Is biopsy necessary & effective for detecting prostate cancer?

Good to see you are going ahead with the biopsy! I am a little over 2 years since diagnosis and 1 year since RARP.
You did not mention your MRI Pirads score (ie, 1,2,3,4, etc) but my MRI came back negative….zip, nada, nothing! Ultrasound negative as well. PSA was under 2 , but had doubled to that number in a year. Only the biopsy revealed the rather large Gleason 7 cancer. So in my case the contrasting MRI, ultrasound was not even a check engine light! At least whatever you have has imaged on the MRI so they will likely use that to better target the suspicious areas. The biopsy itself is in my opinion no big deal and you will at least know with reasonable certainty what you are dealing with. I hope it comes back negative.
All the best…

@thig350
After I had my MRI done it came back with suspicious area like yours. I was told by my urologist that 70% chance would be cancer. But you can see why biopsies are needed.

What I had at Mayo Jacksonville next was a MRI/Fusion biopsy. They use your MRI images to guide urologist but he/she will do more than (at least mine did) areas other that suspicious). Unless someone had said to me all over going home I would have never known I had biopsies done. I had no discomfort before, during, after. I did see some minor blood specs in my urine but was gone if two days.

Since biopsies are a biological tissue exams not looking at a image it in my opinion is direct diagnosis not interpretation seen on a MRI or CT scan. My biopsies gave me a Gleason Score of 3+4=7, Decipher came back low risk and bone and PSMA test were negative. I had 30 rounds of proton radiation no hormone.

It is not barbaric. I suggest whenever possible to have it done transperineally not transrectal. Transperineally is usually done with anesthesia and transrectal not. Transrectal also comes with a 2% (per my Mayo urologist not my opinion) increase in infection which can be serious. Also for me the anxiety and stress of having it done awake and through my rectum was not something mentally or physically wanted to endure.

I have read on MCC some post about transperineally also allowing more of prostate to be biopsied but that comes from other posts not something told to me personally.

I had my first TRUS BX 2.5 years ago & was peeing bright red blood for 3 days then decreasing blood in urine for 1.5 weeks. I had TRUS BX 6 days ago & not peeing bright red but fair amount blood in urine, but developed high fever 2 days post-op, IV antibiotics in hospital for 2 days & now back home on oral antibiotics for 2 week course with current 99.5 fever. First time I self medicated with Augmentin after BX, but did not this time. I suppose I am unlucky 5%, but would do it again because I need to know if cancer & grade.

In the UK although there are some delays TRUS is thought to be substandard. Tranperineal TARGETED biopsies with US MRI fusion can see the less common
anterior lobe cancers. There are urine and blood tests that can guide in lilelihood of
Pc . If you plan on an MRI find out if the technical details of the machine will allow it
to be AI read by precisionprostate(imaging ?)

My urologist said that the biopsy is the best, MRI second, and PSA last in order of accuracy in diagnosing and treatment planning for PC. Thanks for sharing about the transperineal vs. rectal approaches.

@heavyphil My husband's biopsy according to him was uneventful, although he was numbed beforehand. I had a uterine biopsy years ago and vowed I would never allow another one: very painful! I'm sorry, but it's a crapshoot when we have a medical procedure, it seems.

