MRI & Biopsy On Same Day?

User

Posted 18 Feb 2018 at 19:00

Hi, my first post on here. A couple of weeks ago I had a PSA test which came our at 7 and was referred to a urologist for a DRE. The urologist said that I had an enlarged prostate and offered me two courses of action:

Firstly as my GP had not ordered a second PSA test after the first one, he said an option was to refer me back to the GP for a second PSA and then if that was high again, the GP would make a second referral.

The second option he offered was a blood test at the hospital that day and also to book me in for an MRI and biopsy which he said he try to arrange on the same day which surprised me a little as I thought he would have gone for the MRI first followed if necessary, by the biopsy.

He also said that in the unlikely event that my second PSA test was much lower, we could maybe consider the way forward again.

Being a fairly practical type I went for the second option as why wast time I thought; let’s get on with it.

I am fairly relaxed about the situation and feel more grateful than anything that I recently asked my GP for a PSA as I thought in my late 60’s that would be a sensible thing to do.

My question is, is it usual to arrange both the MRI and biopsy as I thought it would be an MRI, wait for the result before going on to a biopsy.

User

Posted 18 Feb 2018 at 21:26

Until very recently - and in some hospitals this is still the case - the biopsy is done first and only if it comes back positive is an MRI booked. It is becoming more common to do the MRI first and if there are grey areas, to arrange a biopsy. The problem with either route is that it can lead to false positives / false negatives ... if the biopsy misses cancer then not having an MRI means that the man can wrongly be given the all clear but on the other hand, if the MRI is clear then no biopsy is ordered and MRIs are not foolproof as some prostate cancers simply don't show up on the scans.

I like your urologist's approach - both on the same day is 'belt & braces' and maybe one day all hospitals will offer this.

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

User

Posted 23 Mar 2018 at 16:19

I had my appointment today with a urology nurse at the hospital for feedback on the MRI and Biopsy. Like a lot of things in life, it turned out to be a bit of a curate's egg.

Nothing had shown on the mpMRI and all looked good from that report but of the 12 cores taken on the biopsy, eleven were clear and one showed a slow growing cancer; so yes, I was diagnosed with prostate cancer having a Gleason score of 6. A strange scoring system when you think about it as 6 is the lowest you can have to be diagnosed with prostate cancer.

The nurse was very practical and suggested that unless I really felt I could not live with the thought of having some cancer in my body, the best course of action for this low-grade cancer would be active surveillance. She suggested quarterly PSA tests via my GP followed by quarterly visits to the hospital to keep an eye on progress then possibly followed up by an MRI, maybe annually or as and when thought wise. She felt that with the way advances in PC monitoring are progressing that mpMRI was the preferred option rather than a further biopsy occasionally in the future although further biopsies were not ruled out of course.

So, the way forward, which I am comfortable with, is active surveillance: all seems sensible enough to me. If things do deteriorate then I could have treatment at Addenbrooke’s who have a good reputation in this field including brachytherapy which if it comes to it, would be my prefered choice.

I have to say I am very impressed with the NHS and the excellent speedy service that they have given me, I only found out I had a raised PSA ( the vale was 7) 51 days ago, I consider that fast service: well done our NHS!

I really must express my great gratitude to this wonderful Prostate Cancer UK site as I felt fairly knowledgeable in terms of receiving the information and hopefully thinking with a good degree of clarity.

I will now have to see how my travel insurance with AXA stands up as I am planning a few trips possible a little earlier than I would have otherwise; the news simply focuses the mind. I have heard of a few refusals from travel insurance companies once the dreaded C is mentioned but will see what they can offer.

User

Posted 19 Feb 2018 at 09:16

Welcome to the site henry.

What a great service you have had.

As far as daft questions go, ask away. It's only daft if you don't know the answer and don't ask!!

Very little is taboo as long as it's relevant.

This is a great supportive site

We can't control the winds - but we can adjust our sails

User

Posted 19 Feb 2018 at 10:06

Wow - I thought my biopsy & all the scans were pretty well regimented but that is first class!

Good luck

User

Posted 23 Feb 2018 at 14:36

Hmm....

Not sure why you received this advice after a TRUS..

I drove 10 miles on my own for my TRUS .....waited for half an hour after the biopsy was carried out..

The nurse checked that I felt ok and then I drove the 10 miles back home!

I had a pad in place to catch any bleeding afterwards...and the usual antibiotics prescribed...

