MRI Fusion Biopsy?

Posted by kugrad1975 @kugrad1975, Dec 15, 2023

70 year old diagnosed with Gleason 3+3 Prostate Cancer 2 years ago. On Active Surveillance. Total of 2 biopsies, Dec 2021 and Dec 2022. Referred to a regional University Medical Center, and had a MRI with dye contrast. RO saw a small lesion and referred me to a urologist for a third biopsy. The urologist then said the lesion was so small at 4 mm, in a large 70 gram prostate, that it was very problematic he could obtain an accurate biopsy of that suspicious tissue. I am thinking MRI fusion biopsy should be able to give us the tissue analysis we need. Is he blowing me off? Need opinions please!

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jc76 | @jc76 | Dec 16, 2023

A 3+3=6 is the lowest Gleason Score. And usually surveillance. When you had the 2 biopsies done how many biopsies were taken during those procedures?

Usually the MRIs give suspicious areas that a biopsy would confirm. It seems a biopsy of the area would be appropriate to determine if it is cancer or not of the area they are seeing.

What I say on MCC is not to guide you what to do but what I would do if in your shoes. I would get another opinion from another urologist about doing a biopsy and also doing a Decipher test with that biopsy sample.

michaelcharles | @michaelcharles | Dec 16, 2023

What has been your PSA history?
If PSA rising it may be time for a fusion guided biopsy.
Layman response.

jc76 | @jc76 | Dec 17, 2023

In reply to @michaelcharles "What has been your PSA history? If PSA rising it may be time for a fusion..." + (show)

Agree with the suggestion!

kugrad1975 | @kugrad1975 | Dec 18, 2023

In reply to @jc76 "Agree with the suggestion!" + (show)

Had 16 core transperineal biopsies in Dec 2021 and Dec 2022 with only 1 core of 16 showing Gleason 3+3. All other cores were negative. Decipher score of .12 which is low. The major University Medical Center Urology dept wants to do a transrectal biopsy, which I am adamantly opposed to based on my own research that shows the transperineal biopsy route to be the most advantageous. My urologist who performed the transperineal biopsy was much younger and trained at a different urology residency program than the other urologists in the practice where I had original biopsies done. I don't think this practice has the technology to do MRI fusion guided biopsies. Maybe I need to find a urology group who can do transperineal biopsy with MRI fusion. The other confusing aspect of my condition is that my first MRI showed a PIRADS 2 lesion, but it was done with a 1.5 Tesla machine. The most recent MRI (Nov 2023) showed a PIRADS 3 lesion, but was done with a 3.0 Tesla machine. Supposedly a 3.0 Tesla machine yields better analysis of the lesion. Comments or opinion, please!

jc76 | @jc76 | Dec 19, 2023

kugrad, My urologist did not want to do transperineal biopsies because I had heart failure. I also did research on transrectal and was opposed so challenged his decision. I did not want to do transrectal as it had added risk of serious infections and you are awake. I had my heart failure cardiologist get involved and he informed urologist that I was cleared to have the biopsies transperineal biopsies done using anesthesia. It was done transperineal.

The transperineal using MRI Fusion is the most advanced and would highly recommend it if you can get it done. Your 3+3=6 is good and means low risk. It is the lowest numbers given on Gleason scores. Your Decipher test confirmed it.

Is it the lesions that are the concern? I am not sure what all the reasons that can cause lesions. I know my biopsies showed suspicious areas which turned out to be 3+3=6 with only 1 at 3+4=7. Which put me in the intermediate risk. But Decipher test came back low risk so my treatment was based on low risk.

If it was me I would seek out a urologist who can do it transperineal.

jamesharrison | @jamesharrison | Dec 20, 2023

In reply to @kugrad1975 "Had 16 core transperineal biopsies in Dec 2021 and Dec 2022 with only 1 core of..." + (show)

Hi kugrad,

You wrote that “only 1 core of 16 showing Gleason 3+3. All other cores were negative. Decipher score of .12 which is low.”

With such low risk findings, I assume you were doing active surveillance, with biopsies once a year. Is that right? Have you still not done any treatment? Just curious.

By the way, my biopsy was done transperenially with MRI fusion.

kugrad1975 | @kugrad1975 | Dec 22, 2023

In reply to @jamesharrison "Hi kugrad, You wrote that “only 1 core of 16 showing Gleason 3+3. All other cores..." + (show)

Yes, I have been on Active Surveillance since Dec 2021. I have not initiated any invasive treatment yet, based on my RO stating that my Gleason 3+3 and Decipher score of .12 do
not merit active treatment at this time. My challenge is to find a urologist who can perform an MRI fusion biopsy transperineally, as my PSA seems to bounce from 5.7 to 7.7 to 7.0 during the course of 2023 calendar year. My last biopsy was Dec 2022, but it was not MRI fusion.