MPMRI biopsy

Best wishes,

Chris

1.2.2Offer multiparametric MRI as the first-line investigation for people with suspected clinically localised prostate cancer. Report the results using a 5‑point Likert scale. [2019]

1.2.3Offer multiparametric MRI-influenced prostate biopsy to people whose Likert score is 3 or more. [2019]

1.2.4Consider omitting a prostate biopsy for people whose multiparametric MRI Likert score is 1 or 2, but only after discussing the risks and benefits with the person and reaching a shared decision (see table 1). If a person opts to have a biopsy, offer systematic prostate biopsy.

In other words the guidelines are quite clear about what a consultant should or should not do. In other words my consultant,if following the guidelines, should make contact and discuss whether or not to have a biopsy. In doing so he or she would go over the benefits and risks - biopsies are not much better at finding PCa than the MRI which is now considered the first line gold standard. It does of course miss some cancers but has been shown to be much more efficient at finding significant cancers which would require treatment.

One of the problems of the biopsy is as NICE points out

You may be diagnosed with clinically insignificant prostate cancer. This is disease that is unlikely to be life-threatening, but will need monitoring and may lead to treatment. Therefore, if someone has prostate cancer that truly is clinically insignificant, it is better not to find it. Between 18 and 23 out of 100 people with a low-risk MRI get a diagnosis of clinically insignificant prostate cancer if they have a prostate biopsy.

In other words they get invasive treatment when it is not required.It is claimed that 25 per cent of those who get MRIs are 1 or 2 on the scale and therefore do not need a biopsy.

In a press release NICE said

"Multiparametric MRI is clinically cost effective as it will reduce the number of biopsies performed. Additionally, cancers are more likely to be detected and identified earlier, therefore, reducing the need for further treatment."

And Lyn my mpMRI is clear. There are no suspect areas - if there were they would be given a score of at least 3 but more likely 4 or 5.

What I am saying is are consultants following the guidelines or not.

My mpMRI showed disease on left, but the biopsy showed Ca on the right, although the post op specimen showed disease both sides.

If you didn't have an enlarged prostate, then perhaps the urologist thought the PSA was disproportionately high?

Just a thought for you to ponder..

Thala

You will read what you want to read into the guidelines. Let me refer you (as you so courteously referred me) to your own quote:-

1.2.4 Consider omitting a prostate biopsy for people whose multiparametric MRI Likert score is 1 or 2, but only after discussing the risks and benefits with the person and reaching a shared decision (see table 1). If a person opts to have a biopsy, offer systematic prostate biopsy

Consider omitting, but only if you have explained to the patient the risk of relying solely on the MRI. It seems your consultant considered and ruled out omitting the biopsy.

I also think that your interpretation of the NICE narrative is taken out of context; over-diagnosis and over-treatment is a serious issue in our country, but over-biopsying is not the cause ... the problem is that men, once diagnosed, are often not confident with the 'low risk' approach of active surveillance. If diagnosed, no one is going to force you to have radical treatment.

If you know that you would not have treatment even if you were diagnosed, then save the NHS some money by not having the biopsy. My father-in-law regretted being diagnosed and refused any treatment that would affect his sex life - he only survived for 4 years but it was a very happy 4 years.  

Edited by member 17 Oct 2019 at 16:56  | Reason: Not specified