be more accurate with MRI than without. If you can get that biopsy without a lot of difficulty, it could very well be worth doing, as @peterj116 said.

retireditguy | @retireditguy | Oct 16 5:41pm

I'm not a medical professional, so take my layman's opinion with a grain of salt. Early last year when my MRI came back as PI-RADS 4, my (young) urologist said he'd be happy to do the biopsy. He then said "but if you were my dad, I'd tell you to drive the 5 hours to where they have the fusion technology". I appreciated his integrity, although part of it may have been he has a very busy practice with HMO patients who generally don't have a choice. I did make the drive as I really wanted to be as sure as possible they hit the tumor. Part of my concern was if it comes back "clean", then I want to feel really comfortable that they had sampled the tumor. I didn't know about the PSE test at the time, which (if it's an option for you) would be another independent method of determining if you have prostate cancer. But knowing about the PSE test, I think I still would have made the drive because that fusion biopsy had an addition beneficial side effect; it exposed me to the high quality level of care available at Mayo Phoenix. I was so impressed with the care I received getting the biopsy, that after my diagnosis Mayo was on the short list of where I considered getting my primary treatment. I did return to Mayo for my primary treatment and the results have exceeded my expectations. So yeah, I'm really glad I listened to my local urologist and drove 5 hours to a CCOE for the biopsy. Best wishes.

surftohealth88 | @surftohealth88 | Oct 16 5:54pm

MRI guided AND transperineal by all means !!!

vincenzo66 | @vincenzo66 | Oct 16 11:33pm

I appreciate all the perspectives. Think I’ll drive to UCSF. Best wishes.

bens1 | @bens1 | Oct 17 5:11am

I agree with all the guys. Getting a good set of samples is important. Get the fusion biopsy.

jcf58 | @jcf58 | Oct 17 7:55am

Definitely go for the Fusion. I watched my urologist circle the lesion and then take 5 cores out of it. She then took 12 random samples. 4 of the 5 in the targeted core had cancer. None of the others did. I happily made the 2 hour drive to Mayo for my treatment.

pdcar4756 | @pdcar4756 | Oct 17 9:39am

You might also consider a PSE test to add further confirmation of the possibility of prostate cancer.

thmssllvn | @thmssllvn | Oct 17 10:06am

I had the perennial US fusion MRI targeted biopsy. It found a 9mm lesion in one sample and two other smaller ones 3/3, 3/4 10/15% of cores. Nine were clear. I was neither told in advance that a general anesthetic would be used nor obviously did I have anesthesia pre-procedure consult. The read of the one sample targeted lesion was 4/3 50% core filled. A second read kicked it up to 4/5. ( I suggest: Discuss how many samples US anticipates taking of the target lesion given 'X' mm as found on the 3T mpMRI . BTW: I saw the non-Medicare bill. 35K, approved 7K, paid 5K, my portion 1.5K.

Wow and one target lesion sample did not correctly estimate its 'classic' Risk category. Decipher and Arterra were both intermediate. PSMA PET CT showed no obvious mets (>2,5mm) The target lesion SUVmax was 15 which was more consistent with the 2nd biopsy read. The two other 3, 4SUVmax.

kenk1962 | @kenk1962 | Oct 17 11:29am

I'd recommend going for the fusion biopsy. That's what I did and I'm glad.

I had two MRIs separated by 18 months. Both MRIs reached PIRADS 3 "indeterminate" conclusions despite my continual PSA climb (from 5.5 to 6.8 and, after the biopsy 8.1).

Biopsy result: Plenty of positive biopsy cores (9 positive out of 13) and an overall Gleason 4+3 unfavorable intermediate classification.

By doing the biopsy with the fusion the procedure accurately pinpointed the single point in my prostate where suspicion existed -- a single Gleason 4+3 lesion. Each of the other eight positive biopsies were of the lower Gleason 3+4 classifications.