time from initial MRI to initial biopsy

Arthur, welcome to the forum, sorry you need to access our support, but we are all glad to give it.
I am not an expert, others will chime in who know way more than me. But it would seem to me that there is no reason for a waiting period after an MRI, as MRI is a non invasive procedure. I would ask the Dr why so long.

You may already know this, but I'll mention it anyway, chances are good that if you do have cancer in there its no a high grade aggressive type. But you never know. One step at a time, if I were in your shoes I would be pushing hard for an explanation as to why you need to wait 2-3 months for a biopsy, of a PIRADS 4 lesion. I don't think that should happen. If its a scheduling problem, then see if you can find another urologist to do it

That biopsy timing is ridiculous, absolutely no consideration of you, the patient. My Uro booked the MRI and biopsy at our office visit. He said we can always cancel biopsy if MRI is negative. Of course, it did not work out that way but it was all done within a month.

There is almost no way to tell someone you might have cancer, probably will not kill you, see you in three months, and not expect to cause anxiety issues that can be minimized with a reasonable schedule. I would definitely follow up and work their system to get a reasonable schedule. Good luck.

Nice, usually being calm and polite helps with people who get yelled at all the time.

Your recollection of PCa treatment is outdated a little. I started my adventure in 2018 and MRI before biopsy was not a standard procedure. After you get your biopsy results may be a better time to think seriously about treatments but you can start reading about the options. You could have virtually nothing from a cancer standpoint to various shades of grey heading towards a higher risk situation.

Radiation treatments have probably changed the most for the better. Standard beam therapy (IGRT/IMRT) is accelerated (hypofractionated) for most men being completed in 5 weeks vs. 8-9 weeks. SBRT is a higher intensity radiation treatment scheme (Cyberknife was a specific tradename) that can be completed in 1-2 weeks and has proven to be quite effective. The older brachytherapy (seeding) is not done very often now but temporary high dosage brachytherapy is becoming more common.

Of course, surgery has advanced also with single port robot assisted surgery used at some places and improved surgical procedures at most places. It is still fairly rigorous and has its own set of recovery issues so helps to be healthy and in good shape for a better recovery. Also helps to have a surgeon that has done a lot of surgeries and does them weekly.

I would not hesitate to head to Madison (if you are not there) to explore treatment options when you get to that point. Most surgeons and radiation oncologists propose what they do, the larger medical centers and universities will have most of the options possible so usually more to consider.

The PSMA scan is a nice idea but another poster got denied by his insurance company recently. My guess is the situation has to be higher risk before insurance wants to cooperate. Your situation so far seems be rather ordinary, not to you of course

Post Edited (Mumbo) : 2/13/2024 5:55:17 PM (GMT-8)

Arthur, yes 3 months seems way too long for a level 4 lesion.

That being said, it's way to soon to be talking about choosing your treatment option. If you're intending to carefully navigate the system and choose the best treatment for you, you owe it to yourself to thoroughly investigate the treatment options.

Here's the basics:

1. If you're G6, particularly if it's low volume G6, seriously consider Active Surveillance. Which means, more or less, that you actively watch it with additional MRI studies and another biopsy in 6 months to a year, and ride it as is. IF (and it's a big if) something changes, THEN you go to an aggressive treatment.

2. Make sure you consult with both a urologist (and they are, by definition, surgeons) AND the Radiation Oncology team. Radiation therapies have advantages over surgery in today. Take your time and give it a thoughtful consideration.

Also, be your own advocate. Don't let your urologist get away with things like, "If you have radiation then you can't have surgery". Which is true, as far as it goes, but it implies that radiation will fail and if it fails, then nothing else can be done.

Don't make ANY treatment decisions until after the biopsy. Just Don't.

Do you have your towel?

Prolaris and PSMA PET scans are both moving into the standard of care lists--they can be helpful and useful in some cases.

Tudpock, I am actively glued to Alex and Dr Scholz. Donated to the Institute. Love the fact both do not talk down to the listener. I sent a question to the site about the wait time. I quickly got a call from one of the facilitators, Jonathon. He gave me a well-considered opinion, reflecting yours, and a wealth of other information.

It has been a week and the Urology Department has not recontacted me. I have been communicating through the Epic message line. I am going more aggressive this afternoon and will phone the Department. I think there are good intentions, I just need to pierce the communication shell.

This forum and the users are quite simply AWESOME.

jr, thank you for your advice. Yes, the anxiety of waiting is the worst. Calm, collected thoughts, and waking up at night with eureka moments, are all part of making my important decisions.

Check to see if your insurance extends coverage for Prolaris or other squencing. Not a PSMA but closer.

Sorry to hear about the insurance. I was going to go on a rant, but you are already there!

Surgery used to be the only option especially if the odds of metastasis is not within your risk cup. The two radiation therapies you mention are time/number tested!

Any further word on biopsy scheduling? I mean, really, with a Pirads 4 lesion, that should light a fire under SOMEONE. (besides you)

Arthur, you will learn that quoted prices for medical procedures are meaningless, unless you're paying out of your own pocket. I'm guessing you already knew that. If you're on Medicare--particularly on an Advantage plan, the facility will get what the plan agrees to pay for--not a dime more.

Good luck! (and don't forget your towel)