"But reading through a lot on here (and elsewhere, naturally) - I see a lot of things about 3 being a watch & observe and also this biopsy is not the best one."
First, I think that you are confusing a Gleason 3 with a PIRADS 3. PIRADS 3 means that on the mpMRI, they saw an area of concern and cannot say either way what the likelihood is that this is a tumour. If it was a PIRADS 5, that would mean that there is a high likelihood of a biopsy finding cancer while a PIRADS 1 means that they are almost certain there is no cancer. So with a PIRADS 3, they can't be sure and the only way of finding out is by doing a biopsy.
What you have read about a 3 being a 'watch and wait' is about Gleason 3 + 3 which is the least aggressive distortion of prostate cancer - you are not in that category because you haven't had a biopsy yet but if the biopsy does identify some cancer then yes, you may have a less aggressive type that doesn't necessarily need radical treatment ... cross that bridge when you come to it!
It is true that an old style TRUS (rectal) biopsy isn't the best but that isn't what you are being offered. The issue with the plain & simple TRUS biopsy was that it was done before the MRI and was the equivalent of sticking a needle in and hoping that it went in the right area. What you are being offered is an image guided biopsy that will sample the area of concern identified in the scan (the PIRADS 3 area).
There is another type of biopsy where they use a template and take lots of samples but a) you don't need that because your mpMRI has already identified the area to target and b) it needs an operating theatre, which are in short supply due to Covid so there might be a very long wait.
A good lesson here - googling is okay to a point but make sure that the info you find is reliable and that you are understanding it correctly. The most reliable source is the PCUK toolkit as mentioned above.
Edited by member 10 Dec 2020 at 20:43
| Reason: Not specified
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Because an MRI can't diagnose cancer - only a biopsy can do that.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Hi Snolly,
sorry that you find yourself on here but it really is a good source of information, this time last year I was at the same stage as you, I had no symptoms but PSA was 5.6, I was just about to get my MRI scan and I came back as a PIRADS 3, I had a conversation with my oncologist and as LynEyre says it’s really an indication that there is something there that needed further investigation so I had the template biopsy in Jan 20 and I was sure that I would be clear but the results came back as Gleeson score 3+4, I have had Brachytherapy and am now heading out the other side of my treatment with very few if any long term side effects. As to when to get on the treadmill, I would say you are on it and you should stay on it until you have all the answers, you’ll be asking yourself why you but If the biopsy comes back with news you don’t want to hear you’ve been got in good time and treatment is very successful. A second MRI will only come back with a similar result as the first one, you do need to get the biopsy it will give a definitive answer and also let you know what stage if any the cancer is at. All the best and don’t be afraid to ask questions.
David
User
Hi Snolly
when faced with this myself at 57, initial PSA 4.5, then two weeks later 4.1. DRE all ok (checked twice) then MRI which did show a lesion and I was told the same in that they did not think there was anything to worry about but the only way of being sure was the have the biospy and that this was my choice as there was no pressure to have this done.
At the time I felt there was no choice as if something was not quite right then I would prefer to know. The procedue to take 10 samples TRUS wasn't too bad and I chose a local anaesthetic. I found the after affects more stomach renching than the actual procedure which is just crazy really, blood in your urine and semen until everything was more or less flushed through.
The result confirmed cancer but not aggressive and very small, almost 5 years on and regular checks which has included 3 sets of biopsies and two mri I am only now at a stage where treatment is now required and everything as I believe has been caught nice and early. Looking back I could have started treatment I was told if the word cancer really bothered me but I felt the advice that I was given was excellent, I had lots of faith in the consultant and sister of the dept and I think its really important to have that.
If you have the procedure then if there is one thing I would suggest is to just tell them to get on with it and not to tell you when they are about to take another sample. Maybe some doctors just do this but I found the first time around as they soon as they say " ok I'm going to take another sample" you automatically tense up. so the second time when I was on the bed for round two biospy I said "I know the drill, I would like the local anaesthetic and don't tell me when you taking a sample", she said I was going to recommend a local as I'm taking 20 samples!!, my response was " thanks, you wait till you have a blokes pants off then tell him that lol". At 12 samples she asked how many did I think she had taken and I said 8.
If I were you just go and let them investigate, we are one of the lucky ones in that if there is anything then we are in the system and everything should work out fine.
