Biopsy Decision

Hi...you can click on my name to see my history and where I'm coming from, but you asked for thoughts, so here's mine...

Catch it early, kill it early!

I didn't...no bueno. Your lesion has already been identified on MRI and can be targeted during biopsy. Why guess? Best wishes.

Just one recommendation. ChatGPT is a good place to fish for information and questions to ask, but nothing it says is conclusive, and sometimes it's flat-out 180° off course because it's just a (massive, surprisingly sophisticated) word-association game with no intelligence, artificial or otherwise.

So by all means, use genAI as a starting point, but *always* verify anything important using credible non-AI sources.

I've seen it hallucinate whole (non-existant) passages from books, flip things to their opposites, etc.

On the bright side, you can ask ChatGPT (or Gemini, or whatever) to give you sources from credible medical sites. But then you need to go and read them, because about 50% of the time (in my own experience) they'll not support the text that AI generated.

And in the end, trust your oncology team (getting second opinions when needed). It's ok to use AI to generate questions to ask them, but don't trust it for actual answers.

I'm not a medical professional so take my layman comment with a grain of salt. First, getting a second read on the MRI is a good idea. But if it's still a PI-RADS 4 the doctor is probably still going to want a biopsy. If the second MRI read is PI-RADS 3 you might consider a PSE test as well for an additional indication as to whether or not it's cancer. But if the PSE indicates cancer or the 2nd MRI opinion is also PI-RADS 4, then in my layman's opinion you're going to need a biopsy (tissue sample) to confirm if it's cancer and gauge it's aggressiveness. But a trans-perineal biopsy is usually well tolerated by the patient. I had one at age 70 and it wasn't a big deal at all. In fact, the next day got in my car for a 10 day road trip and was just fine. If it comes to a biopsy, I'd try to have a fusion biopsy if at all possible so you have better assurance they sampled the lesion. But as @mjp0512 said, if you have prostate cancer and it's aggressive, you really want to catch it early as you'll have a much better prognosis and more treatment options as compared to catching it later. As far as I know the only way to measure its aggressiveness is to look at the cells to determine the Gleason score and a test like the decipher, both of which require a tissue sample (hence biopsy). But as I said, I'm not a medical professional so this is just my laymans opinion. Best wishes.

Definitely get it ...and I'm not going to mess around with this stuff. Going to get a second opinion at Mayo but everything I read referencing the major cancer centers (Mayo, UCLA, Johns Hopkins) advises to hold off on biopsy as risk of infection is effectively equivalent to signficant cancer risk (ie.... 3- 6%) with Pirad 3 and low PSAD. Again --- not going to take AI's word for it but does create a bit of a conundrum for me (would be lying if I said I wasnt' trying to avoid biopsy if at all possible)

Going to see if it's downgraded and hopeful Mayo 2nd opinion can either confirm or refute what I've been reading....appreciate your perspective.

Yours is a textbook example of why 2nd opinions are needed on scan and biopsy results.

What one specialist saw as a PIRADS 4 on your initial MRI, another might have seen as a PIRADS 3. (And there might even be some microscopic 5s that no one sees.)

It’s always a good idea to get a 2nd opinion on biopsies and scans — not because you don’t trust the 1st one or don’t like that opinion. But, because much of the interpretation of images and biopsies is often as much an art as it is a science, and is dependent on the skill and experience of the person reading the scans/slides. It’s good to have an independent set of eyes reviewing anything requiring a medical interpretation or opinion.

Other data to use in making the tissue biopsy decision:
> what is your % Free PSA?

With a low PSAD, your PSA variation might very well be due to your BPH, or a UTI, or prostatitis, or other causes.

I consider any < you name it>GPT tool output no more gospel than a fellowship-trained urologist/oncologist’s opinion. Both pull their data from others’ clinical trials, results, and documented data. But, I would never consider either as absolute truth.

Whether it’s a PIRADS 3 or 4, typically still calls for a tissue biopsy to confirm.

If your hesitancy is actually due to your own ambivalence about getting a tissue biopsy, then ask them to do a liquid biopsy; there are a number of them that can provide additional information for making the next decision.

Instead of “trying a round of antibiotics,” have they confirmed that you have a UTI or some other infection? If it were me, I’d confirm that first before doing unnecessary antibiotics.

This also buys you time to get a biomarker (genomic) test, a genetic (germline) test, and then also another PSA (or PSE) test. Then, you’d have all the data you need to determine next steps.

If it were me, I’d follow all the data collected and then make my own decision, instead of following any < you name it>GPT tool or my urologist/oncologist.

