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Biopsy versus MRI

Posted 19 November 2017 21:42:34(UTC)

I have recently had two consecutive, higher than normal, PSA test results (6 and 9) and am about to undergo a prostate biopsy. I have been doing some internet research and am wondering if there would be any benefit in deferring the biopsy and trying to get a (preferably multi-parametric) MRI scan. I have been told the MRIs are not routinely offered in my local area. If I opted for a scan I would have to pay for it myself.

Should I go with biopsy or wait and try to secure a scan? Would a scan confirm definitively whether or not there is cancer? Any advice, guidance or participants' personal experiences of this situation would be greatly appreciated.

Posted 20 November 2017 00:50:21(UTC)

Welcome to this forum though ssorry for the reason that brings you here.
It is indeed a post code lottery as to whether the treating hospital does an MRI before biopsy or the other way round. Both can fail to indicate or show PCa. The MRI can sometimes show suspicious areas for PCa which can help when biopsy needles are inserted as with a TRUS biopsy there are usually a maximum of 12 needles. I had a Transperineal Template biopsy of 50 needless before my last radical treatment. Cancer was found in only 1 out of the 50 cores taken. Had only a 12 core TRUS biopsy been done, the chances of hitting the small tumour would have been much less likely.

You may find some of the info given in this link of interest. https://prostatecanceruk...te-tests/prostate-biopsy

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Posted 20 November 2017 07:50:20(UTC)

The scan can show suspicious areas but cannot always tell the difference between cancer, infection and bruising so even if the scan was indicative you would still need the biopsy. A clear scan can give false security; my husband's scan was clear but the biopsy was positive - when his prostate was removed there was cancer in every bit of it and it had spread to his bladder.

The best results are achieved by biopsy + scan + DRE combined. Ideally, MRI would come before biopsy but as you have been told, this is not available in all areas. Has your nurse practitioner or specialist said the MRI will be done afterwards or are they indicating that you won't get a scan at all? That is almost unheard of these days.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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Posted 20 November 2017 09:47:06(UTC)

Originally Posted by: Online Community Member
The scan can show suspicious areas but cannot always tell the difference between cancer, infection and bruising so even if the scan was indicative you would still need the biopsy.

Exactly right. Ideally, you should have both, but only a biopsy can confirm the diagnosis. Biopsy can miss a cancer: the lab can only analyse what they have, of course - but,  other than a very small tumour, that is unlikely. Even less likely, of course, if the biopsy is taken after the scan.

You don't mention your digital examination or any other signs and symptoms, but with a PSA only a little above "normal", I suspect there's something that concerns the docs for them to be pushing you straight to biopsy (PSA is notoriously unreliable!).

If you had the scan first, and it appeared completely clear, you could argue that the biopsy was unnecessary at this time, but if it were me, I'd accept the biopsy (it's pretty quick and weird rather than painful), but still push for the scan, regardless.

[apologies for edits, I'm thinking as I type, which makes for untidy posts!]


-- Andrew --

"I intend to live forever, or die trying" - Groucho Marx
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Posted 20 November 2017 15:31:33(UTC)

Good afternoon

I has a mpMRI scan before biopsy.  When I went for my biopsy, I was told by the urologist that he fully expected to find cancer.  That's because of what he had seen on the scan.  I got a PIRAD score of 5 - meaning that clinically significant cancer was highly likely to be found.  Only mp MRI scans do that, I think.  He told me he couldn't officially diagnose me on the basis of the scan alone, but he also said he had no doubts in his mind.

Don't know if that helps or not, but wanted to relay my experience.


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