Going for Prostate Biopsy Tomorrow ….Looking for Opinions and Thoughts

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.

@jeffmarc
I did have an MRI first, but it didn’t reveal anything suspicious. The biopsy, on the other hand, revealed cancer. I am very happy with the process my urologist used. If he had decided that the MRI was enough to determine there was no cancer, I could have ended up in a very bad place.

I appreciate all of the replies…thank you.
My biopsy had to be rescheduled that I was supposed to have today, there was a mixup on my appointment. So now I go on 12-11.

I do have another question. Do you think that a fusion guided biopsy is a pretty straightforward and easy procedure for most urologist ?
My urologist is booked up more than a month from now. The office suggested that I can go to another urologist in the office and be seen sooner for the biopsy. He has been there for years…I was hesitant to see someone else but decided to do it so I could get in sooner. The results will be sent to my urologist.
What do you all think about that ?

@climateguy
Hello,

Do you remember how big your lesion was ?
My is supposedly 1.2cm.
I don’t know for sure what it considered large …over 1.5cm ?

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.

@climateguy the three big questions are:

1) what is your Gleason score?
2) is there a Cribriform pattern to the cancer?
3) have cancer cells escaped the prostate gland?

Answers to these plus considerations about you, your medical status any any other challenges, drive your individualized treatment options a decisions. You want o be comfortable with the doc(s) who present your options, and their thoughts about which might be best for You.

My Urologist referred me to a wonderful Medical Oncologist to discuss further. It's good to have multiple docs.

As Jeff noted below, your PSA density is very low which is very favorable in terms of explaining why your PSA is somewhat elevated and slowly trending upward.
For what it is worth, I had an MRI that showed a PIRADS 4 lesion and had a follow up MRI-guided biopsy which included four cores sampling that lesion; those all were negative for prostate cancer. So it is very possible that the lesion that showed up on your MRI is caused by BPH or some other factor other than cancer.
The biopsy itself if really nothing to be all that concerned about - it is a quick procedure and generally well tolerated. The pathology report on the biopsy samples will probably be posted in your medical provider's patient portal before you hear from your doctor so you should make sure you have access to the portal and check it frequently after the procedure.
All the best to you.

@indyguy
Where are you having your biopsies? Are you at a instiution with experienced urologists.

A MRI/Fusion is a very accurate and widely used way to do biopsies. I say that because that is what I had at Mayo Jacksonville. I did have to asked my urologist what it meant MRI/Fusion biopsies.

What it means is the urologist doing the biopsies is using the MRI taken to guide them to suspicous areas. Do you have access to call or portal message to your urologist seeing you about your cocern with having someone else do your biopsies?

I think that would help reduce your anxiety over a different urologist doing procedure. I make this post as that would have been what I would have done if this had happened to me and a differernt urologist was going to do my biopsies that was not the one I have been seeing.

If you are at a large and experiencd medical institutions probably have a wide selection of expereienced urologist but always good to reach out with your concerns to your treating urologist.