All the best
User
If you were my brother or mate, I think I would want you to have the biopsy after Christmas - not sure what is to be gained by delaying 3 months.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Hi Snolly,
With your current situation ie PIRADS 3 I would agree with LynEyre and get the biopsy carried out ASAP, firstly if the biopsies come back and are clear that would put your mind at ease but if you do have prostate cancer the earlier you get diagnosed the more options you have for treatment and the more successful your treatment will be.
User
I agree and will be getting the biopsy done asap. I think the theory is if they find something but it doesn't require treatment then that can cause unnecessary ongoing stress and worry along with the ordeal of the biopsy itself.
Show Most Thanked Posts
User
Hi,
That's a very good question.
The point of the MRI is to target lesions so they can be more focused at the biopsy.
There was a time when they did the biopsy first more as a hit and miss.
Many people strongly prefer the template biopsy because it has more chance of finding something and the more evidence there is the better, but it is a bigger affair being under general anaesthetic.
Once you start on this treadmill it's hard to get off and you could ask how big the lesions are and whereabouts are they located in the prostate. For example if they are near the bladder or the edge of the prostate you might want them treating even if small. You could then alternatively reject the biopsy or put it off with a bit of re-assurance if that is your choice.
I must admit that my choice would be to have the standard biopsy and hope your medical team are cautious and not people who over treat. I was offered surveillance if I had a template biopsy with a fairly large and higher graded lesion to show they weren't over treating he said. They usually put the onus on the patient to drive choices unless it's obviously wrong.
Regards
Peter
Edited by member 10 Dec 2020 at 15:48
| Reason: Not specified
User
Thanks Peter. That's the question, when to get on the treadmill. Read time and time again that some biopsies are done unnecessarily but how on earth does the layman know ? And also which one to go for if at all, why not a second MRI instead ?
I'll ask more questions obviously when they call but for now they're just recommending I got for the (cheaper) biopsy.
User
So you could do yourself a favour and order the “Toolkit” information folder from this charity, available from the publications section of this website, in case you do have the Big C, which is by no means certain at this stage.
A biopsy should determine if you have any worrying cells in your prostate gland, but I would counsel you to avoid a TRUS (up the bum) biopsy, and instead go for a transperineal biopsy under either a local or general anaesthetic.
The reasons are two-fold, TRUS biopsies have more risk of infection, take less samples, and I know and have heard of many men who have had a TRUS, only to endure a more accurate transperineal biopsy subsequently. Buy one get one free!
Best of luck.
Cheers, John.
User
"But reading through a lot on here (and elsewhere, naturally) - I see a lot of things about 3 being a watch & observe and also this biopsy is not the best one."
First, I think that you are confusing a Gleason 3 with a PIRADS 3. PIRADS 3 means that on the mpMRI, they saw an area of concern and cannot say either way what the likelihood is that this is a tumour. If it was a PIRADS 5, that would mean that there is a high likelihood of a biopsy finding cancer while a PIRADS 1 means that they are almost certain there is no cancer. So with a PIRADS 3, they can't be sure and the only way of finding out is by doing a biopsy.
What you have read about a 3 being a 'watch and wait' is about Gleason 3 + 3 which is the least aggressive distortion of prostate cancer - you are not in that category because you haven't had a biopsy yet but if the biopsy does identify some cancer then yes, you may have a less aggressive type that doesn't necessarily need radical treatment ... cross that bridge when you come to it!
It is true that an old style TRUS (rectal) biopsy isn't the best but that isn't what you are being offered. The issue with the plain & simple TRUS biopsy was that it was done before the MRI and was the equivalent of sticking a needle in and hoping that it went in the right area. What you are being offered is an image guided biopsy that will sample the area of concern identified in the scan (the PIRADS 3 area).
There is another type of biopsy where they use a template and take lots of samples but a) you don't need that because your mpMRI has already identified the area to target and b) it needs an operating theatre, which are in short supply due to Covid so there might be a very long wait.
A good lesson here - googling is okay to a point but make sure that the info you find is reliable and that you are understanding it correctly. The most reliable source is the PCUK toolkit as mentioned above.
Edited by member 10 Dec 2020 at 20:43
| Reason: Not specified
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Because an MRI can't diagnose cancer - only a biopsy can do that.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Hi Snolly,
sorry that you find yourself on here but it really is a good source of information, this time last year I was at the same stage as you, I had no symptoms but PSA was 5.6, I was just about to get my MRI scan and I came back as a PIRADS 3, I had a conversation with my oncologist and as LynEyre says it’s really an indication that there is something there that needed further investigation so I had the template biopsy in Jan 20 and I was sure that I would be clear but the results came back as Gleeson score 3+4, I have had Brachytherapy and am now heading out the other side of my treatment with very few if any long term side effects. As to when to get on the treadmill, I would say you are on it and you should stay on it until you have all the answers, you’ll be asking yourself why you but If the biopsy comes back with news you don’t want to hear you’ve been got in good time and treatment is very successful. A second MRI will only come back with a similar result as the first one, you do need to get the biopsy it will give a definitive answer and also let you know what stage if any the cancer is at. All the best and don’t be afraid to ask questions.
