I experienced what I thought was an alarming delay in getting a diagnosis after getting an MRI report that stated "PI-RADS v2.1 score 5: clinically significant cancer is highly likely to be present", with "Bilateral seminal vesicle invasion seen".

At the time, I did not understand exactly what this meant if a biopsy confirmed it, but I did understand that an MRI finding of "clinically significant" meant I needed doctors to get a better understanding as soon as I could.

I thought that some centers would offer a fusion biopsy, but when I went to the nearest NCI designated cancer center the urologist I saw gave me an appointment for a non fusion biopsy slated for two months from the date I saw him, which would be three months from the date of the MRI. He said don't worry, data shows that a delay won't affect anything.

I wondered about that. I was doubtful.

I went to a community urologist close to where I lived. I had studied a bit about MRI by then, and saw that studies were still showing a wide variation in MRI reports. The same MRI interpreted by different individuals at the same centers of excellence would be found to vary tremendously. Hence, I thought, the somewhat less urgent attitude displayed by the NCI designated center guy. MRI is taken to indicate a need for further investigation, not diagnosis.

I was able to get in to see a local "community urologist" within a few weeks. I asked about why the NCI designated guy didn't seem motivated to get to the bottom of this very quickly. He said that during COVID, many patients experienced significant delays in getting diagnosis, and a subsequent study (or studies) had found no significant difference in eventual treatment outcomes. However, he questioned the idea that no consequence was likely to come as a result of delay.

He was able to schedule a non fusion biopsy very quickly - the next week or two as I recall. He said the MRI image showed a lesion big enough it would not be possible for him to miss it. He took cores from various areas including the seminal vesicles. The biopsy confirmed the MRI finding and made things more concrete: Grade group III, cT3b, "high risk". The "b" means the cancer was confirmed to have managed to get out of the prostate already by invading the seminal vesicles.

I took this result to the NCI designated center. Suddenly, things were taken more seriously. They gave me an appointment for one week later. At that time, the guy discussed surgery and referred me to a radiologist for consultation.

If in my present state of understanding things, if I was presented with an MRI like yours and things were being held up because the people I was seeing needed MRI data to perform their fusion biopsies and they couldn't get it, I'd pursue getting a non-fusion biopsy.

When my biopsy was performed, it had still proved impossible for the local guy to get the images from my MRI report because it was done at the NCI designated center and there was some kind of incompatibility.

The images were available to me on my laptop as they were posted on MyChart at the NCI designated center. I took my laptop in with me as the biopsy was about to be performed. The local urologist studied the images on my machine, and performed a "cognitive biopsy". His study of the images produced a picture in his mind, and guided by the ultrasound in my rectum, he took cores from the suspicious areas and also cores from some random locations.