How many cores for a needle biopsy?

Posted by ericp502 @ericp502, Apr 8 11:33am

I have a question to the number of cores during a prostate cancer biopsy.

I had a MRI that identified a Gleason 7+ PI-RADS spot on one side of my prostate. Scheduled a biopsy to confirm and that happened last week.

20 minutes before the procedure I met with my urologist that was doing the biopsy and he said they were going to do 20 - 25 cores. They were going to target the area around where the MRI identified the spot but was also going to cores from the rest of the prostate.

Got my results yesterday and it was good news. Two needles found Gleason 6 (3+3) but no Gleason 7+. The issue I have is they only did 10 cores and only one of the needles was in the area of the spot found by the MRI.

I sent my urologist a message asking why the change from 20 - 25 cores to only 10 cores but he hasn’t answered me yet.

Would you be concerned if they only did a single needle biopsy on the area the MRI spot was found? I was happy hearing the Gleason 6 diagnosis but worried now that they just decided not to do more cores and missed the more aggressive area.

I’m meeting with the Brown Cancer team in a couple weeks and will bring this up as a concern but seems like this biopsy was a waste in my opinion.

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survivor5280 | @survivor5280 | Apr 8 12:15pm

20 is a lot, 10 seems a few. Ask for a PSE test, it will tell you with 94% accuracy if you have prostate cancer. I don't know if it eliminates G6 since that's not really cancer these days but worth it. I'd be concerned that the MRI showed more than the biopsy did.

I do hope that everything is A-OK, I really do, but it sounds like there's some gambling going on and you certainly don't want a gamble here.

topf | @topf | Apr 8 12:22pm

Maybe they wanted to do a perineal biopsy first.

ericp502 | @ericp502 | Apr 8 12:27pm

In reply to @topf "Maybe they wanted to do a perineal biopsy first." + (show)

This was a perineal biopsy. Just before they put me out for the procedure he said they were going to do 20 - 25 cores so no clue why they decided to change that plan. Im just not willing to take a chance on Gleason 6 active surveillance with a single needle core in the area the MRI said was a Gleason 7+.

jayhall | @jayhall | Apr 8 1:00pm

My first biopsy was 12 cores. My second one was 24. For my second biopsy they found an area of concern and took additional cores from that area only and then recored areas from the first biopsy. I would be interested in the answer you get from your urologist.

jeff Marchi | @jeffmarc | Apr 8 8:11pm

In reply to @ericp502 "This was a perineal biopsy. Just before they put me out for the procedure he said..." + (show)

If you can get that PSE test that would really do the job like @survivor5280 mentioned. There are other tests like it (ArteraAI) that your doctor may prefer, That would be better than getting nothing. since you are truly in a quandary.

tom9410 | @tom9410 | Apr 8 9:38pm

My first two MRI's showed two lesions appox 1cm in size. In subsequent biopsies to each MRI , 5 cores were taken from the area of each lesion, along with 12 random cores for total of 22 cores. It is confusing as to why less than half of the pre-stated cores were taken. Definitely worth a further explanation. Good luck clearing up your concerns.

jcf58 | @jcf58 | Apr 9 7:59am

That seems odd that they would only do one core in the lesion. My MRI also showed a single lesion. They took six cores from the lesion and then 12 random. 5 of the six cores in the lesion were cancerous. None of the other cores showed cancer.

garylr | @garylr | Apr 10 11:44am

My understanding is that a "standard" prostate biopsy involves 10-12 samples spread around different sections of the prostate. Not exactly a "random sample," but attempting to check various sections of the gland.

My first biopsy was an MRI fusion TRUS procedure, and they took 13 sample. The doc told me it was 10 samples from around the gland plus three samples that were focused on two areas that looked suspicious in the MRI. Came back with five positives, all Gleason 6.

My second biopsy (about a year after the first) was another MRI fusion TRUS procedure, but it was what my doc referred to as a "saturation" biopsy - they took 28 samples. This followed a couple of upticks in my PSA number and my understanding was that the doc wanted more samples in case the first biopsy had missed important stuff. And in fact, the second biopsy came back with some Gleason 3+4 results.

I noticed when I looked at the report on the second biopsy that some of the 28 samples had been lumped together (I assume because they were taken in close proximity to one another), so it looked like there were results from only 13 or 14 samples. Could it be that this is what happened with your results?