David
User
Thanks you make a lot of sense and already answered some of the questions I had. I appreciate that.
User
Hi Snolly
when faced with this myself at 57, initial PSA 4.5, then two weeks later 4.1. DRE all ok (checked twice) then MRI which did show a lesion and I was told the same in that they did not think there was anything to worry about but the only way of being sure was the have the biospy and that this was my choice as there was no pressure to have this done.
At the time I felt there was no choice as if something was not quite right then I would prefer to know. The procedue to take 10 samples TRUS wasn't too bad and I chose a local anaesthetic. I found the after affects more stomach renching than the actual procedure which is just crazy really, blood in your urine and semen until everything was more or less flushed through.
The result confirmed cancer but not aggressive and very small, almost 5 years on and regular checks which has included 3 sets of biopsies and two mri I am only now at a stage where treatment is now required and everything as I believe has been caught nice and early. Looking back I could have started treatment I was told if the word cancer really bothered me but I felt the advice that I was given was excellent, I had lots of faith in the consultant and sister of the dept and I think its really important to have that.
If you have the procedure then if there is one thing I would suggest is to just tell them to get on with it and not to tell you when they are about to take another sample. Maybe some doctors just do this but I found the first time around as they soon as they say " ok I'm going to take another sample" you automatically tense up. so the second time when I was on the bed for round two biospy I said "I know the drill, I would like the local anaesthetic and don't tell me when you taking a sample", she said I was going to recommend a local as I'm taking 20 samples!!, my response was " thanks, you wait till you have a blokes pants off then tell him that lol". At 12 samples she asked how many did I think she had taken and I said 8.
If I were you just go and let them investigate, we are one of the lucky ones in that if there is anything then we are in the system and everything should work out fine.
All the best
User
A little update having spoken with urology earlier today..
I have a lesion on both sides of prostate
They can't tell what it is hence pirads 3
It appears (?) to be contained within - though they didn't really want to say that outright.
I have a small prostate!
They ran some math and said 8% chance it's cancer and 2% significant cancer, based they said on "lots of my medical figures"...
And after the consultant initially said do the rectal biopsy they said wait 3 months if you want to !
I'm a big worrier, so edging on going for the biopsy just after Christmas anyway...but it does make you wonder whether waiting is best. But I suppose with PSA at 3.2 and my prostate being small that might equate to more in a normal sized prostate. Guessing.
Anyway thought I'd update in case it helps anyone else reading.
Cheers
Snolly
User
If you were my brother or mate, I think I would want you to have the biopsy after Christmas - not sure what is to be gained by delaying 3 months.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Hi Snolly,
With your current situation ie PIRADS 3 I would agree with LynEyre and get the biopsy carried out ASAP, firstly if the biopsies come back and are clear that would put your mind at ease but if you do have prostate cancer the earlier you get diagnosed the more options you have for treatment and the more successful your treatment will be.
User
I agree and will be getting the biopsy done asap. I think the theory is if they find something but it doesn't require treatment then that can cause unnecessary ongoing stress and worry along with the ordeal of the biopsy itself.
User
My biopsy wasn’t an ordeal. Went in in the morning, had general anaesthetic, woke up with it done, painful pissing blood and razor blades for the first two post-operative micturitions, and discharged myself about 2pm.
Pink semen for about two weeks and a bloody big yellow, blue and purple bruise on my perineum where they had inserted the 42 biopsy needles, and that’s about it. Not anything like an ordeal at all.
I hope yours goes as smoothly and you end up with a good result.
Cheers, John.
User
Good thing this forum doesn't allow pictures or I'd show you my photo album of my perineum bruises after my biopsy 😁. Seriously, though, anticipation of the biopsy is worse than the event. You're doing the right thing getting it over and done with.
Chris
User
"Good thing this forum doesn't allow pictures or I'd show you my photo album of my perineum bruises after my biopsy 😁"
This is exactly why we voted not to have photo capacity on the forum 😂😰
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|