One reason I transferred my care to an NCI designated cancer center, other than I thought they would provide a higher standard of care, was I thought it likely they would do a fusion biopsy. I was also interested that they use a perineal approach as opposed to rectal. I think they only do perineal. But, it turns out, they only use fusion when they think the circumstances warrant.

My community urologist was going to do his normal "cognitive" biopsy, i.e. he looks at the relevant MRI image and remembers it when he's sticking the needles in, guided during the prcedure by ultrasound.

Anyway, as a new patient with no firm diagnosis, facing a busy time in the NCI center doc's schedule, they offered me a perineal non fusion biopsy several months away.

This was going to be 3 months from when I first saw disturbing MRI results, some ten months from when I saw my first jump up in my PSA reading.

There were lots of reasons for the delay: a few months of me denying the problem, time waiting in line for a new patient appointment with a community urologist who then retired and shut his practice down, time to wait for a new patient appointment with the next community urologist, time to wait for the appointment with the NCI designated cancer center urologist new patient appointment, etc.

I was quite uncomfortable about any further delay. So, I went back to my latest community urologist. His schedule had me getting a biopsy a week later. He then ordered a PET scan. That took place quickly as well. I was glad he had time to do this.

Perhaps the fusion guided biopsy would have been better. But I now had a biopsy result and a PET scan result to show the NCI designated center. Suddenly, I was given an appointment a week later. They decided to redo the "outside" pathologists report on the community doc's biopsy, but they didn't order a new biopsy. They are ordering treatment. I take it they didn't think they'd get relevant info from a new biopsy.

I was glad I took the opportunity to have a biopsy done sooner rather than possibly better and later. I have respect for the community urologist who did it. He had said the MRI had shown a lesion big enough he could not miss it. He found cancer in all the places indicated by the MRI. He did a perineal biopsy at my request even though his usual and faster method is rectal.

I don't regret transferring to the NCI designated cancer center either.

Obviously, your mileage may vary.