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Is biopsy necessary & effective for detecting prostate cancer?

Posted by thig350 @thig350, Jan 15 7:21pm

So, 57 years old and received a PSA of 11.7. Since then, I did some research and got my legs under me and had my Urologist order an MRI with contrast but said he would most likely order a biopsy regardless of the MRI results to better ensure whether or not PC is present given my elevated PSA level.

MRI results came back "suspicious for PC along with prior PSA level." I am now scheduled for MRI targeted TRUS biopsy in a few days that incorporates the MRI images.

So, self-guided research is great for the most part but now I've read comments that the biopsy is barbaric, that the MRI alone is good enough to assess presence of cancer, that the biopsy is the gold standard for determining the presence of cancer...

My personal common-sense meter tells me that it makes sense to obtain samples of the prostate and get it under the microscope. I'd be interested in hearing thoughts on this from those of you who have actually been through the MRI and the what sounds like the "wonderful" biopsy experience - is the biopsy a good tool to assess PC presence and next steps or is it just medical check the boxes so to speak?

Thank you in advance.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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cole5055 | @cole5055 | Jan 29 7:50pm

I am totally with you! PSA 15.1 MRI ° came back PIRADS ° 5 also had the PMSA-PET CT SCAN & MRI both showed a target, had the “Random” 12 core Biopsy under general anesthesia painless no side effects. Biopsy negative then the Doctor wanted to due “Saturation random” biopsy 25-30 cores! I said absolutely not. I requested a Targeted MRI Fusion biopsy, unfortunately they do not do them in Las Vegas, so l am waiting to go to Mayo Clinic been waiting months I did finally get scheduled Mar 12 -2026.... Did get the PSE test, but the Doctor said he did not trust it? Please let me know your thoughts? It's been pretty rough mentally over the last three years with no end in site......U.S. Air Force Veteran 20yrs Desert Storm

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yarddogman | @yarddogman | Jan 29 9:18pm
In reply to @jc76 "@yarddogman First so sorry you had this experience. I see you had MRI Guided Fusion. Did..." + (show)
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@yarddogman
First so sorry you had this experience.

I see you had MRI Guided Fusion. Did you have it done transrectal or transperineally?

Normally (can only advise what Mayo Jacksonville does) transperineally is done with anesthesia and thus you would not be awake. Transrectal biopsies are done through your rectum where transperineally is done through the perennial.

From your post I assume you had it done transrectal is that correct? I did not have transrectal as I posted. Could they have used as enema to clean you out? Would be something to asked. Again did not have transrectal so if you had it done that way can't give you my experience with it but your post does not seem to be the norm I have seen on MCC

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@jc76 I was done transrectally. I gave myself an enema the early morning of. My biopsy was at 3:00 that afternoon . I called when I got home and they said nothing additional was added during the procedure. I just cannot imagine what caused that eruption of liquid. Anyways , I am not 100%, and a little weak but no pain. As everyone else here has experienced I am in the position of waiting for the report…. I am grateful for this resource

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jc76 | @jc76 | Jan 30 6:24am
In reply to @yarddogman "@jc76 I was done transrectally. I gave myself an enema the early morning of. My biopsy..." + (show)
Profile picture for yarddogman @yarddogman

@jc76 I was done transrectally. I gave myself an enema the early morning of. My biopsy was at 3:00 that afternoon . I called when I got home and they said nothing additional was added during the procedure. I just cannot imagine what caused that eruption of liquid. Anyways , I am not 100%, and a little weak but no pain. As everyone else here has experienced I am in the position of waiting for the report…. I am grateful for this resource

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@yarddogman
The eruption may have been caused by left over enema liquids or product. Did you use something in the enema?

Did they require you to do an enema? Did they give you the liquids for enema, or pill type?

How much stress were you under? I know my wife when she has a lot of stress and anxiety has what she calls explosive diarrhea.

