Is biopsy necessary & effective for detecting prostate cancer?

@cole5055 I'm surprised in a city as large as Las Vegas, there's no Urology practice that does MRI fusion biopsy. I live in a smaller city and they have them here.

I ended up going to Mayo for my care, but my local urologist said he can do the MRI fusion biopsy, but we'd have to go to another location (a surgery center) to use their equipment.

Not doubting what you are saying, just wondering if maybe there's another urologist in Las Vegas that can do it?

I am with you ☝️ been a long fight to get treatment!

Reading your comments and where you are in the diagnosis process reminds me of my own path over two years ago when I was 54. as My elevating PSA scores lead me to a visit with a Urologist. Had the same exams MRI that was followed by a guided biopsy with 11 cores taken out 10 were cancerous. The biopsy is not a big deal as you are knocked out, it’s an outpatient procedure. After that also had a Pet scan to rule out the spread of the cancer, this showed it was contained in the prostate. Now I’m 57 and nearly 2 years since the RP removal my latest PSA test number last week is as low to zero as possible and that’s the good news. It’s the post RP your recovery you need to worry about. Regaining full bladder control, as well ED have been my biggest hurdles. Wishing you the best of luck in your treatment may your biopsy core samples all come back non-cancerous.

Where do you live such that you are knocked out during a biopsy?
Usually it is done with only local anesthetic injections, at least here in California.
You may be offered nitrous oxide at a price, but it's not a pain reliever, it's just a relaxant.

@jercalif I'm in the US and they put us to sleep.

Here's a couple of articles which will make it clear as mud...
https://www.urotoday.com/conference-highlights/suo-2025/suo-2025-prostate-cancer/165264-suo-2025-reducing-over-detection-in-prostate-cancer-the-case-for-reflex-biomarkers.html
https://www.urotoday.com/conference-highlights/suo-2025/suo-2025-prostate-cancer/165263-suo-2025-reducing-over-detection-in-prostate-cancer-the-case-for-reflex-imaging.html
I'm dated...my diagnosis in 2014 was based on a DRE and TRUS. Biopsy.

Besides being somewhat "embarrassing," as most medical procedures are, the TRUS biopsy was not a big deal. I was given medication to take beforehand to reduce the risk of infection, the procedure itself was not overly painful, afterwords there was blood in my semen for a short time.

What would I do today? Well, certainly not just go VFR direct from DRE to TRUS biopsy!

At a minimum it would be a MRI guided biopsy. I would probably throw in testing for some of the biomarkers I posted about in an earlier response...,

I've learned in my 12 years that a "good amount" of clinical data is useful in discussions and decision making with one's medical team!

What's a "good amount??" That's for you and your medical team to decide! Remember, you are the 51% shareholder in this process, your vote counts! That of course is predicated on your vote being an informed one!

Kevin

@tdgillett
the staple gun metaphor does not sound very good?

to thig350, the guided biopsy is done in the hospital due to the equipment necessary for the procedure. Guided is only done when you have a MRI to direct the biopsy. If there is no cancer to explain your high PSA, then your urologist will want to put you on active surveillance which usually is biopsies every 8-12 months. I did my first non guided biopsy awake in my Dr's office and would never do that again. It's like going back to the middle ages. After I told him I would not do that again, he offered to have it done back in the hospital where they would put me under. If I didn't decide on a procedure, that is the only way I would have it again. Sometime active surveillance seems worse that radiation or surgery. Good luck.

@edtrucks
I had my biopsies 17 and 16 years ago. No such thing as guided biopsy back then. While it was uncomfortable it was not a terrible experience for me. No antibiotics or numbing agents were used. After having it done, I really didn’t have any issues with it after I left the office.

I wonder what it was that made so painful for you. A technique problem?

@jeffmarc
As thig350 identified, people had told him it was barbaric. I agreed. With a real concern of infection going through the rectum to the prostate, my office experience started with a shot of antibiotic to my butt before the procedure that must of hit my sciatic nerve. I could hardly sit down in my car and experienced discomfort for days after. After two shots into the prostate to numb the area and 20 minutes with a large device up my rear taking 16+ samples, I was ready for the procedure to end. I was in a small examination little room in a fetal position on a small gurney facing a wall. When I finished I went to wipe what I thought was lubricant from my bottom only to go through multiple wipes of blood, a lot of blood. My impression of the procedure was that one day people will look back and say I can't believe doctors did this to patients, especially in the 21st century. I associate it with using leaches to bleed people. I'm sure others have had better experiences, but that was my feeling regarding the in office biopsy.