Maybe different hospitals offer different advice...I would ring the urology dept and discuss it with the specialist nurse..

User

Posted 23 Feb 2018 at 15:58

After biopsy in 2004 I could drive. A more recent biopsy included Ciproxin so was advised not to drive.

Ray

User

Posted 23 Feb 2018 at 17:24

Henry, I'm sure the advice applied to the anaesthetic effects rather than discomfort from the procedure. I'd have thought after the usual cup of tea and a rest afterwards driving would be fine. I'm sure that's what I did years ago!

User

Posted 24 Mar 2018 at 03:00

As far as insurance goes, my dodgy friends in the death insurance business are always trying to sell why they call “Clitoral Illness Insurance” which pays out if you have a serious medical condition. It’s really “Critical Illness”, but then they are very puerile!

You may be encouraged to know that many Clitoral Illness insurers will not pay out on a Gleason 6 score as it’s not considered life-threatening. Mine is 7 but I didn’t buy a policy anyway!

User

Posted 25 Mar 2018 at 03:13

I have always told my insurers but asked that they did not raise an excess for cover for PCa even if it meant excluding this. from the policy. Further down the line when more urgent treatment might be needed at short notice would cause me to reconsider.

Barry

User

Posted 26 Mar 2018 at 15:22

Henry,

You might be encouraged to read my note above that Gleason 6 is not classed as “life threatening” by many Critical Illness insurers, so I suggest you carry on regardless and keep up with your quarterly PSA tests.

If you want to be really gloomy you could check the various life-expectancy calculators which produce estimates for low-grade cancers such as yours. I wouldn’t bother unless your results change.

Was yours a TRUS or template biopsy?

All MRI’s and PSA’s are not 100% accurate, and they would only know your real status if you had a prostatectomy and it was analysed, which is not necessary in your case.

Keep calm and carry on!

And the best of luck!

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User

Posted 18 Feb 2018 at 21:26

I like your urologist's approach - both on the same day is 'belt & braces' and maybe one day all hospitals will offer this.

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

User

Posted 19 Feb 2018 at 06:03

This I have to say is a really good site and thank you so much Lyneyre for your speedy reply. Having somewhere to ask questions, even daft ones is so comforting. I am more than happy to have both MRI & Biopsy as close together and on the same day if possible. The consultant also prescribed some ciprofloxacin that I am to take about an hour or so before the biopsy and then for a couple of days afterwards.

As ever, very impressed with the NHS.

Thanks again.

User

Posted 19 Feb 2018 at 09:16

Welcome to the site henry.

What a great service you have had.

As far as daft questions go, ask away. It's only daft if you don't know the answer and don't ask!!

Very little is taboo as long as it's relevant.

This is a great supportive site

We can't control the winds - but we can adjust our sails

User

Posted 19 Feb 2018 at 10:06

Wow - I thought my biopsy & all the scans were pretty well regimented but that is first class!

Good luck

User

Posted 23 Feb 2018 at 14:22

I am very grateful for the advice and information; great to receive.

I now have an appointment arranged for an MRI next week then 6 days later a biopsy via us guided transrectal. When I saw the Urologist I feel sure he said I would be ok to drive a little while afterwards. However, in the supplementary information with the biopsy letter, it stated: “it is advisable not to drive after the examination so please arrange a lift home”. Strange I thought as it’s only a minor local anaesthetic; bit like a dentists visit according to the urologist, well in terms of anaesthetic anyway.

Now the problem I have is that I live about 20 miles away from the hospital and there is absolutely no connecting public transport, a lift is not possible so if absolutely necessary I will have to take a taxi each way.

Strangely though, looking at other clinics/hospitals advice, they often suggest that you are able to drive home after a short rest. So, a little confused.

Any thoughts from others who have needed to drive after a biopsy.

User

Posted 23 Feb 2018 at 14:36

User

Posted 23 Feb 2018 at 15:58

After biopsy in 2004 I could drive. A more recent biopsy included Ciproxin so was advised not to drive.

Ray

User

Posted 23 Feb 2018 at 17:24

User

Posted 22 Mar 2018 at 16:12

Well, I have now had the MRI followed 6 days later by the biopsy.

The biopsy itself was nothing to be terribly frightened about and for up to about 8 hours later it just felt like a dull ache which was sorted with a couple of paracetamol. Passing water again was a bit of a worry but 5 hours after the biopsy that started to sort itself out.

