MRI Fusion Biopsy?

@kugrad1975
I have Microsoft Co-Pilot. It is a A.I. tool I get with my subscription to Microsoft 365.

I can type in institutions and urologist in my area who do transperineal prostate biopsies. It will then come back listing them.

I am not sure if you have access to A.I. but a tool that can help you find a urologist or institution close to you that offers transperineally. Just now that some urologist will lean toward transrectal versus transperineally as are more familiar and experience with one or the other.

There are differences in abilities of both and also increased infections rates with transrectal and how the procedures are done. That information would be best to come from your urologist and your research on each as you will get very different opinions on MCC. But that is good as you hear both pro and con on both.

@jc76 Thank you-I am in the clear with regards to the heart. I was curious about how the transperineal approach worked for you, if there was much post operative pain, bleeding, etc.?
I assume that they did not put you under general anesthesia, but just used local injections of pain killers?

@drcopp
Glad to give you my experience with this. My transperineally biopsies were done with anesthesia. I think anesthetist use different type of anesthesia depending on the surgery. However I was not awake so what ever they used I has no conscious awareness of the procedure prior to, during, after and when awoke had to be told over.

I do know I had I.V. and anesthetist was there talking to me prior to going asleep. He was assuring me he was there if anything came up. I am a heart failure patient with ICD/Pacemaker. I just had this anesthesiologist week prior at a colonoscopy.

I had zero post operative pain. Would not even known if had the biopsies if they did not assure me it was over. Nothing of discomfort, or irritation after, even days after.

My urologist did want to do transrectal because I had heart failure. However I had anesthesia many times prior to biopsies with procedures colonoscopy. I got my heart failure doctor involved. HR doctor advised urologist there was no contradiction with me having anesthesia. Thus urologist then changed to transperineally using MRI/Fusion.

I did not want transrectal. I did not want to be awake with knowing up in colon and feeling the procedure. I also did not want the increase risk of infection. My Mayo Jacksonville urologist said that increase risk was 2% increase. I have read others being told they were told or read 1-2%. I go by and post what my medical doctors tell me directly and what Mayo Jacksonville uses as statistics.

Great report, thanks so much. Did they do small arthroscopic type incisions along your bottom of your pelvis/belly region?

@drcopp
Are you asking jc76?

If so I have no idea? I was out (thank God!). I just know I had no irritation, no pain, even days weeks after. I think, but not sure, he took 22 different biopsies. I am off probably a couple either way as don't have the report in front of me as I typed this.

The area they briefed me they were using to access the prostate is called the perineum. Thus the term transperineally biopsies. It is the area between your anus and your Scruton (spell? the sack that your testicles are in).

@jc76 Yes, jc76 thanks.

@jc76 I had the Fusion transperineally biopsy. I was awake and they gave me 4 or 5 lidocaine shots for pain. They use some kind of transponder in your butt and go directly to the lesion as noted on my MRI. They took core samples there and then 12 other “random samples” in other places. It wasn’t painless but I didn’t have any bleeding or infections. Go back to see the dr on Wednesday. 14 cores with 7 positive. Gleason scores all 3+4=7 and one 3+3=6.

@kennyo
I had read and my urologist at Mayo Jacksonville mentioned some urologists now doing the biopsies transperineally without anesthesia.

Not for me though would like to be out. Some of us, like me, just have to much anxiety and stress over procedures. I wish I did not feel that way but we are all different. I developed PTSD back in 2015 and it caused a anxiety/panic disorder. Take medications since then but I work really hard to keep the stress and anxiety down as much as I can.

You probably are going to get a lot of choices for treatments. I had additional test done to help R/Os decide which treatments I needed and options. If you urologist or R/Os does not mentioned additional test asked them about Decipher (will give you a more accurate risk level), PSMA (see if cancer has spread. Many many more advances in other tests but not familiar with them.
Good luck,

@kennyo Would advise LOTS of homework - and a Decipher test - before you make any decisions regarding treatment.
I don’t think AS is advisable with so many 3+4 cores, but you are in a kind of gray area, as is the case with most intermediate grades.
Certain biopsy findings - cribriform cells , intraductal carcinoma (IDC), and a Decipher test for aggressiveness, are critical in your decision making: choice of surgery vs radiation.
Many men choose surgery if their cancer is deemed more aggressive and has a higher chance of returning; radiation can then be used as a salvage treatment.
However, if you have a less aggressive form of PCa, radiation may be a better way to go ( factoring in your age, medical status, etc)… if you wish to avoid surgery.
Bottom Line: All Gleason 3+4’s are different and you need to know what type yours is before moving forward. Best,
Phil

@jc76 The area they briefed me they were using to access the prostate is called the perineum. Thus the term transperineally biopsies. It is the area between your anus and your Scruton (spell? the sack that your testicles are in).
That's what we professionals call the "taint" . 😁