The explosive diarrhea could cause the weakness. Just from experience my doctors have warned me to drink a lot of liquids if you have diarrhea. Don't get dehydrated

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jeff Marchi | @jeffmarc | Jan 30 10:50am
In reply to @cole5055 "I am totally with you! PSA 15.1 MRI ° came back PIRADS ° 5 also had..." + (show)
Profile picture for cole5055 @cole5055

I am totally with you! PSA 15.1 MRI ° came back PIRADS ° 5 also had the PMSA-PET CT SCAN & MRI both showed a target, had the “Random” 12 core Biopsy under general anesthesia painless no side effects. Biopsy negative then the Doctor wanted to due “Saturation random” biopsy 25-30 cores! I said absolutely not. I requested a Targeted MRI Fusion biopsy, unfortunately they do not do them in Las Vegas, so l am waiting to go to Mayo Clinic been waiting months I did finally get scheduled Mar 12 -2026.... Did get the PSE test, but the Doctor said he did not trust it? Please let me know your thoughts? It's been pretty rough mentally over the last three years with no end in site......U.S. Air Force Veteran 20yrs Desert Storm

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@cole5055
The PSE test is 94% accurate. I would question working with a doctor that didn’t trust the test. Considering the fact that you can’t even get a Fusion biopsy this guy must be really out of date.

Sometimes the best thing you can do is find another doctor, Good to see you’re working on that.

You’ve not given any information about the test results. What did the PSE test show? Did the MRI find any PIRADS 4 or 5 lesions?

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cole5055 | @cole5055 | Jan 30 12:00pm

Hi Jeff,

Yes, I totally agree 👍🏻 he would not share any of this information? Which gave me a lot pause… He wanted to go directly to the prostatectomy! And stated he was a surgeon. Yes he said it did find a Pirads five lesion and I was able to see it on my last MRI he insisted I do another 25-30 Random Biopsy which I am sure would have been negative also! So I asked are we going to keep doing Biopsies until we find something? He looked at me like a deer in the headlights……. He did make a referral to Mayo for me which I was very grateful for……..

I did finally get an appointment at Mayo for the fusion biopsy Mar 2-2026 thank you God 🙏 I had been fighting with the VA to go to Mayo for the last three years they said absolutely Not! there was no funding available.

Well that all changed when I turned 65 in September as a 20 year Air Force veteran I now have A&B & Tri care for life which enabled me to go to Mayo. It’s sad that is is all about money 💰

Thanks for your reply
Ray 😊

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ddavid | @ddavid | Jan 30 11:23pm

Yes, a biopsy is the best way to assess the extent of prostate cancer. No, it is not barbaric. It is not pleasant either. I had transrectal by a urologist who had the touch of a blacksmith. I did have an infection afterwards that lasted several unpleasant days. Still it gave me the answers I needed to make my plan to address the cancer.
Some are urologists are better than others, when I had my radiation markers implanted through a similar procedure the pain and discomfort was remarkably less.

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edinmaryland | @edinmaryland | Jan 31 7:54am

I am no expert
in my case PSA was rising and then I had three biopsies over a year or two ( on active surveillance)
the biopsies can detect location within the prostrate. At one point I may have been eligible for partial ablation ( I hope I have this correct) this mean I could have had a procedure where part of my prostrate was frozen and burned or burned and frozen?0 instead of having the entire prostrate removed. This is an oversimplification I am sure but in my case knowing where the cancer was ( what quadrant and still inside the prostrate guided some important decision
it is far from pleasant getting these biopsies ( 15-20 little 'pricks' that you do feel however fighting cancer trumps this discomfort in my opinion
I ended up getting RARP and it seems -for now at least- that the cancer was contained inside the prostrate

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surftohealth88 | @surftohealth88 | Jan 31 7:30pm
In reply to @jercalif "@brianjarvis I think that what it boils down to is that if you are in a..." + (show)
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@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).

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@jercalif

Angelina removed both breasts and both ovaries .
She has BRCA1 gens which put her at extremely high risk of developing breast and ovarian cancer.

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