MRI before biopsy, & then fusion biopsy if targets found (?)

Likely even now a patient has to really push to get pre-biopsy MRI, fusion biopsy, and probably push even harder to get a trans perineal fusion biopsy.In Australia, all of this is apparently standard practice. Also new is perineal RALP.

On Wed, Jan 21, 2026 at 10:56 AM, Mayo Clinic Connect< nf+ea6bba12+96279614@n1.hubapplication.com> wrote: @media only screen and (max-width:596px) {#yiv0017021154 .yiv0017021154small-float-center {margin:0 auto !important;float:none !important;text-align:center !important;}#yiv0017021154 .yiv0017021154small-text-center {text-align:center !important;}#yiv0017021154 .yiv0017021154small-text-left {text-align:left !important;}#yiv0017021154 .yiv0017021154small-text-right {text-align:right !important;}}@media only screen and (max-width:596px) {#yiv0017021154 table.yiv0017021154body table.yiv0017021154container .yiv0017021154hide-for-large {display:block !important;width:auto !important;overflow:visible !important;}}@media only screen and (max-width:596px) {#yiv0017021154 table.yiv0017021154body table.yiv0017021154container .yiv0017021154row.yiv0017021154hide-for-large {display:table !important;width:100% !important;}}@media only screen and (max-width:596px) {#yiv0017021154 table.yiv0017021154body table.yiv0017021154container .yiv0017021154show-for-large {display:none !important;width:0;overflow:hidden;}}@media only screen and (max-width:596px) {#yiv0017021154 table.yiv0017021154body img {width:auto !important;height:auto !important;}#yiv0017021154 table.yiv0017021154body center {min-width:0 !important;}#yiv0017021154 table.yiv0017021154body .yiv0017021154container {width:95% !important;}#yiv0017021154 table.yiv0017021154body .yiv0017021154column, #yiv0017021154 table.yiv0017021154body .yiv0017021154columns {height:auto !important;padding-left:16px !important;padding-right:16px !important;}#yiv0017021154 table.yiv0017021154body .yiv0017021154column .yiv0017021154column, #yiv0017021154 table.yiv0017021154body .yiv0017021154column .yiv0017021154columns, #yiv0017021154 table.yiv0017021154body .yiv0017021154columns .yiv0017021154column, #yiv0017021154 table.yiv0017021154body .yiv0017021154columns .yiv0017021154columns {padding-left:0 !important;padding-right:0 !important;}#yiv0017021154 table.yiv0017021154body .yiv0017021154collapse .yiv0017021154column, #yiv0017021154 table.yiv0017021154body .yiv0017021154collapse .yiv0017021154columns {padding-left:0 !important;padding-right:0 !important;}#yiv0017021154 td.yiv0017021154small-1, #yiv0017021154 th.yiv0017021154small-1 {display:inline-block !important;width:8.33333% !important;}#yiv0017021154 td.yiv0017021154small-2, #yiv0017021154 th.yiv0017021154small-2 {display:inline-block !important;width:16.66667% !important;}#yiv0017021154 td.yiv0017021154small-3, #yiv0017021154 th.yiv0017021154small-3 {display:inline-block !important;width:25% !important;}#yiv0017021154 td.yiv0017021154small-4, #yiv0017021154 th.yiv0017021154small-4 {display:inline-block !important;width:33.33333% !important;}#yiv0017021154 td.yiv0017021154small-5, #yiv0017021154 th.yiv0017021154small-5 {display:inline-block !important;width:41.66667% !important;}#yiv0017021154 td.yiv0017021154small-6, #yiv0017021154 th.yiv0017021154small-6 {display:inline-block !important;width:50% !important;}#yiv0017021154 td.yiv0017021154small-7, #yiv0017021154 th.yiv0017021154small-7 {display:inline-block !important;width:58.33333% !important;}#yiv0017021154 td.yiv0017021154small-8, #yiv0017021154 th.yiv0017021154small-8 {display:inline-block !important;width:66.66667% !important;}#yiv0017021154 td.yiv0017021154small-9, #yiv0017021154 th.yiv0017021154small-9 {display:inline-block !important;width:75% !important;}#yiv0017021154 td.yiv0017021154small-10, #yiv0017021154 th.yiv0017021154small-10 {display:inline-block !important;width:83.33333% !important;}#yiv0017021154 td.yiv0017021154small-11, #yiv0017021154 th.yiv0017021154small-11 {display:inline-block !important;width:91.66667% !important;}#yiv0017021154 td.yiv0017021154small-12, #yiv0017021154 th.yiv0017021154small-12 {display:inline-block !important;width:100% !important;}#yiv0017021154 .yiv0017021154column td.yiv0017021154small-12, #yiv0017021154 .yiv0017021154column th.yiv0017021154small-12, #yiv0017021154 .yiv0017021154columns td.yiv0017021154small-12, #yiv0017021154 .yiv0017021154columns th.yiv0017021154small-12 {display:block !important;width:100% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-1, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-1, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-1, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-1, #yiv0017021154 td.yiv0017021154small-1 center, #yiv0017021154 th.yiv0017021154small-1 center {display:inline-block !important;width:8.33333% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-2, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-2, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-2, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-2, #yiv0017021154 td.yiv0017021154small-2 center, #yiv0017021154 th.yiv0017021154small-2 center {display:inline-block !important;width:16.66667% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-3, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-3, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-3, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-3, #yiv0017021154 td.yiv0017021154small-3 center, #yiv0017021154 th.yiv0017021154small-3 center {display:inline-block !important;width:25% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-4, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-4, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-4, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-4, #yiv0017021154 td.yiv0017021154small-4 center, #yiv0017021154 