You could get a PSE test, which will analyze your blood for known prostate cancer biomarkers and if it finds you do have them, you should almost definitely have a biopsy.

I would not trust AI to tell you that a PIRADS 4 is a PIRADS 3. You can get an MRI second opinion, But just searching AI is not really 100% accurate medical advice.

I use AI quite a bit and would not trust it to give me medical advice, however as a tool to help you to better understand and ask good questions, it is very useful. You landed here, no more need for ChatGPT/Grok, you'll get personal experiences from those that have been there!

So, I also spiked to 4.8, was 54 when I was diagnosed, also PiRads 3, and opted for surgery with zero incontinence, zero ED and so far so good (10 months in). The biopsy and decipher took me from possible active surveillance to surgery and without those two things Grok and ChatGPT can't be telling you to simply wait. That's analogous to calling a mechanic and telling them that your engine is on fire and him telling you to just let the flames subside and then you are OK again. You need actual medical advice from actual doctors now. Medical pros need to do tests because your Pi-Rads, which your AI seems to think is the end-all diagnosis, is only one of many factors that must be considered and none of us here want you to get worse!

I'm not a physician, but one thing is for sure...you have a lot of time to do your own research and consider all your options....so don't let anyone rush you into a decision.

I was 66 y/o when my PSA increased from 5.06 to 7.8 in 6 months. At that point my GP referred me to an urologist. Five months later my mpMRI showed PIRADS 3, PIRADS 4 and PIRADS 5 lesions and my PSAD was 0.18...I had a targeted MRI TRUS biopsy two weeks later.

The biopsy indicated the PIRADS 3 lesion was benign and the PIRADS 4 & 5 lesions were low volume Gleason 3+3. A 12 core systematic (random) biopsy, performed at the same time, revealed two low volume Gleason 3+4 cores. I never received an entirely satisfactory answer as to how this could have happened, however, the best explanation seems to be that the two more aggressive cores were taken from lesions that were just too small to be seen in an MRI, so called "MRI invisible lesions". Of course, I probably should have had my pathology reviewed to determine if the 3+4 were indeed that....I've heard of cases where a pathological 2nd opinion can downgrade a Gleason score.

In any case, my Decipher score came in at 0.22. I was given potential treatment options and active surveillance was also presented as a viable possibility. I implemented an "aggressive AS" plan, based on the many hours of research I put into the subject. Being a retired chemical engineer who had spent 45 years doing technical research work, made me a prime candidate for the task...but that's just me....

That was over two years ago...I'm still on active surveillance.

In fact, my latest PSA was 5.76 and a 12 month follow-up mpMRI indicated the PIRADS 3 and PIRADS 4 lesions were not able to be visualized; while the PIRADS 5 lesion's T2 and DWI/ADC signals were reduced from "moderate" to "mild". My PSAD had also dropped to 0.13.

We just moved to a new city and I had a first appointment with my new urologist. I think we are on the same page, he's already provided some new ideas and I'm willing to go with his advice concerning the best plan for monitoring my PCa.

My experience (of course) is anecdotal and I'm aware that a small percentage of men, with low PSA levels, can be found with more aggressive PCa. So each man needs to consider all his biomarker data and review it with a well chosen physician who you are willing to trust with your care.

For better or for worse, there is no "one size fits all" answer for men dealing with the unpredictabilities that come with the lead up, the diagnosis and the follow up options related to prostate cancer.

All the best as you consider your best path forward!

@broderbund1
My Mayo Jacksonville urologist gave me the infection rate for biopsy if done transrectal as 2%. If done transpernial was so insignificant was not going to give me a number.

When biopsies are done transpernial at major medica institutions the risk of infection is very very low. I am not sure where you are getting your information on infection rates.

I can only pass on to you what my Mayo Jacksonville urologist stated to me are Mayo statistics uses. This come from decade of experience active, praticing urologist at Mayo Jacksonville.

If you are going to a major medical instutition they are treating patients I would use real time feedback from your prosfessional medical doctors.

@handera
I am had PC. I had a normal PSA of 3.75 when I was diagnosed. My Mayo PCP did not like the continued rise of my PSA over last couple of years and referred me to urologist. That began my journey to diagnosis and treatment for PC.

A normal PSA does not mean a person has PC. Nor does a high PSA mean you have. PSA rising over time is a concern that should be checked and not (which you can see in my case) base in solely on what your PSA number is.

I am posting this not necessarily a reaction to your post but the posts of others and wanted to show PSA is something you use as a warning not a diagnosis of whether you will have PC or not have it.