On Active Surveillance. MRI and Biopsy-Type Questions.

With 12 out of 12 many doctors would want to do something even though 11 are 3+3. At a recent conference, they mention that if more than six were 3+3 it was time to do something.

With your low decipher score, Small prostate size low PSA And nothing else found, active surveillance does sound attractive.

I would definitely get a transperineal biopsy next time. They really only get about one percent of the prostate when they take a sample, With all the positive cores you have, it would be a good idea to get more spots.

The MRI results sound real good too. Not much found.

Jeff thanks. Hopefully my urology group can do that type and Medicare pays for that type

I think I did read there is less chance for infection for the trans perineal …. although my Trans rectal went very smooth.

@jgk
if you have a choice, a higher tesla may help the doctor make a better analysis.
In terms of diffusion weighted MRI, I have read it picks up smaller molecules of potential cancer cells than other types of MRI's but it is worth a discussion with your doctor(s).
Attached is a list I found online of places that offer DWI in Cincinnati. Not sure of its accuracy.
In terms of medicare with supplement, mine picked up imaging, PSA and PSE testing, MyRisk genetic testing, Decipher test, consultations and radiation treatment. Give your healthcare provider a call to make sure.

@bens1
Thanks. Very helpful.

What type of biopsy did you have?

Your numbers sound a lot like mine. I'm 79, had MRT guided biopsy in early 2025; scheduled for another in February 2026 after another MRI with contrast. 2 samples, 3+3 and 3+4, all others negative. PSA was 7.97 prior to MRI and biopsy but 4.46 in April 2025. Go figure. I've been on active surveillance this year. I had a transperineal biopsy and will stick with it (no pun intended) for the 2nd one. From what I've read, there are several advantages to the transperineal approach. Good luck!

@tdgillett
Tommy. Thanks.

How was your transperineal biopsy experience.

I read you just have a local anesthetic and not asleep?
How was residual pain etc?

I had no issues with my transrectal biopsy in February 2025

@jaygk

I had a transrectal. If I had to do it over again, I might very well do the transperennial guided by Mri.

@jaygk
Took about 10 minutes, no pain, a bit uncomfortable but not painful. Joked with my urologist during the procedure. He was saying the numbers of the prostate zones randomly throughout the needle sampling. He said, "There's one more I haven't done yet. If you tell me the right number, that's the last one. If you get it wrong, we start over again." I got it right but his joke was enjoyed.
He may have given me a local anesthetic--lidocaine by shot? I was definitely not asleep.

Thanks. That is what I’m read online for the procedure.

I wouldn’t mine being out to sleep like the trans rectal I had. I had no issue with that.

I had a MRI guided trasnsperineal at my request, with anesthesia. I chose MRI guidance for best accuracy, and perineal due to lower infection risk. Anesthesia because some friends had painful biopsies (although they were transrectal, but don't know if that matters for pain).

MRI had one area light up, strongly suggesting cancer. So that got 4 extra samples. I had one sample that was 4+5 (Grade Group 5). So, a small tumor. But the Gleason 9 meant action was necessary.

I spoke with both a radiation oncologist and a urologist - the latter to discuss surgery.

Due to my age (77) ,the surgeon strongly steered me away from surgery. His approach (after having reviewed my chart and my interview with his PA): "do you ever want to have sex again, do you want to wear diapers." That was pretty convincing.

So, I did proton beam radiation (70Gy/28fx). I chose proton beam because it has fewer side effects and downstream cancer risk than Xrays ( Bragg peak limiting damage outside the target volume, if you want to get tecchnical). I also chose proton beam also because I could and it was convenient - I live near the only proton beam facility in the state (Mayo Clinic, Phoenix). But I met people in the proton waiting room who were from out of town and had rented places to stay through the treatment.

Best wishes.