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

I watched this webinar and thought it was interesting about the biopsy decision after a negative or clear MRI.
“In this ASPI webinar, Dr. Mark Emberton (University College London) explains how high-quality prostate MRI (and, increasingly, PSMA PET) is changing the traditional “high PSA → biopsy” pathway. For many men, these tools can help reduce unnecessary biopsies while still identifying clinically significant cancers.”

This may not be completely relevant if you have a pirads 4 or 5 lesion but might give some more context….
“In this ASPI webinar, Dr. Mark Emberton (University College London) explains how high-quality prostate MRI (and, increasingly, PSMA PET) is changing the traditional “high PSA → biopsy” pathway. For many men, these tools can help reduce unnecessary biopsies while still identifying clinically significant cancers.”

This webinar covers this topic for another point of view….In this ASPI webinar, Dr. Mark Emberton (University College London) explains how high-quality prostate MRI (and, increasingly, PSMA PET) is changing the traditional “high PSA → biopsy” pathway. For many men, these tools can help reduce unnecessary biopsies while still identifying clinically significant cancers.

@ezupcic
I saw it too! It was excellent.

A large 2023 study, in the case of breast cancer for women, indicated a 28% higher risk of breast cancer-specific mortality for those women who underwent core needle biopsy, as compared to vacuum-assisted biopsy. So there is evidence of issues with biopsies.

Unfortunately, comparative studies with men and PCa have not been done.

Professor Emberton plans on conducting such research, but (as you might imagine) there’s not a lot of funding available, from the medical establishment, for such.

To be clear, Professor Emberton is NOT against prostate biopsy; his research, practice and POV is that this procedure should be made as rare as possible AND he has demonstrated and continues to research alternative noninvasive MRI based tests to monitor PCa progression.

This is a huge issue for those of us on active surveillance with low risk PCa.

No one wants to be looking at biopsies every year or two for the rest of their lives.

With a full 60%+ of all newly PCa diagnosed men choosing AS this is a major issue.

The demand for something other than biopsy, for men on AS is growing; especially by those like myself who fully understand what is at stake.

The next 5 years of research into viable alternatives to biopsies will be transformative.

@ezupcic
Yes. That is me. Level 4, prostate the size of an orange, high (9.7) PSA, density levels in the 90%, and pain. My MRI says “significant cancer present”. The only biopsy was on the lesion that has doubled in size in the last 4 years. I am 62! My doctor is great but doesn’t care about emotional or mental issues. He is a scientist!

What treatment options are you considering? or are you there yet?

None as of yet! Not sure I will

I had two MRI's last year and 6 PSA tests all fluctuating between 8 and 4. I had to convince my doctor to order the MRI's which showed no focal lesions, Pirads 3 and 2 respectively, characteristics of Prostatitis and an enlarged prostate but my Doctor still wanted to proceed with a standard 12 core transrectal biopsy essentially "blind" and seemed uninterested when I suggested the idea of more surveillance or another biomarker test like the PSE. My doctor is probably technically great at what he does but the lack of interest in further diagnostic testing was frustrating.

Exactly! Mine is the same. They are not concern with emotional, mental, financial issues - only scientific results. I appreciate that but I am the one dealing with the fallout! At 62 I will die from “other” stuff before PC. My doctor at UF Health acted insulted because I would not subject myself to a prostate biopsy and then a removal or “scooping out”. Before he left the room he said “I am a surgeon and treat people with surgery” and he warned me that herbal approaches will badly affect my liver.
At the end of the day I am concerned with quality of life not trying to live to be 116.5 years old. I will die with a hard on! Damnit! lol. Peace