Biopsy v non-Biopsy: Can you be diagnosed without a biopsy?

I very small study in Germany did this, but not based on an mpMRI and biomarkers.
https://www.renalandurologynews.com/news/urology/prostate-cancer/prostate-cancer-surgery-without-prior-biopsy-possible-treatment/
“In a study of 25 men with a high suspicion for significant prostate cancer based on imaging with multiparametric magnetic resonance imaging (mpMRI) of the prostate and prostate-specific membrane antigen positron emission tomography (PSMA-PET), all patients had Grade Group 2 or higher prostate cancer on postoperative pathology.”

HOWEVER:

“Dr Leapman, who is clinical program leader of the Prostate & Urologic Cancers Program at the Yale Cancer Center, said he interprets the findings with caution “as the consequences of exposing even 1 patient without cancer to prostatectomy is substantial, regardless of how they are counseled. Moreover, widespread use of PSMA-PET and prostate MRI raises questions about long-term cost effectiveness and sustainability.”

I seriously doubt any physician in the US would be willing to treat without having a biopsy confirming the presence of prostate cancer.

My guess is that most physicians would not even order a PSMA-PET scan without a confirmatory biopsy already indicating the presence of prostate cancer and insurance would almost certainly not cover the costs of the PSMA-PET.

If your PSA and mpMRI are suggestive of the presence of prostate cancer, then a biopsy is your next step, as “technically” you have not been diagnosed with prostate cancer until a biopsy confirms that diagnosis.

Is it because your scared of having the biopsy? If so, I too was scared, and just had one done after Christmas, and trust me, it wasnt that big of a deal. I know you have probably read a lot of horror stories on the internet, for I did too, but I got worked up over nothing.

@handera
I met yesterday with the Urologist at the University of Florida Health. They basically said the same thing. I am avoiding a biopsy, that’s all! I will keep plugging away.

@mpersonne
Yep - horrible stories and I have very little trust in the system. 100% Disabled Veteran and use the VA for my healthcare - enough said!

I know a few people that have had this happen. They have no idea what their Gleason score is as a result so the aggressiveness of their cancer is in question, But this is done because their cancer already shows aggression.

This happens when people have serious prostate cancer cases with metastasis that the doctors don’t feel make a biopsy necessary. They immediately start treating the people rather than doing a biopsy.

@csbarry yes, ive heard horrible stories when using the VA. Its sad!!!!!!!!!

@csbarry
You might want to get the PSE biomarker blood test which is 94% accurate in telling you whether you are likely or unlikely to have cancer though your MRI's seem to have confirmed that.

I was put under twilight drugs for my biopsy and there were no issues but the only thing I would change would be to find someone with the right skill set for a fusion biopsy which essentially adds better imaging to the insertion of the probe process.

If you don't like needles for the IV, ask for or buy at least 5% Lidocaine and put it on both arms 20-30 minutes before they put the IV in for your nice little nap.

@csbarry Well yeah, there are always horror stories. I weep in fear when I have to fly, thinking about a recent plane crash; but why don’t I think instead of the MILLIONS of uneventful take offs and landings?
It’s just human nature…
But if a biopsy scares you, death from metastatic prostate cancer should really scare you more! Do you want to have to rush to the ER and have a catheter rammed in cause you suddenly can’t pee? Do you really think that modern treatment is always pain free? Always successful? No vomiting, uncontrollable diarrhea, nausea, urinary blockage???
Believe it brother, there is a shit show waiting for you if you think hunkering down with the enemy advancing is a good strategy…
There are plenty of VA hospitals - some very, very good (friends have gone there) and some not so good (ditto)…find a good one.
Phil

PSE was already mentioned. ISOPSA is another option. That said, you will still want the information in the biopsy before treatment (Gleason score, adverse features, decipher test). I also delayed my biopsy by several months because everything was borderline and some opinions conflicting. The ISOPSA test showed that I needed it. I had heard the same horror stories, but in the end, it was a damp squib. The only thing that I would do differently is to look for a transperineal biopsy.

1) regular PSA testing if it jumps up unexplainably, and up still on retest.
2) EpiSwitch (PSE, Prostatic Screening of Epigenetics) 94% accuracy
3) Multiparametric preferably dye enhanced magnetic resonance imaging [3T mpMRI], if tumor evident,,,
4) Artificial Intelligence 2nd read of MRIs 'Male Scan' by PrecisionProstateAssociates.com ($259.00 if no ins,)
(it can discover less obvious tumors that the eye may not 'see', [comparison with thousands of other MRIs]
5) targeted biopsy by trans perineal ultrasound-MRI, general anesthesia optional. (UK: "transrectal substandard")
6) PSMA PET CT scans to see if ds. is outside of the prostate, plus how strong signal(s) are produced inside,
7) DECIPHER genetic test of bx tissue, ARTERRA AI comparison of bxs to thousands = in Gleason score.
[Both tests: LOW, INTERMEDIATE, and HIGH risk of metastasis

Treatment Planning: Radiation modalities:
8) ProsTox (Miradx ) to see if LOW or HIGH likelihood of DELAYED GU symptoms (sxs) in months/years.
(ACUTE self limiting post procedural sxs are the same for EBRT, (SBRT 5x Tx, MFRT (20x Tx or CFRT 30x Tx)

PS: In My Humble Opinion (IMHO) EpiSwitch (PSE) will lessen the need for repeat bxs.