"Absolutely" have the 12-core biopsy...your life and longevity depend on it. But remember this: the "Gleason Score" obtained from the biopsy is just the tip of the iceberg. There are men like me that had a low-moderate risk Gleason Score of 3+4=7, but surgical pathology examination of your removed prostate can reveal much worse pathology.
My urologist is vehemently against "Active Surveillance" ("You HAVE cancer, it is not going to 'heal' or 'go away', so why give it two years to get worse with Active Surveillance?"). I had the prostatectomy and my surgical pathology report of the entire microscopic exam of the prostate revealed far worse pathology and tumor aggressiveness than the Gleason Score would have ever suggested. A bit of definition and clarity between biopsy and surgical pathology exam of tissue:
The biopsy is a "cytological" lab test. If you observe what is going on, the core samples are injected into their own jar of formalin to preserve the sample. Those 12 jars are then sent to the lab where a Cytotech centifuges the core tissue from the jar, and the centrifugal force deposits those small quantities of cells directly onto a microscope slide which is then removed from the Cytocentrifuge, and is then stained and examined under a microscope. This is done for all 12 cores taken from different parts of your prostate. Even those small quantities of cells from the 12 core samples taken, are not enough tissue to fully diagnose you other than saying: "yes you have cancer" or "no you don't have cancer." And again, the pathologists will rate or classify those cells as level 3, 4, or 5, to yield whatever your Gleason Score will (3+3=6, 3+4=7, 4+3=7, 4+4=8, 4+5=9, etc.). The Radical Prostatectomy is followed with an anatomical pathology examination of the entire prostate. It is frozen and put into paraffin (wax) blocks and serially-sectioned ("sliced") on a microtome in microscopically thin layers of tissue that are then "floated" onto microscope slides (the paraffin is melted away in a hot water bath), and the entire mini-sheet of prostate tissue is stained and examined as a whole..."many, many slides" are examined. It is through these examined slides that things like Extraprostatic Extension (EPE), Surgical Margins, Cribriform Glands, Seminal Vesicle invasion, etc. are revealed. None of that is seen, or is part of, a Gleason Score. Your urologist may also remove some lymph nodes based on a high Gleason Score that could suggest that the tumor has broken out of the membranous "capsule" that surrounds and contains the prostate (EPE), thinking it may have spread to the lymph nodes. So, the Pathologist will also similarly freeze and serial-section the lymph nodes. It is appropriate here to also offer that your doctor should order a PET Scan. You will be injected with a small quantity of Gallium-68 isotope. After one hour of waiting, you'll be scanned from shoulders/neck down to your knees in slow, incremental movement of your body through the open scanner (no claustrophobia). If you have prostate cancer, hopefully all of the detected radiation will be confined to the prostate. For those with higher Gleason Scores and PSA levels, some radioactivity may be picked up in the lymph nodes and/or bones, showing metastasis to those areas. You hope and pray that will not be you. And...(I write this a lot on this blog)...
Make sure your biopsy or a sample of your removed prostate is sent for the Decipher test. This is a proprietary genetic test for 22 prostate cancer-specific genes performed at Veracyte Labs in San Diego, CA. It is "their" proprietary test that no one else does. Depending on what cancer genes your prostate tissue has, the Decipher test yields a "Decipher Score" from 0.1 to a maximum of 1.0...all dependent on which genes you have. You can have some bad cancer genes that will indicate a more difficult journey for you even if your Gleason Score was low. All that means is that you caught the cancer early...but you still have the bad cancer genes. Or...you may have a high Gleason Score, but be a somewhat lucky guy who doesn't have any of the worst cancer genes. The Decipher Score will categorize you and give you numerical percentages for longevity/mortailty at 5-years, 10-years, and 15-years. As an example: My Gleason Score was a 3+4=7 with only 6-10% of cells being graded "4" (a Low-moderate risk that was very close to being a 3+3=6), but my Decipher Score was 0.5 - right smack in the middle, but...I fortunately didn't have any of the really bad genes, so my probability of being alive in 15 years is between ~93-97%. I still had bad pathology to include, among other things, EPE and left seminal vesicle invasion that automatically put me in the more ominous pT3b classification, with a 25-50% likelihood that my cancer will return "within" five years. So, the bottom line, is that you want your doctor and you to have as much clinical and genetic information as is possible, to properly classify your cancer, and more importantly, to plan a treatment program to monitor and control/kill your cancer. Good luck, and again, my advice is to definitely have the biopsy.

@rlpostrp
Your doctor, that won’t consider active surveillance, is one of the reasons they stopped doing PSA testing 14 years ago. Doctors were treating people that didn’t need it, and a 3+3 biopsy is very frequently not cancer. Such arrogance on his part!

It is true that only one percent of the prostate is biopsied but In the case of active surveillance, they usually do it multiple times over years.

The first biopsy I had showed nothing. The second one a year later did show 3+4.

Somebody who has a 3+3 can get a PSE test which diagnoses what’s in their bloodstream and with 94% accuracy can tell whether or not they have prostate cancer.

I know my brother was on active surveillance for six years before his PSA Hit 4+3. He only had radiation and it seems to have worked just fine for him.

I know people that have been on active surveillance for 15 years. Only 50% of the people that are on active surveillance, at some point, need to have treatment because their PSA has started to rise and their biopsy shows cancer.

To say the biopsy is barbaric is pure hyperbole in my view. I found it a 5 day inconvenience before I could get back on my mountain bike. There are out liar events such as infection to be considered like all invasive procedures. I bet dollar to donuts that 98% of the guys in here had successful biopsy's without any unexpected issues.

PSA 15.1 MRI ° came back PIRADS ° 5 also had the PMSA-PET CT SCAN it did show a target, had the Random 12 core Biopsy under general anesthesia painless no side effects. Biopsy negative then the Doctor wanted to due Saturation random biopsy 25-30 cores! I said absolutely not. I requested a Targeted MRI Fusion biopsy, unfortunately they do not do them in Las Vegas, so l am waiting to go to either USC or Mayo Clinic been waiting months no reply from either Hospital .... Did get the PSE test, but the Doctor said he did not trust it? Please let me know your thoughts? It's been pretty rough mentally over the last three years with no end in site......U.S. Air Force Veteran 20yrs Desert Storm 🇺🇸