On Active Surveillance. MRI and Biopsy-Type Questions.

Posted by jaygk @jaygk, 4 days ago

Cancer Discovered in Feb of this year. Currently on Active Surveillance
12 of 12 Cores Positive (had 2nd opinion by Dr. Epstein)
1 3+4 (only 1% 0f 4)
11 3 + 3 (5-40% of 3)
Grade Group 2
MRI: 2 tiny lesions found (3 x 4 x 3 mm; 3 x 3 x 3 mm)
No Cribiform or Perineural invasion
PSA 4.41
Decipher 0.32
Prostate: 22mL
PSA Density: 0.18

I am scheduled to have repeat MRI and Biopsy Feb 2026.
My questions are:
MRI- 1) should I insist on a 3 Tesla vs. a 1.5 Tesla MRI machine? I believe I had a 1.5 Tesla with contrast enhanced MRI. 2) Should I request ultrasound guided MRI, or a diffusion weighted MRI (not sure what these differences are). Does Medicare pay for this? Do many hospitals have this option?

Biopsy- I believe my biopsy was trans-rectal. I understand this type misses the anterior transition zone (my lesions are in posterior peripheral zone). My doctor said my lesions are so small he could not sample them with a needle so I think my 12 samples were grab samples. So I believe the type of biopsy is critical for me. Should I request the transperineal biopsy? What are the advantages and disadvantages of this biopsy? Not sure if my Urology Group of Cincinnati does this type of biopsy.

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jaygk | @jaygk | 1 day ago

Thanks for the info. Very helpful.
Interesting the way the surgeon put it. They someone am still on active surveillance.
When it’s time for treatment I will consider the proton. The University of Cincinnati perform it near my home.
How many tremendous did you have for the proton?

surftohealth88 | @surftohealth88 | 1 day ago

You got a lot of good advice. I would only add that you should have in mind that what you have now can change and it usually does over time (gleason and decipher) so you should be super vigilant now that you have one 3+4. It is "one" since they caught one, not because there is not more of it in a gland. Biopsy samples less than 1 % of a gland.

Yes - next time it should be MRI guided and with more cores taken that target lesions or place where they found 3+4 and preferably transp. since it is more precise and there is a lower chance of getting very serious infection.

Make sure that your do not miss next biopsy by all means and start doing your research about all possible treatments if and when you need them. The lower the gleason, the more options you have.

My husband had RP 8 weeks ago and definitely does not need diapers. ED is all over the place with results and about 50% have ED after age 50, and 60% after 60 even without any surgery etc., so I do not think RARP is the sole cause of it for men who have problems after RARP. BTW, radiation can cause both issues but in lesser %. I am saying all of this so you do not limit your research to one method - everybody is different and everybody has to make his decision for their particular case.

Wishing you the best of luck with your AS and don't forget to read about nutrition, supplements, diet and exercise which all can make your SA longer and more successful. By all means also buy and read a book written by Dr. Patrick Walsh that was already mentioned .