I now have an appointment tomorrow, Friday 23/3, to see a urology nurse at the same hospital as a follow up to discuss results. To be honest I thought from what I had read on this site that I would be seeing the consultant urologist as seems to be the experience of others on this site but maybe this is the norm as I rather new to this.

Fingers crossed for tomorrow.

User

Posted 23 Mar 2018 at 16:19

I had my appointment today with a urology nurse at the hospital for feedback on the MRI and Biopsy. Like a lot of things in life, it turned out to be a bit of a curate's egg.

User

Posted 24 Mar 2018 at 03:00

You may be encouraged to know that many Clitoral Illness insurers will not pay out on a Gleason 6 score as it’s not considered life-threatening. Mine is 7 but I didn’t buy a policy anyway!

User

Posted 25 Mar 2018 at 03:13

Barry

User

Posted 26 Mar 2018 at 10:38

As ever, thank you for the helpful advice; this site is absolute gold dust.

If it helps anybody else, after making a phone call to the insurers today for my annual travel insurance, I updated them on my diagnosis as it stands. After going through a list of relevant questions, my medical history with the insurers (AXA via Smile Bank) they have updated my declared medical record without adding any additional cost to myself; very happy with that. New certificate in the post. The following link gives a very sobering account of an individual inadvertently not fully declaring their medical history: http://www.thisismoney.co.uk/money/bills/article-3731989/The-slip-travel-cover-forms-cost-heart-attack-victim-Peter-36-000.html

As I said in an earlier post on this thread, I was diagnosed on Friday last week as Gleason 6 and thanks to the enormous amount of help available both on this site and others to aid understanding, I somehow don’t feel really fazed by “my little inconvenience”. In fact, I intend to benefit myself in some way bringing forward planned trips to now & the near future rather than planned for a few years time.

Whilst on the subject of holiday insurance, it’s wise to keep a valid EHIC card for travel in Europe: not they are valid for 5 years so keep an eye on your renewal date.

User

Posted 26 Mar 2018 at 12:52

Originally Posted by: Online Community Member

I had my appointment today with a urology nurse at the hospital for feedback on the MRI and Biopsy. Like a lot of things in life, it turned out to be a bit of a curate's egg.

Thanks for sharing your recent experience Henry as it has helped me to understand how the process can work as different health authorities seems to have a different approaches.

I was offered an MRI before a biopsy I had my MRI scan and was told by the hospital doctor that I saw that an MRI scan is 90% accurate at detecting cancer if present and that a biopsy is 50% accurate.

I had my MRI scan last Friday now I am waiting to see what happens next.

I hope that the medical team will be guided by the results of the MRI scan before putting me in for a biopsy as I believe that depending on the results the MRI scan can suggest where best to take the cores from when doing the biopsy.

User

Posted 26 Mar 2018 at 14:31

Yes, Lazarus, I must admit it did make me think a touch: I was first told the MRI was clear. Then in the next breath told one of the 12 cores showed low-grade cancer and the planned follow-up would be quarterly PSA supported by MRI when necessary “as MRI is thought to be so good”. Whilst I was reassured to hear it was a Gleason 6, when driving home the thought went through my mind “ well the mpMRI looked normal but a biopsy found one segment of cancer”. Probably a conversation for me to have in three months time during my next hospital visit.

At the moment I am taking the view that the one core was a sleeping pussy-cat that did not show on the MRI; so nothing that needs rapid actioning but just AS.

As I say, I am new to this prostate world and would welcome any view from those who have been travelling a touch longer than me.

User

Posted 26 Mar 2018 at 15:22

Henry,

If you want to be really gloomy you could check the various life-expectancy calculators which produce estimates for low-grade cancers such as yours. I wouldn’t bother unless your results change.

Was yours a TRUS or template biopsy?

All MRI’s and PSA’s are not 100% accurate, and they would only know your real status if you had a prostatectomy and it was analysed, which is not necessary in your case.

Keep calm and carry on!

And the best of luck!

User

Posted 26 Mar 2018 at 15:44

Thanks, Bollinge I did see your note on Gleason 6 and insurance and today's call was just to keep their schedule/medical declaration updated. What I don't want to to have an injury abroad (non-PC related) and they some smart insurance company dismiss my claim as I had not updated my medical declaration.

My biopsy was via TRUS (updated my profile this pm).

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