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dionysus

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Prostate Cancer
Any experience with this situation
MRI/ultrasound fusion guided biopsy versus ultrasound only guided - 100.0% - 1 votes
MRI/ultrasound fusion guided biopsy - 0.0% - 0 votes
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Posted 12/2/2021 4:11 AM (GMT 0)
My psa 1 year ago was 1.01. As of 11/22/2018 my psa is 16.37. My urologist wants to do a ultrasound guided biopsy. When I mentioned a MRI/ultrsasound fusion guided biopsy he said that was unnecessary and too expensive. I live in a small town. I made an appointment at the University of Iowa clinics to see a urologist. The appoint is not till 11/29/2021. Anyone have any experience with this?
Posted 12/2/2021 4:58 AM (GMT 0)
Hello Dionysus, welcome to the forum. Glad you found us but sorry you found yourself needing to look.
I take it that your local uro checked for a urinary infection. Sometimes am infection can make your PSA peak and if antibiotics bring it back down then it's probably not prostate cancer.
Your uro is right that MRI fusion biopsies are more expensive but whether or not they are too expensive is a judgement call. They tend to be a bit more accurate but all biopsies can miss stuff.
It seldom makes any difference to wait a couple of weeks for a biopsy. Prostate cancer is almost always a slow-moving beast and waiting until the 22nd is unlikely to make much difference in the results.
Posted 12/2/2021 10:46 AM (GMT 0)
I had 4 biopsies before my cancer was found.

1) Ultrasound-guided - nothing
2) MRI guided - nothing
3) Saturation biopsy - nothing
4) Ultrasound-guided - finally located cancer.

Take what you want from this, but the simplest was the ultrasound and had the easiest recovery, The other 2 methods require an operating room and you are usually put under.
Posted 12/2/2021 11:01 AM (GMT 0)
Even though they’re Hawkeyes smile, you’re actually illustrating why you MUST pursue excellence. Your dates look wrong bit on a reasonable interpretation it is WELL worth the wait.
Posted 12/3/2021 3:40 AM (GMT 0)
I’ve had nine prostate MRIs and six prostate biopsies, both transrectal and transperineal. There are several ways to do a biopsy, including one or two specialists who biopsy men while they are inside an MRI. That is not usual.

The general consensus, across the many forums I participate in, is that new patients should have a 3 Tesla multi-parametric MRI, then followed by a combination systematic and MRI targeted MRI, in that case, the suspicious lesions seen on the MRI are located by the biopsy ultrasound and extra needle cores taken from them.

My last biopsy used real-time imaging from an ExactVU micro-ultrasound when doing a Precision Point transperineal biopsy. But, that would probably not be justified for a new patient.
Posted 12/3/2021 10:14 AM (GMT 0)
You should not have to come to a forum to have a distrust of your doctor alleviated. The fact that you are tells me you need another doctor, even if a forum tells you (in their medical opinion) the doctor is doing stuff right. I vote for waiting on U of I.

It’s my opinion, from what you’ve written, you sense your doc isn’t a straight shooter. Instead of telling you, “We cannot do what you ask but that’s OK because you don’t need it anyway” he told you “You don’t need it” and left out the “can’t” part. If this is what happened, get another doctor.

I can tell you from experience, small town medicine doesn’t always tell patients the truth. They tell you the truth from within their own framework of what they can and/or cannot do. While *possibly* correct in their approach, a patient still deserves all the information the doc is basing his spdecisions on. “Too expensive” may mean “l can’t”. If that is the case, he should have told you both and that is where your instincts are kicking in.

Shoot me lol.

You gotta trust your doctor.
Posted 12/3/2021 9:10 PM (GMT 0)
Thanks for the replies. I was upset when I wrote this post. My PSA reading of 16.37 was taken on 11/22/2021. I have an appointment later this month at the U of Iowa clinics. I do not have a UTI. My small town hospital does not have any MRI equipment for diagnosis. I met my urologist for the first time a few days ago. I was referred to him by my GP. The high PSA reading was caught during my annual exam. The guy is a jerk. I am done with him. If I need surgery I need to go to the U of Iowa anyway. This increase of PSA from 1.01 to 16.37, in one year, has me concerned.
Posted 12/3/2021 9:47 PM (GMT 0)
Often that kind of PSA jump is due to something other than cancer. I would get another PSA test before you go to U of I this will at least confrim the number and give the guys at U of I more info. Given what you described going to U of I does make sense even if does not turn out to be cancer cause they will have more resources to help you. It does make sense to have an MRI before biopsy but many insurance does not cover it(use of a reliable MRI(pirads standard) is relatively recent(past five years or so) and taking many time to catchup. with my biopsy my urologist thought mri was useless. had the biopsy done anyway but moved on to penn medicine a much better place. So in that regard similar to what you are doing--best of luck
Posted 12/3/2021 9:55 PM (GMT 0)

dionysus said...
I met my urologist for the first time a few days ago... The guy is a jerk. I am done with him.

Dionysus,
I don't know what it is about urologists, but plenty of here have had that experience. 🙂

I think you will be in good hands at the U of Iowa clinics. Please let us know what's going on.
Posted 12/4/2021 12:02 AM (GMT 0)
A slow steady rise is indicative of cancer. Your rapid increase could be related to an infection or many other factors that could have caused a higher PSA? Usually they prescribe antibiotics to see if the number goes down. What about the DRE? Was it unremarkable? I would rule out other reasons for the rapid increase, verify the DRE is normal and re test the PSA
There is another non invasive test I think it’s the free PSA, below 10% along with elevated PSA is another indicator for that you should have a biopsy.
Might be other tests available since my time
Posted 12/16/2021 4:07 PM (GMT 0)
Very puzzling. PSA 10052017 1.4, 12122018 2.16, 10232020 1.01, 11222021 16.37. Changed urologist and had PSA 12102021 2.74. No UTI, DRE inconclusive. An MRI was scheduled before PSA reading of 2.74. I am 70 years old do I even need. an MRI?
Posted 12/16/2021 5:48 PM (GMT 0)
Dionysus, I went through 2 Uros who wanted to watch and wait and I did. That was a mistake as they said my cancer was slow growing. My current Uro took action and found GLEASON 8. Please advocate for yourself. If something doesn’t feel right get more opinions. Not saying you have cancer. Jack
Posted 12/16/2021 6:05 PM (GMT 0)
Prostatitis is different than a UTI, can be difficult to diagnose, and can spike PSA quickly. Have you had any symptoms down there or any unexplained sickness of any sort? Usually they try to get a semen sample to check out prostatitis further or possibly scans.
https://www.pcf.org/c/prostatitis-misdiagnosed-and-misunderstood/

That being said, after my annual PSA jumped (4-> 5), I saw the urologist and he recommended the MRI scan first to see what might be there prior to doing a biopsy. It show two lesions and he did the MRI/ultrasound guided fusion biopsy with a couple of targeted cores. The biopsy found want it was looking for and the rest is history.

I think getting the MRI before seeing the U of Iowa doctors might be a good idea but please check with them first unless they ordered the test. They certainly should know about your last PSA drop.

Your question about being 70 years old and an MRI would be easier if you were 80. At age 70, I hope you are planning to beat the odds and live to 90+ so catching things early still applies to you. If not, you have a lot more latitude with medical recommendations.
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