th.yiv0017021154small-4 center {display:inline-block !important;width:33.33333% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-5, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-5, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-5, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-5, #yiv0017021154 td.yiv0017021154small-5 center, #yiv0017021154 th.yiv0017021154small-5 center {display:inline-block !important;width:41.66667% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-6, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-6, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-6, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-6, #yiv0017021154 td.yiv0017021154small-6 center, #yiv0017021154 th.yiv0017021154small-6 center {display:inline-block !important;width:50% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-7, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-7, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-7, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-7, #yiv0017021154 td.yiv0017021154small-7 center, #yiv0017021154 th.yiv0017021154small-7 center {display:inline-block !important;width:58.33333% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-8, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-8, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-8, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-8, #yiv0017021154 td.yiv0017021154small-8 center, #yiv0017021154 th.yiv0017021154small-8 center {display:inline-block !important;width:66.66667% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-9, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-9, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-9, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-9, #yiv0017021154 td.yiv0017021154small-9 center, #yiv0017021154 th.yiv0017021154small-9 center {display:inline-block !important;width:75% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-10, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-10, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-10, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-10, #yiv0017021154 td.yiv0017021154small-10 center, #yiv0017021154 th.yiv0017021154small-10 center {display:inline-block !important;width:83.33333% !important;}#yiv0017021154 .yiv0017021154body .yiv0017021154column td.yiv0017021154small-11, #yiv0017021154 .yiv0017021154body .yiv0017021154column th.yiv0017021154small-11, #yiv0017021154 .yiv0017021154body .yiv0017021154columns td.yiv0017021154small-11, #yiv0017021154 .yiv0017021154body .yiv0017021154columns th.yiv0017021154small-11, #yiv0017021154 td.yiv0017021154small-11 center, #yiv0017021154 th.yiv0017021154small-11 center {display:inline-block !important;width:91.66667% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-1, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-1 {margin-left:8.33333% !important;Margin-left:8.33333% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-2, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-2 {margin-left:16.66667% !important;Margin-left:16.66667% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-3, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-3 {margin-left:25% !important;Margin-left:25% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-4, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-4 {margin-left:33.33333% !important;Margin-left:33.33333% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-5, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-5 {margin-left:41.66667% !important;Margin-left:41.66667% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-6, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-6 {margin-left:50% !important;Margin-left:50% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-7, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-7 {margin-left:58.33333% !important;Margin-left:58.33333% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-8, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-8 {margin-left:66.66667% !important;Margin-left:66.66667% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-9, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-9 {margin-left:75% !important;Margin-left:75% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-10, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-10 {margin-left:83.33333% !important;Margin-left:83.33333% !important;}#yiv0017021154 table.yiv0017021154body td.yiv0017021154small-offset-11, #yiv0017021154 table.yiv0017021154body th.yiv0017021154small-offset-11 {margin-left:91.66667% !important;Margin-left:91.66667% !important;}#yiv0017021154 table.yiv0017021154body table.yiv0017021154columns td.yiv0017021154expander, #yiv0017021154 table.yiv0017021154body table.yiv0017021154columns th.yiv0017021154expander {display:none !important;}#yiv0017021154 table.yiv0017021154body .yiv0017021154right-text-pad, #yiv0017021154 table.yiv0017021154body .yiv0017021154text-pad-right {padding-left:10px !important;}#yiv0017021154 table.yiv0017021154body .yiv0017021154left-text-pad, #yiv0017021154 table.yiv0017021154body .yiv0017021154text-pad-left {padding-right:10px !important;}#yiv0017021154 table.yiv0017021154menu {width:100% !important;}#yiv0017021154 table.yiv0017021154menu td, #yiv0017021154 table.yiv0017021154menu th {width:auto !important;display:inline-block !important;}#yiv0017021154 table.yiv0017021154menu.yiv0017021154small-vertical td, #yiv0017021154 table.yiv0017021154menu.yiv0017021154small-vertical th, #yiv0017021154 table.yiv0017021154menu.yiv0017021154vertical td, #yiv0017021154 table.yiv0017021154menu.yiv0017021154vertical th {display:block !important;}#yiv0017021154 table.yiv0017021154menu .yiv0017021154filtered99999 {width:auto !important;}#yiv0017021154 table.yiv0017021154button.yiv0017021154expand {width:100% !important;}}
| ## reply above this line ##
|

