in-bore MRI guided biopsy locator?

The following article is interesting although it is from someone with a vested interest in the fusion process

https://www.focalhealthcare.com/mri-for-biopsy-mri-us-fusion-vs-in-bore/#

The article does put the biopsy methods in perspective. I think one problem you are having is that urologists would not be the one’s pushing the in-bore method and you might have to talk with a radiologist who might be set up to do such a procedure.

It may also be a method originated from Europe that has not had wide spread acceptance in the US. I found papers that ranged from significant benefit to no benefit and most seem to think that the matter has not been resolved yet.

As they say, don’t let perfect be the enemy of good. Keep trying but you will get a decent biopsy with the MRI guided method with doctors that are good at it. I would think that Mayo would do a good job and the pathology review of the biopsy cores is also very important so you need a couple of good doctors involved.

I agree with the above. It's a fine line between wanting everything to be the best possible and going down a never ending rabbit hole, but I think an MRI-guided biopsy, followed by a JHU second opinion would give you all the info you need to decide on next steps. And here's to hoping you don't need any next steps!

PBH said...
Correct me if I am wrong in my thinking here but it seems logical that someone whose PCA was LESS obvious and had a less likelihood of even having PCA would benefit much more greatly from an in-bore than someone like me with an MRI PI-RADS 4.

PBH:

What you want above all is for the biopsy to sample the highest grade of tumor that is present. That is what an expert in-bore biopsy achieves that typical biopsies may not. The fact that you have high grade tumor is not the same as saying that there is a lot of it to be found.

I went through this in 2017 when my first ever PSA test came back highly elevated.

I researched in-bore MRI prostate biopsy for the same reason as you. If it was available and affordable, why not get the best.

I learned the following:

1. Requires 3-tesla MRI machine and multi-parametric technique.

2. Requires highly experienced practitioner to accurately read the MRI output. Many practitioners do not qualify.

3. Both of the preceding are expensive.

4. For those reasons, true in-bore biopsies are performed at a very small number of "centers of excellence" nationwide, something you have verified with your search efforts.

The value of getting the best is two-fold. In addition to the likelihood of sampling the highest grade of tumor, if the practitioner is truly expert, a negative finding upon MRI analysis can be the basis of avoiding a biopsy that is not yet indicated. As already discussed, there are several reasons for PSA to suddenly jump.

Note the following:

When the true in-bore biopsy is performed, the practitioner is not referring to the previously obtained MRI images, because things move around some. He has studied the images to know the overall situation, but he is relying on the same expertise he used to assess the output of the first MRI to identify the target(s) in the real-time in-bore view. A proper in-bore biopsy is performed by the same practitioner who did the assessment of the first MRI output. Or, alternatively, a second practitioner of equal or greater expertise, will ignore the first report, and use the output of the original MRI to do his own assessment, and biopsy if indicated.

PBH said...
I find it a bit unethical when a doctor doesn't tell you about your better options like an in-bore MRI-guided biopsy.

With doctors, as with every other area of human endeavor, it is a very small percentage of the working population that is involved in advancing the boundaries of knowledge. Most working people spend the vast majority of their work-time doing what they already know how to do. Most doctors are no different.

Many people with prostate cancer are retired, as I am. We have vastly more time, and a greater interest in knowing all the possibilities, than a working doctor who has invested much time and money along a certain path.

about any one individual doctor, I would not assume that it is anything more than ignorance.

ps: it takes a while but you can find in-bore MRI places around the western US

https://medicine.utah.edu/radiology/news/2017/02/mri-guided-prostate-biopsy.php

Men on some other sites always mention Dr. Joseph Busch of Alpharetta, GA as THE guru of in-bore real time biopsies, and will only go to him, although he only takes cash, and is expensive. I would describe him as an interventional radiologist.

His website is:

https://buschcenter.com/

I am familiar with the Busch Center and know some men that have used them. Their clinic is about 15 minutes from my home.

Mostly they do MRI imaging and have done nearly 2,000 in bore MRIs. As for treatment, up until recently it has been basic ultrasound ablation and now they have added the TULSA procedure, which is not reimbursed by either Medicare or other third party payors. It was FDA approved late last year for focal prostate ablation and a month ago one of the forum members recently used it by the first doctor to perform it in the USA.

If one needs stronger treatment or want treatments that are third party reimbursed, they will refer to surgeons and radiation oncologists and collaborate with them.