MRI Fusion Biopsy?

Posted by kugrad1975 @kugrad1975, Dec 15, 2023

70 year old diagnosed with Gleason 3+3 Prostate Cancer 2 years ago. On Active Surveillance. Total of 2 biopsies, Dec 2021 and Dec 2022. Referred to a regional University Medical Center, and had a MRI with dye contrast. RO saw a small lesion and referred me to a urologist for a third biopsy. The urologist then said the lesion was so small at 4 mm, in a large 70 gram prostate, that it was very problematic he could obtain an accurate biopsy of that suspicious tissue. I am thinking MRI fusion biopsy should be able to give us the tissue analysis we need. Is he blowing me off? Need opinions please!

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Profile picture for kugrad1975 @kugrad1975

Yes, I have been on Active Surveillance since Dec 2021. I have not initiated any invasive treatment yet, based on my RO stating that my Gleason 3+3 and Decipher score of .12 do
not merit active treatment at this time. My challenge is to find a urologist who can perform an MRI fusion biopsy transperineally, as my PSA seems to bounce from 5.7 to 7.7 to 7.0 during the course of 2023 calendar year. My last biopsy was Dec 2022, but it was not MRI fusion.

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@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.

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Profile picture for jc76 @jc76

@drcopp
When I got my MRI back and urologist wanted to do biopsies I kind of freaked out as I saw he was going to do a MRI Fusion technique.

I have a ICD/Pacemaker and contacted the urologist (Mayo Jacksonville) and said you are aware that I have a ICD/Pacemaker and can't have MRI without special precautions. He came back with the MRI/Fusion is a technique of fusing the MRI to guide the biopsies you are not getting another MRI.

Just thought I would pass on my experience with this and how I got the experience with this type of biopsies. I had it done transperineally not transrectal. That is something you should you really discuss the pros and cons with you urologist. You can also do some research of your own and the opinions on this are all over the place.
Good luck

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@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?

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Profile picture for drcopp @drcopp

@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?

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@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.

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

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Profile picture for drcopp @drcopp

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

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@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).

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Profile picture for jc76 @jc76

@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).

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@jc76 Yes, jc76 thanks.

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