|
| |

|

|
|
Mayo Clinic Connect
|

|

|
| Comment posted by @squash05 on discussion "MRI before biopsy, & then fusion biopsy if targets found (?)".

Agree strongly. I had two 12 core needle biopsies over two years apart which showed nothing despite an advancing PSA. DRE was normal. When 24 core was suggested, I insisted on an MRI, which showed the lesion to the anterior part of the prostate, which I like to call "the dark side of the moon" This allowed for a targeted biopsy. When discovered, PSA was over 17 and I had extracapsular extension and Gleeson 4-3. Can't help but think had the CX been discovered 2-3 yrs earlier, might not now be dealing with BCR. This was 11 yrs ago, so perhaps getting an MRI at outset is now standard of care?
| |

|

|
| VIEW & REPLY | |

|

|
| Unsubscribe from this content and see links to review my email settings. | |

|

|

|

@jercalif
I was so glad to read your last sentence!

It is worth noting that the transperineal biopsy (bx) shows the anterior lobe unlike transrectal
I suggest getting an AI 2nd read of the MRI through Precision
Ptostate Associates. My MRI was unable to be ‘read’ digitally. COROLLARY find out if the planned MRI machine can meet
their criteria. They compare your
pics eith 1,000s of others. Normal and cancerous prostate tissue look similar, Dispassionate computer eyes is the future

@thmssllvn Good advice. I am changing urologists to one 3 hours away who does UroNav fusion biopsies, and perhaps he is interested in new information, unlike my original local one (who still does systematic biopsies without doing MRI first, and actually got angry with me when I asked about the fusion biopsy option).

