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Posted 6/29/2018 11:27 PM (GMT 0)
Can someone help me out on a couple of different points:

1) why would my doctor have me do a biopsy first and not the other way around.

2) I feel as though the benign result from the biopsy is worthless and in my mind the parametric mri will for sure find something. I read somewhere that showed the accuracy of a biopsy is 48% compared to 94% for the mri.

The more I read, the more inaccurate the biopsy is how detailed the mri is.

Trust me, I’m praying my symptoms are from BPH or prostatitis and nothing else but the mind starts thinking something else is causing the enlarged prostate and other urination symptoms. Mri not until the 20th. Long time to wait.
Posted 6/29/2018 11:48 PM (GMT 0)
John,

An MRI can show 'suspicious spots', but is not diagnostic for cancer. The only way to diagnose cancer is to have cells under the microscope.

In the end, you had a biopsy because your PSA is slightly elevated for your age, your free PSA falls in the 'mid zone', of could be or maybe not. You don't have cancer. At least not today. An MRI at this point is going to add to your anxiety, not decrease it: Let's say it comes back with a report of a lesion at some location. Are you going to assume it is cancer and get it cut out only to find that it isn't?

Remember: PC is asymptomatic until it is well advanced, and then the symptoms are not in the prostate, they are elsewhere in your body. PSA is not a cancer test, neither is an MRI. You HAD the cancer test--the biopsy--and it's negative. Get off the internet, don't spend hours searching through google. Go enjoy life.
Posted 6/30/2018 12:42 AM (GMT 0)
You are right about enjoying life but it consumes my thoughts. The fear of finding out I could have an aggressive form and that it spread outside the prostate. It’s too much to think about. I feel like the more they dig the likelihood they will find cancer and I can’t think positive. Something is causing my % t/f psa to be low at 14, what is it if it’s not cancer ? How did it go low? That’s my way of thinking. Besides, my urge to go, dribbling etc. are all the same symptoms of cancer. Something caused the inflammation or enlargement of the prostate. I’m sorry. Just struggling with it all.
Posted 6/30/2018 1:21 AM (GMT 0)
John,

Your PSA is 5.5. Which is average to slightly elevated for your age. Emphasis on slightly. You have all the symptoms of BPH. Which you know you have. The enlargement is part of normal aging. Inflammation is from some kind of infection..which are notoriously difficult to treat.

I don't know what else to say. Trust your doctor--or trust us--not. Your choice.
Posted 6/30/2018 1:39 PM (GMT 0)
A couple of thoughts:
1. At least half of your PSA is from the enlarged prostate.
2. Your doctor is probably just being cautious and since the biopsy was negative he/she wants to see what the mpMRI finds. I agree, it would have made more sense to have MRI first, but some insurance companies wont let you do MRI until after biopsy is negative and other indications are suspicious. I know it's stressful but many blind biopsies are negative, not because there is no cancer there, but because it's a very small sampling of the prostate. My doctor said it's like walking onto a football field with a child's beach bucket and shovel and taking 12 little samples of dirt from the field. Easy to miss something.
3. I'm surprised your doctor didnt tell you the reason for the MRI.
4. I've never heard of anyone sending pathology for 2nd opinion when all findings are negative.

Post Edited (hrpufnstuf) : 6/30/2018 7:44:12 AM (GMT-6)

Posted 6/30/2018 3:26 PM (GMT 0)
As stated, an MRI can't diagnose cancer. The only way to do that is to get a needle in there, pull out some cells and look at them under the microscope. It's just another look inside. Also, is it possible that the doc is doing the biopsy to look for things other than cancer?

Are biopsies 100% perfect in detecting cancer? No they're not, but I would also disagree with the analogy that hrpufnstuf's doc gave about the football field and the child's bucket. Your prostate is about the size of a walnut--a sampling of 12 cores in something that size certainly can miss something but it's also a decent representation of what's in it.

I think a better example is a blueberry muffin. If you think of a blueberry muffin you could probably stick a needle in it 12 times and miss all the blueberries, but it would be unlikely. In the case of your prostate, the more cancer in it, the less likely a biopsy would miss it. So if you're worried about an aggressive cancer that's growing outside the prostate--your biopsy would be highly unlikely to miss that.
Posted 7/1/2018 1:03 AM (GMT 0)
Thanks Michael_T

What else do you think he would be looking for from a pmMRI other than cancer ?

Not sure what else to think or say. I just pray the MRI and ConfirmMDx come back with no findings. It’s been a tiring few weeks. Thanks for your advice and thoughts !
Posted 7/1/2018 1:52 PM (GMT 0)
JohnN...I don't know what else he could be looking for, but given that MRIs are typically given prior to biopsy, it seems like an odd way to try and find PCa. The purpose of a pre-biopsy MRI is to look for suspicious areas (which is all it really can do) and then target that for the biopsy.

BTW, when guys here have had MRIs prior to their biopsy, a lot of time the suspicious areas don't turn out to be positive on biopsy--or they are low grade G6 cancer--it's just not that good at seeing individual cells within the prostate.

Hope you get an answer from your uro and hope you get some mental down time with the holiday week coming up!
Posted 7/1/2018 3:26 PM (GMT 0)
While MRIis a great technology, as others have noted, it is not the definitive modality for diagnosing PC. It indicates areas that may be suspicious for PC, but those still need to be biopsied in order to make a definitive diagnosis. I have been scanned numerous times and none of the suspicious areas/lesions (PIRADS 3 and 4) have turned out to be PC upon biopsy. So certainly not infallible. And the actual G6 lesions that I have were not detected by the MRI.

