MRI or no MRI

"MRI guided biopsy" can (as I understand it) mean three different things:
1. An MRI followed by a biopsy, with the MRI image reviewed by the doctor conducting the biopsy as a guide for areas on which to focus the biopsy. This is known as a cognitive fusion biopsy.
2. An MRI followed by a biopsy, with the MRI image merged by use of software with the ultrasound image used during the biopsy. This is known as an MRI fusion biopsy.
3. A biopsy procedure performed simultaneously along with an MRI procedure, while the patient is in the MRI machine.

Since your signature indicates two previous MRI guided biopsies, you probably have a good idea of which of these your doctor is prescribing - which is it?

Both of my biopsies have been of the cognitive fusion variety. This year I'm not slated for a biopsy, but my doctor wanted an MRI nonetheless. When I questioned the need and whether insurance would cover it, and raised the issue that the high deductible of my policy which made for hefty out-of-pocket costs even if insurance did approve it, he told me that they had cut a deal to allow self-paying customers to get an MRI for $199, which is what I'm scheduled for in November. That might be something to inquire about in your case.

Toyoung said...
I have been on Active Surveillance for 6 years. My recent PSI was 11 and my new Dr. prescribed a MRI guided biopsy. My insurance company denied the MRI since I was already diagnosed with PCa. Do I fight it or just go with the TRUS Biopsy. Any thoughts or comments?

You can look at my sig and tell how I feel.. If you get a "true" fusion BX, then I would say do it for sure.. Ed

Thank you to all who responded. I have a questions for Ezhoe, from your signature can you explain why you started HT before surgery or radiation?

You've had two mpMRIs (the last one 2 years ago) already - I assume both of those were negative (Pirads 1 & 2) and gave no guidance as to where to take cores from. The biopsies were negative as well. Only your first biopsy was positive, finding an insignificant amount of cancer.

You are experiencing a steady rise in PSA that may be due to benign causes (BPH, prostatitis). There are a couple of biochemical tests that may prove more useful than an mpMRI:

(1) Prostate Health Index (PHI) - it is PSA-based but less affected by BPH or prostatitis - FDA-approved, covered by most insurance, inexpensive
(2) Select MDx or ExoDx Prostate Intelliscore - these are not PSA based, but they have not yet been prospectively validated

If one of those suggests that a biopsy is warranted, you may wish to have a transperineal template mapping biopsy, which is the gold standard.

Toyoung said...
Thank you to all who responded. I have a questions for Ezhoe, from your signature can you explain why you started HT before surgery or radiation?

Going to start RT (of some type) in november TA is right.. if your mri's don't show any lesions or such then it could be BPH driving the PSA.. Ed

GuitarHunter, be alert with a PIRADS 5. I got a cognitive, not guided, biopsy afrter my mpMRI that showed tiny amounts of G6. But I decided to have surgery anyway due to the MRI findings and my path report showed a brutal upgrade and a significant tumor extension. I hope this will not be your case but, again, be alert.