MRI w/Pi-Rads 4 - scheduling biopsy

Hi NiteOwl and Welcome to the Forum! As you know, mpMRIs are not diagnostic of prostate cancer, but they can locate suspicious areas. Anything that is a PIRADS 3 or above should be investigated by biopsy. Even taking your low-end of 40% -- it's not a risk you want to run for not biopsying and living with clinically significant PCa.

(I assume you meant paternal grandfather.) Your family history, high PSA and, especially, MRI result mean that the biopsy is needed. We here all know the anxiety of waiting, but a biopsy is win/win in my book. Negative is certainly great, and you'll have a baseline for future comparison. Some low-grade PCa cases can be monitored with treatment delayed and sometimes never required. But if you do have clinically significant PCa, early diagnosis and treament is the biggest weapon that can lead to a cure-- so you want to know what's going on in your prostate.

Know that we are all here for you and will do our best to support you and answer your questions. Here's to a great biopsy report!

Djin

Between you, me, and the many who read and post here, you were wise to choose the MRI now rather than waiting

Although BPH also causes a rise in PSA, it does not rule out that PCa is also contributing to that rise (as in my case). This complicates the diagnosis picture; however, for biopsy-naive men, investigation is usually a very good idea.

My own rule-of-thumb is that when a doc says to me "We can do X now or wait," if we're talking about something potentially serious, I do it now.

Djin

Post Edited (DjinTonic) : 11/13/2020 9:32:52 AM (GMT-7)

Good job on getting the MRI so early on.
I had to push my doc pretty hard to get one a year after my first Biopsy and rising psa numbers for a couple of years.
This forum helped me a lot to get to where I am now.

Thanks for the kind words J, GTO, and Will - it is appreciated and not an obscure movie reference at all for our age bracket! Pretty sure I saw that in the theater.

No call today to schedule, but they were quick to get my prescription for the Fleet filled...

NiteOwl_ said...
Going to have to wait until the week before Christmas for the biopsy - concerns me that I may not get my results back until after the holidays. Waiting is awful...

Of course if you get the biopsy on the 24th you will end up waiting. But if it's early that week you may be able to get the results sooner. I got my biopsy results the next day. Talk to your doc's office and tell them what you want.

Jim

Yes, that is good news. Now you have thorough baseline documentation should your PSA rise more than your uro thinks can be attributed to your BPH. Six-month monitoring is a good idea.

My suggestion for any future biopsies is to request that more than 12 cores be taken if there are MRI-identifies targets. With no MRI (or no MRI targets), one core is taken from each of the 6 zones on both sides of the prostate. I saw a recent study that found 3 cores were statistically the smallest number to take to be reasonably certain of hitting an MRI-identified target. Keeping in mind that you always want to sample all prostate zones. If one has two targets (lets assume in two diffrerent zones), that would be 6 cores. Plus 10 other zones requiring 1 core each, for a total of 16 cores. Or, if your uro balks at that, at least one extra core per target.

My uro had felt a new nodule prompting the last of my many biopsies. I asked how many cores he planned on taking at my biopsy visit, and he said 12. I requested extra, he agreed and he took 14. All the cores from the nodule were benign, but two cores in other zones found one G 10 and one G 9 lesion! If you want extra cores, you should discuss this before your biopsy visit, so your uro will have the appropriate specimen-cup set up.

My 2 cents,

Djin