Is biopsy necessary & effective for detecting prostate cancer?

@brianjarvis I think that what it boils down to is that if you are in a seller's market then you have to limit your urologist "negotiations" that might alienate your urologist to only the ones that are the most important to you, and since I want a relatively hard to find fusion biopsy I think I'm just going to have to "go along to get along" with regard to the pain, and then once I have my fusion biopsy done I can then see how hard to find the next step will be, and then decide whether it is worth risking alienating my urologist over that next step.
That next step (probably) that I would prefer is a [RALP + suprapubic catheter], but I expect that it might be impossible to find a urologist that will give me a referral for that until it is deemed to be "medically necessary", even if I am willing to pay cash for it. Actually, from my perspective, a truly well-contained prostate cancer might be a better biopsy result for me than a "no cancer" biopsy result, because cancer might entitle me to a RALP, whereas no cancer won't.
If it were breast cancer, I could do an Angelina Jolie and have a prophylactic removal, but that isn't normally done for men's prostates, and I understand the reasoning...my prostate isn't isolated and exposed like a woman's breasts are, and so it's a far more risky operation than a double mastectomy (I assume).

@jercalif There are a number of focal therapies you could look into that simply ablate the cancerous tissue by ultrasound, freezing, heat, or water vapor/pressure.

Not quite like a breast cancer lumpectomy, but about as close as you’ll get.

@derbydog71
You wrote: "My urologist said that the biopsy is the better route to go instead of an MRI".
Hopefully you mean that he was recommending a biopsy as opposed to an MRI WITHOUT a biopsy? Yes, an MRI alone is not good enough, at least not currently. But an MRI plus biopsy... preferably a targeted "fusion" biopsy...is better.

My original urologist wanted to go right to a systematic biopsy without doing an MRI or even mentioning the existence of fusion biopsies, transpirennial fusion biopsies, etc.,...and why would any ethical and competent urologist recommend to a patient to do an untargeted biopsy when targeted biopsies are available? I still haven't found the answer to that question, but whatever the answer is I would consider it malpractice to not at least mention alternative superior procedures to a patient.
I'm not suggesting substituting an MRI for a biopsy, I'm just saying why do a "blind" systematic biopsy when an MRI at least offers a chance at finding some targets to shoot at, in addition to the systematic samples.

@brianjarvis I think that what it boils down to is that if you are in a seller's market then you have to limit your urologist "negotiations" that might alienate your urologist to only the ones that are the most important to you, and since I want a relatively hard to find fusion biopsy I think I'm just going to have to "go along to get along" with regard to the pain, and then once I have my fusion biopsy done I can then see how hard to find the next step will be, and then decide whether it is worth risking alienating my urologist over that next step.
That next step (probably) that I would prefer is a [RALP + suprapubic catheter], but I expect that it might be impossible to find a urologist that will give me a referral for that until it is deemed to be "medically necessary", even if I am willing to pay cash for it. Actually, from my perspective, a truly well-contained prostate cancer might be a better biopsy result for me than a "no cancer" biopsy result, because cancer might entitle me to a RALP, whereas no cancer won't.
If it were breast cancer, I could do an Angelina Jolie and have a prophylactic removal, but that isn't normally done for men's prostates, and I understand the reasoning...my prostate isn't isolated and exposed like a woman's breasts are, and so it's a far more risky operation than a double mastectomy (I assume).

@brianjarvis To me, the barbaric aspect is the fact that it is usually done without general anesthesia (nor spinal anesthesia)...but that's just my opinion.

@brianjarvis
I echo your post.

I have PTSD anxiety/panic disorder and I wanted my biopsies done transperineally with anesthesia. My urologist (was at Mayo) wanted to do transrectal as I was a heart failure patient and pushed me to have it done transrectal. My opinion was he wanted to do transrectal as was not as complex as transperineally done in surgical section versus a special office setting.

I did not accept his insistence and contacted my heart failure doctor about his stance. My HF doctor and I knew I had no restrictions on having anesthesia as had had it several times and just weeks prior for a colonoscopy. I had my HF doctor contact the urologist and advised him cardiology had no restrictions on me having anesthesia.

My urologist informed me he had been contacted by HF doctor and would schedule me for MRI/Fusion procedure with anesthesia.

So like you said, stand up, speak, get what is best for you when you have options. I also did not want the additional increase in infection (was told 1-2%) if it could be avoided and did not want it done transrectal.

I don't think the transperineally is barbaric but a very specific and precise surgery. It confirmed I had PC when my MRI just showed suspicious areas.

Some on MCC had no problem having it done transrectal and that is their decision to make.

I initially hesitated to tell of my experience yesterday with my mri guided fusion biopsy because I thought it might scare someone from having one who NEEDED one. But I guess we must all be honest on this forum. I received the antibiotic shot on right hip while laying on left side. My doc is the head of urology at my clinic in Houston. The actual biopsy went as planned ,as some have described. It was not exposed except for my butt.Uncomfortable of course,but manageable. Pain around 3 on a 10 scale. The shot in the hip was worse. The nurse said it was a penicillin derivative which most of us old guys are familiar with from back in the day. Rather painful. However the ride home was one to remember. I bled though my underwear and jeans ,through a jacket I hurriedly put under my butt to protect my seat.( didn’t help) I felt a powerful urge to move my bowels and when I couldn’t hold it anymore…….i let loose. I let loose four more times while driving myself home. Took about an hour. Got home and investigated. No stool just liquid. I thought they must have squirted a volume of saline in me. But I guess I am a bleeder. What a ride home ! Of course I called the doctor. He seemed more concerned about infection. Amazingly(this happened yesterday) I took no pain meds yesterday and today. Feel fine.