MRI Results: What are the chances the lesion is cancer?

You need to know that there are two biopsy options. The first is MRI guided Transrectal UltraSound (TRUS) biopsy. The second is MRI guided Transperineal biopsy. TRUS which has been around for a long time involves a probe which contains the sampling needles which goes up the rectum and then goes through the rectum wall to access the prostate. The doctor will place some antibiotic gel inside the rectum and the patient must take a Cipro pill prior to the procedure. Shortly before this you must perform an enema at home. How well it is done is very important since there is some risk that some fecal matter could pass through the hole in the rectum wall resulting in an infection/sepsis. MRI guided Transperineal biopsy totally ignores the rectum route. It involves numbing the area between the anus and scrotum. The doctor then (I think) makes a very small incision and with the aid of the MRI, guides the probe directly to the MRI detected spot to take samples. Note that at least 2 Mayo doctors don't even do TRUS anymore. One person on this forum said that more areas of the prostate are accessible with the MRI guided Transperineal biopsy. It is not possible to post a webpage URL, so I will give you the titles of the articles to read as follows: Mayo Clinic Minute: Prostate biopsy technique reduces infection risk (June 13, 2022) and also Ultrasound-guided transperineal prostate biopsy (Nov 05, 2019). I will be consulting with my urologist on Feb 16 about the one spot that the MRI detected and will request a MRI guided Transperineal biopsy along with a whole lot of numbing juice!! Please be sure to connect with the rest of us regarding anything new you have learned. In my case I cancelled my TRUS appointment since they did not offer Transperineal in my area. It's your body, go with what your gut tells you. Knowledge is power.

Sorry, just caught an error in my post. Should have said fusion guided BIOPSY. .

I don’t know if the chances of lesion being positive. On digital rectal exam was prostate enlarged? PSA pattern? age? Your overall health and lifestyle? all these situations create could tilt the opinion but that’s still only a opinion really..
The timing of the process can be stressful as I have been there. Research no dumb questions be your own advocate.. many people do have extreme side effects to Eligard/Lupron myself just a few hot flashes currently in 6th month. With last week of 8 weeks radiation treatments experiencing mild fatigue and that could just be the 4am wake up necessary for daily travel to clinic..
hopefully you and your journey never have the need for either treatment
prayers going

Thank you for your reply! Best of luck to you as you move forward in the process to become cancer free!!

Restarting 4 mos regimen of Orgovyx tomorrow (stopped/ interrupted 4 wks ago after 7 days to "clear" med and retake PSMA PET scan today). Expect /hope to start 8 wks radiation tx w/in next 2 - 3 wks.

Will require 90 im drive each way daily and concerned about fatigue.

Understanding that everyone responds differently; I am concerned/interested in the impact of both therapies, which I will be receiving together.

Your individual experience sounds hopeful and any additional comments would be appreciated.

See Dr. John Mulhall's videos, e.g.

I am considering Dana Farber (Mass Gen) for 5 treatments using the Viewray MRIdian system for prostate cancer. This would require me to fly/drive from the Wash DC metro area to Boston. Do you know if they have agreements with any nearby Boston hotels where patients would receive a discount?

Marriott Residence Inn in Hunt Valley had a Johns Hopkins rate available to me for radiation treatment that I was receiving at the JH Green Spring Station/Timonium MD campus.
I would ask a Marriott property convenient to Dana Farber if they have a patient rate, or any hotel nearby, or ask Dana Farber.
Good luck with your treatment and arrangements.

Yes, the Dana Farber/BWH Mass general hotel deal is the Longwood Inn (I think) just around the corner and mediocre but very suitable.

You have probably already got your results and chose. I had a normal PSA but rising numbers. I did a MRI and showed two areas of concern. I was asked to do a rectal biopsy because of my heart failure but I asked my cardiologist to get involved as there was little risk of cardiovascular event with me my exercise routine.

My urologist definitely wanted to do the more simpler rectal biopsy in his office but I wanted the transpereneal biopsy and anesthesia. I was told there was only a 2% chance of infection with rectal biopsy and only a 2 day hospital stay if got infected. I did not want to add any risk I did not have to and did the transpereneal biopsy. Nothing to it but did find prostrate cancer.

You will have a lot of test and procedures prior to any treatment. It seems like forever and I was getting irritated. Then I read on a prostrate support group that it was standard procedure to wait 4-8 weeks after a biopsy to let prostrate recover from biopsies. That lesson my anxiety a lot but still a real issue with waiting.

Going on my 4th week now of proton radiation treatment. Little or no side effects. A lot of things are mental not the cause of the radiation treatment. Just pick a great provider and great radiologist/oncologist.