I agree with that statement and I am one of those 8-10% of men that had clinically significant PC with a negative MRI, negative Ultrasound, and negative DRE with a PSA of 2.0. The truth is that with a negative MRI (Pirads 1 or 2) unless you have something else going on they may not want to do a biopsy which was my situation so I offered to pay for my own “blind jab” biopsy after the Contrasting 3TMRI showed nothing …12 jabs later there it was….Gleason 3+4 with about 20%G 4 occupying 20% of the right side of the prostate.
The hematuria (brown spots in semen) that I had been experiencing for a year prior was the dead giveaway for my self diagnosis and the Urologist and other doctors discounted that due to my low PSA and negative MRI.
The other fun thing that happens with MRI negative cancer is treatment options slip off the table.. like focal therapy's
and even the Radiation doctor gets skittish about recommending very precise Proton radiation preferring SBRT so he can “throw a broad net” to the prostate and prostate bed since it is hard to tell from scans where the PC was or whether it had spread. He said surgery might be a better choice as then we would have pathology and know the extent of things and he could follow up with salvage radiation if necessary. I did RARP 14 months ago and final pathology was Gleason 3+4 (30% G4) with negative margins and such. The surgeon said “I was lucky as many of the 10% MRI negative guys dont catch it till it is way advanced”
Anyway, when in doubt, get second and third opinions and if all else fails ..advocate for yourself!

@beachflyer Was the cancer in the peripheral zone? Transitional zone cancers are harder to distinguish on MRI imaging from BPH, apparently.
Actually, it is cases like yours that make me think that radical RALP (which I think is the same as what you are calling RARP) is the best treatment for most patients with well-contained prostate cancer, especially if they have a severely enlarged prostate as I do (82cc=82g).
The only downside to radical RALP that I am aware of is likely loss of sexual function, but that ship has already sailed, in my case...my main concern is urinary retention, and my belief is that a radical RALP could solve my urinary retention problems and my cancer problems at the same time.
I can live with incontinence and lack of sexual function because neither of those hurt or require catheterization, whereas urinary retention can require self-catheterization five times per day, and if a kidney stone lodges in the stricture then it's a midnight trip to the emergency room for emergency catheterization...ouch!... And then they have to figure out how to get the kidney stone out of my bladder, somehow.
I have a friend that had a radical RALP done by Dr. James Porter in Seattle, Washington, and he said that other than having to wear a catheter for 7 days after the surgery, it wasn't a terrible experience.
Was your experience similar?

@beachflyer
Around 5% of prostate cancer patients don’t produce PSA. Makes it difficult to diagnose what’s going on. Can make reoccurrence real difficult to see coming. Probably requires regular scans.

Hi Jercalif,

Great question about location so I just looked at the biopsy report and the 3/4 was in the left apex and left lateral mid. Apparently, PC in the apex is close to pelvic muscles and any muscle movement can blur the image of the lesion. Surgery (RALP) was my best option for a number of reasons with continence being my number one concern. It seems that for most of us, modern surgical techniques have reduced long term incontinence issues and the surgeon I chose at UCI Medical Center had a very good track record in this area and I had zero continence issues when the catheter came out.
To answer your question, yes my experience was similar to your friend. The surgery was not bad at all and I was surprised by the low level of pain in the days following the procedure. I only took Tylenol the first two days mainly for the shoulder pain from the gas they use during the surgery. Prior to the procedure I was starting to have some issues peeing ....due to aging I suppose. After the procedure I can pee like a teenager again so that aspect is great as I am no longer the guy standing forever at the urinal trying to get a stream going! I did not have ED prior to surgery however I have "some" ED now 14 months later. The surgeon told me that sexually, I would be 80% of what I was at 24 months. The question that is tough to answer is where you really are sexually to begin with. All in all, I am happy with the outcome and believe the surgery choice was good.

@jeffmarc

You are correct, my medical team told me "you would do well to get to zero PSA" (aka surgery) so that any recurrence would be easier to spot when compared to determining if something is back that might possibly be masked by PSA falling to NADIR following SBRT.

@ezupcic YES!