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MRI versus biopsy

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Posted 4/29/2016 12:06 AM (GMT 0)
My husband had prostate biopsy - 8 cores - negative but because rise in PSA to 6.3 urologist recommended MRI which showed small diffusion bright ADC dark lesion within the peripheral zone of the left posterior mid gland. Findings consistent with a PIRADS 4 lesion. Targeted biopsy recommended.
He had another biopsy - 4 cores, 1 core showing high grade PIN, confirmed with immunohistochemical stains. The other three negative. However because of the MRI findings, the urologist recommended a fusion biopsy. I of course like the last biopsy findings, but the urologist said MRIs are very rarely wrong. Has anyone else had this issue. Thanks so much, I really appreciate all the information on this site. Good luck to you all!
Posted 4/29/2016 1:00 AM (GMT 0)
this link explaines diffrence and advantage of live in bore guided biopsy over fusion
biopsy
http://sperlingprostatecenter.com/mri-guided-biopsy-vs-fusion-whats-difference/
Posted 4/29/2016 2:35 AM (GMT 0)
I trust there was some time elapsed between the biopsy and the MRI? Uncleared blood and scarring from a biopsy can obscure MRI results. MRIs only detect suspicious areas -- not cancer. Only a biopsy can do that. Also, not everyone is equally good at reading a multiparametric MRI - it takes experience. If you have reason to believe that the radiologist who read it may not have the requisite experience, you can send the MRI CD to another more experienced radiologist.

But why is he having so few cores taken? The norm is 12 cores, and if there is a suspicious area, a few extra cores from that area are usually taken. Once he was in for the biopsy, I don't understand why they took only 4 cores.

Even if it's not PC, I hope his urologist is investigating the cause of his elevated PSA. Did any of the cores show areas of chronic or acute inflammation? What about BPH?

- Allen
Posted 4/29/2016 1:10 PM (GMT 0)
HGPIN can appear as a PIRADS 4 lesion on a 3T mpMRI. I know because it's happened to me, and I've had several fusion biopsies to analyze it.

Don't panic, as this is not uncommon, and HGPIN is not an immediate threat.
Posted 4/29/2016 4:41 PM (GMT 0)
My second biopsy found HGPIN and my third biopsy found cancer....I know biopsies are no fun at all but if a rising PSA can't be explained any other way......
Posted 4/30/2016 10:05 PM (GMT 0)
I decided on an mpMRI first, hoping to avoid a biopsy, it found a 9mm lesion.
I followed up with a 28 core transperineal grid biopsy - which found a second lesion (Gleason 7). That urol avoids offering TRUS biopsies.
Final pathology after robotic prostatectomy found a third cancer (Gleason 6).
I used a different urologist for each procedure. Second opinions are readily available.

Post Edited (shudderingThud) : 5/1/2016 1:29:59 AM (GMT-6)

Posted 5/2/2016 12:45 PM (GMT 0)
Get an MRI guided biopsy. It is the best technology. You likely need a major university medical center to find it, but not always. I had that and it was able to find a small tumor that two failed biopsies did not pick up. the longer you wait, the more likely cancer will grow and possibly spread.
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