So your physician is looking, but I wouldn’t get all wrapped up in what the MRI might or might not find. It is helpful, but not definitive.

Post Edited (Pohaku53) : 7/1/2018 2:53:07 PM (GMT-6)

Posted 7/3/2018 2:55 AM (GMT 0)
I get a favorable biopsy only to read 38% of initial negative biopsy’s are actually PCa. My doctor forwarded my 12 core tissues to ConfirmMDx AND I’m getting an mpMRI done. It’s hard not to feel through all of these tests something bad will surface. Don’t get me wrong I hope and pray it will b good news but it seems never ending.
Posted 7/3/2018 5:01 AM (GMT 0)
Don't get ahead of yourself and the situation. It's good to get the second opinion, but if it's different, and it's a big if, it's going to be low risk.

Deep breaths -- all will be well. Seriously. Don't stress yourself out.
Posted 7/3/2018 10:09 AM (GMT 0)
John:

I'm not sure where you found that 38% figure--was it published in a real medical journal or some random internet comment--context matters. You'll find in this forum that we like data, but that data has to be real, verified, codified, and tested data. Not internet rants that take some deeply researched data and pull a comment out and published out of context.

Here is what is reality: about 30% of the time, a prostate biopsy gleason score is different on second opinion or on final post-surgery pathology. And, about half that time it's an upgrade (like mine), and about half the time it's a downgrade. The up/down is rarely more than one total gleason point: such as a G6 coming back as G7 or vice versa. Some percentage of the time, a biopsy that shows a gleason 6 diagnosis comes back as NO CANCER on final surgical pathology: Imagine that, a man gets a cancer diagnosis, has the gland removed with all the downsides-and finds that he didn't have cancer at all.

So, based on all that, it's possible you have cancer. It's also possible that a second opinion will give you a cancer diagnosis. If it does, your likely gleason score will be G6--which is the lowest possible grade--and you'll almost certainly be a candidate for Active Surveillance--which means no treatment for now, and it may be several years--if ever--that you'd need treatment.

What it sounds like is that your doctor is saying, "hey, you don't have cancer--but something is causing your high PSA, let's see if we can see what it might be"--which is not a bad thing.

One of the hardest things for all of us to wrap our heads around is the idea that Prostate Cancer, in most men (like 90% of the time or more?) is really slow growing and rarely the medical disaster that other cancers bring to the table. Most US men over the age of 60 or so have low grade PC and never know it. Think about that: research has shown that if you live to 90 and die of something else, it's likely you have PC that you never knew about and it never caused you any harm.
Posted 7/3/2018 11:10 AM (GMT 0)
I think you are right about the benefits about getting a mpMRI. But it is not recommended after a biopsy. You have to wait some months or, otherwise, the results can show suspicious spots that are just artifacts due to the biopsy.
A free psa of 14% is suspicious, but it may aldo be caused by prostatitis. The same can be said about your total psa. In this case,it can also be caused by BPH as well.
I am not a medical professional and I definitely know less than most of them, but let me tell you what I would do in your case. I would wait 3-6 months and I would relax from the negative thoughts (yes, it is possible). Allowing this period of time is sure since, in any case, PCa cannot progress fast. Then, I would have a biopsy only after a previous mpMRI. This way a) you can avoid the biopsy if it does not show anything suspicious or b) the biopsy can be directed to the suspicious spots. Be sure the MRI is reported by an experienced specialist.
Also consider that your situation is common for many men now. We have many medical tests and some of them may show worrisome results. This is the price to be alert. The reward is an earlier response to any threat.
Posted 7/3/2018 12:43 PM (GMT 0)
Prostatitis affects the free psa ?
Posted 7/3/2018 1:22 PM (GMT 0)
You just got very good news. You do not have cancer. The doctor would not use an MRI to look for cancer if a biopsy didn't find it. That would make no sense at all. Instead, he is probably looking for a non-cancer explanation for your urinary symptoms. He is doing what a good doctor does, working systematically through all the possibilities to find out what ails you. When you see the doctor again, ask him what he was looking for with the MRI.
Posted 7/3/2018 2:06 PM (GMT 0)

Prostatitis affects the free psa ? said...
johnN


I think so. For instance, read this old publication:
/www.ncbi.nlm.nih.gov/pubmed/9554361
As others said, enjoy the 70% (or whatever %) probability that you are cancer free based in your negative biopsy. But if PSA keeps frightening you, follow the "first mpMRI, then biopsy" route. It is the standard way now after a negative biopsy and persistent PSA.
And always remember, your doctor is supposed to know more about your problem and it is sure he knows more about you.
Posted 7/3/2018 3:31 PM (GMT 0)
If you think about it, how could anyone determine what percentage of negative biopsies are actually cancer? It means proving a negative. I do see that on the ConfirmMDx website they say that a false positive is "as high" as 25-35%, which implies they're trying to extrapolate from some general assumptions, but the range implies there's no hard data.

So let's take the midpoint and say that it's 30%. It's logical to assume that the majority of false negatives are low risk cases where there's a low volume of cancer that would be more easily missed. An aggressive, higher volume cancer would be much harder to miss. Also keep in mind that low-risk cancers are much more common than high risk cancers.

This is a long-about way to say that 1) the chances are still good that you don't have cancer (70%, based on the 30% false negative midpoint) and 2) even if you did, the chances are that it's a low risk PCa that you don't even have to treat but can just watch with AS.
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