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Worried about biopsy

Posted 23 Nov 2021 at 13:18


My PSA readings have been higher than normal for some time now - September 2020 6.28, May 2021 5.71, Oct 2021 11.6. Have had a MRI scan 2 weeks ago which showed no lesions anywhere and graded by the consultant radiologist as highly unlikely to be cancer however BPH changes were noticeable. 

The only thing that the radiologist noted was a PSA density of 0.21, and my urologist has recommended a biopsy solely due to this.

I was thinking that before rushing into the biopsy it would be good to repeat the PSA blood test first. Please can I have anyone's thoughts on this, thanks. 

Posted 23 Nov 2021 at 22:10

Hi newb,

I would want to be fairly certain there was something worth looking for before having a biopsy. If you look at my profile you will see I had three PSA tests over a few weeks at the start of my journey.

 A PSA 11 and consistently rising needs attention, but it has had that and a clear MRI reported. 

A biopsy is not a big deal, but a transrectal (TRUS) one has about a 1% chance of sepsis, which in my opinion is too high unless it is strictly necessary. However the more modern transperineal biopsy has less risk so if that is on offer I would not be worried about risk of the biopsy.

Personally if I had a PSA history like yours and a clear MRI I would wait three months and have another PSA. If it continued to increase I would probably then have the biopsy.

Your decision really depends how much you can accept uncertainty and risk, and how much you enjoy being prodded by medics.

I am of the opinion prostate cancer is very over treated and you should avoid getting drawn in to treatment unless the case is well made. Most on this site have had cancer and have benefitted from treatment or watched loved ones die who had treatment too late, so you may get other replies suggesting a more proactive approach.

In the end it is your decision, you are wise to solicit a wide range of opinions, and here the arguments from all sides, then you can make an informed decision.

Edited by member 23 Nov 2021 at 22:55  | Reason: Not specified


Posted 23 Nov 2021 at 22:37
Fairly critical to know whether your MRI was a really good quality one- usually referred to as mpMRI or multiparametric MRI - do you know if that was what you had?

If it was mpMRI your prostate volume measurement will be quite reliable in which case your PSA density is high and a template biopsy is very sensible.

If the scan was a standard MRI without contrast agent, the bone density calculation nay not be so reliable but if you were my brother or mate, I would be driving you to the biopsy clinic anyway.

Do check though that they are not proposing a TRUS biopsy - in your situation with a clear MRI, a TRUS would be the equivalent of sticking a pin into a fruit cake and hoping to spear a cherry.

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

Posted 24 Nov 2021 at 08:37
As Matron says above, check what MRI you had, and maybe find out the resolution of the machine. Older ones are low-res 2T (Tesla, the scientist, not the car) resolution, the latest ones are 3T hi-res - the difference between normal telly and 4K, Ultra-HD.

Avoid a TRUS biopsy (up the bum) at all costs.

We have fewer CT and MRI scanners per head than virtually all other countries in Europe. So much for our ‘wonderful’ under-funded NHS.

Wait for the results of your next PSA test. If it increases, something’s going on.

Best of luck.

Cheers, John.

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