@thig350 I would ask for a PET scan first...you PSa is not really that high and doesnt at all positively indicate cancer...but should be investigated...even contrast MRI would be a much better first step, IMO..unless you are experiencing lots of blood and DRE indicated nodule...a targeted biopsy might be worthwhile a bit down the road..but it is invasive and may not be necessary

@thig350 I would get the MRI with contrast. You want to know if there is a lesion BEFORE the biopsy. My biopsy was 5 cores out of the lesion area on the MRI and 12 random. 4 of the 5 in the lesion were cancerous. None of the other ones were. They also took a little deeper core out of the lesion area (I assume for a better sample size).

@thig350 Going straight to biopsy is what’s referred to as a “blind biopsy” because it’s just taking blind stabs into the prostate with hopes of hitting something of interest.

Doing an MRI first allows for identification of suspicious areas (and assigning them a PIRADS score - from 1 to 5 - indicating the likelihood of significant cancer being present), and then (if a PIRADS 3, 4, or 5 is identified) doing an MRI-guided fusion biopsy of those suspicious areas (plus a few random areas adjacent to those suspicious areas).

Yes, what your urologist wants to do can be done, but it’s very old-school - the way it was often done in 2012 when I was initially diagnosed with prostate cancer.

Actually, the “strength” of doing an MRI first is that it does not rule out cancer - because its purpose is only to identify possible suspicious areas in as least invasive a way as possible. You want to hold off invasive procedures until necessary.

If you research the modern standard of care for diagnosing prostate cancer, it involves the sequence: elevated PSA —> (sometimes a DRE) —> mpMRI —> MRI-targeted fusion biopsy.

Of course, discuss all this with your urologist.

@thig350 I can only agree with all the men who advised an MRI FIRST before biopsy. Your urologist does not seem to be up to speed on current accepted practices; and if he is THIS out of touch now, I shudder to think what his future treatment of you may hold.
Not saying he’s not a nice guy or a good doctor, but right now you need an excellent one!
Phil

@thig350 yes, I think it is common for physicians to “cover their bases” when it comes to preliminary diagnoses. That being said, it is also common for a patient to react from a perspective of fear or anxiety and assume the worst, even though it was mentioned only as a possibility by the physician. I hope your tests will lead to more clarity for both you and your doctor (s).