I believe it's an insurance issue, the biopsy being this least expensive alternative. Do your husband a huge favor and schedule the biopsy to include conscious sedation. If he has it performed without, it will be comparable to an episode in the shower room at any maximum-security prison. It was the most barbaric event I have ever endured. The downside is, you'll need to allow extra time in your day in order for him to recover from the anesthesia, and he can not drive afterward.

I did not have the conscious sedation for my biopsy. It is no day at the beach. Out of the 12 cores that were taken – 2-3 hurt. I was not prepared for the noise that goes along with the biopsy device. It really makes things worse hearing the noise created by the spring.

Did you have an MRI in addition to the biopsy?

I did have an MRI as well after the biopsy. You have to wait a period of time after the biopsy to have the MRI. I believe it was 4 weeks. Maybe 6 weeks. Gives you time to heal up after biopsy and get more accurate MRI. I also had a bone density scan, ultrasound and CAT scan before I started treatment.

The doctor offered the MRI before the biopsy as an extra measure towards accuracy and specificity. If insurance doesn’t cover the MRI, which is $10k, it won’t be done, just the biopsy.

My impressions of reading “Dr. Google” are that: [1] PSA, DRE, PHI, and PCA3 are not accurate. [2] %freePSA is better, [3] 4K & 3TMRI are very accurate. [4] blind 12-core biopsy is not accurate. [5] 3TMRI guided fusion biopsy is better than blind 12-core. [6] 3TMRI in-bore, real-time, biopsy is most accurate. Are those impressions wrong? I am 78, with family history, PSA=9.7, PHI=100, %freePSA=10, 4K=83, and 3TMRI found 2 lesions PI-RADS=4. Should I skip the biopsies and just schedule 3TMRI in-bore, real-time robot assisted partial prostatectomy to remove the 2 lesions? Jerry

Hi @chesstutorjerry and welcome to Connect. You may have noticed I moved your post to this existing discussion so that you and connect with others who have faced similar questions.

I'd like to tag @wizard59, @dmadi61 and @stoney as they have experience with deciding how to diagnose prostate cancer and may be able to offer you support.

Back to you @chesstutorjerry what was your doctor's suggestion?

To Ethan McConkey, Thank you. My urologist wants to do BOTH a random blind 12-core biopsy AND a fusion (not in-bore, not real-time) 3TMRI guided biopsy. From what I have read on the internet: [A] the inaccurate random blind 12-core biopsy was rated a grade of "D", [B] the fusion 3TMRI guided biopsy is more accurate than the random blind 12-core biopsy, and [C] the real-time in-bore (not fusion) 3TMRI guided biopsy is more accurate than both [A] and [B]. My current question is: "Should I skip all biopsies and just schedule 3TMRI in-bore, real-time robot assisted partial prostatectomy to remove the 2 lesions?" Jerry

My impressions of reading “Dr. Google” are that: [1] PSA, DRE, PHI, and PCA3 are not accurate. [2] %freePSA is better, [3] 4K & 3TMRI are very accurate. Jerry