Remember that PSA is not a cancer test. (In fact, prostate-specific antigen is not even prostate specific.) The PSA number is similar to a “check engine” light in a car; it indicates that something may be wrong, and further checks should be made “under the hood.” Might be as simple as a UTI; might be BPH; might be more serious, such as prostate cancer. Just need to have further checks.

Also, an MRI doesn’t diagnose prostate cancer. With an MRI, they can provide a probability that “clinically significant cancer is likely/unlikely” and assign those suspicious areas a PIRADS score.

So, that leaves the biopsy —> Taking a sample of those suspicious areas is the only way to definitively diagnose prostate cancer. The TRUS biopsy is the old-fashioned way of doing a prostate biopsy.

> Why aren’t they doing a transperineal prostate biopsy?

Yes, some call prostate biopsies barbaric - but isn’t that the case for every invasive procedure or surgery? I’ve had 2 knee surgeries - are those considered barbaric? I’ve had 1 back surgery - is that considered barbaric? I had my gallbladder removed in 2023 - is that considered barbaric? Basically, there is no logical reason to call a prostate biopsy barbaric and not every other invasive procedure or surgery. Common sense should play a role in all this.

(Note that there are two types of biopsies - tissue biopsies (like you’re talking about) and liquid biopsies. That’s a separate lengthy discussion.)

Diagnosed with prostate cancer in 2012, I had four TRUS biopsies between 2012-2021. For my first TRUS biopsy, I drove myself there and back home. Yes, for my first experience it was quite unnerving, but not terrible or traumatic (with enough Lidocaine!). For my fourth (& final) TRUS biopsy before receiving active treatment, I invited my wife to be in the room where the MRI-guided procedure was being done. I wanted her to see that it wasn’t as painful as she was imagining. She said ok; the urologist said ok. So she sat in the corner of the room (towards my head) during the entire procedure. She’ll probably never get that image out of her head!!!