Concerns About Recent Biopsy Experience

Almost everyone referred on what used to be called the 2 week wait for potential prostate cancer will have an MRI with a PIRADS result 1-5. Given more people referred don't have prostate cancer than do, 25% is not out of the question, but I would have guessed it was higher than 25% in most hospitals.

The DRE feels through the capsule, so it can feel what's inside the capsule. Prostate cancer is most often in the peripheral (edge) zone at the rear, so DRE is good at picking it up, but it can occur anywhere in the prostate, and DRE won't pick it up anywhere else. Mine was mainly at the front, and my DRE felt normal.

Normal prostate size is usually quoted at about 25-30cc, but many men's prostates never stop growing, so prostates many times this size are common. Mine was 97cc, but was not giving me any symptoms even so. In a recent support group meeting, one member said their prostate was 600cc, which is the largest I've heard of (also heard of a 500cc), and even so it was only just starting to give him problems. While many men get symptoms from an enlarged prostate which get worse as it grows further, not all do. Enlarged prostates are slightly less likely to get prostate cancer.

Your consultant said they took more samples from the suspicious area, so yes they did use the MRI. There are techniques known as MRI fusion where the MRI image is merged with the live ultrasound image which they might have used if they had the equipment capable of doing so.

The principle in the UK since mid-2018 is MRI before biopsy. There were some exceptions during COVID due to lack of access to MRI. Some people can't have MRI due to metallic or electronic implants, in which case a CT scan might be used but doesn't usually differentiate cancer as clearly. There is also a high definition ultrasound which a few centres have, but that's expensive kit.

Edited by member 01 Nov 2023 at 11:46  | Reason: Not specified

I would think that they will give you the results with details of "target zone" and random samples. 

The steps you learn about prostate cancer are:

PSA: elevated levels depends also on the size of your prostate so it would worth asking how they take this into account with the size of yours.

DRE:  no one noticed anything wrong with my prostate until I had a MRI. So again not a 100% valid test

MRI: if you had an MRI before the biopsy I would guess that they would follow with a target biopsy

BIOPSY: for target biopsy they need to merge the MRI image and the image they have during the biopsy. It is possible that some hospitals don't have yet the technology (I don't know). So it is important to make sure they have results for the target zone.

GLEASON: the biopsy results gives you a Gleason score. The first grade is the most predominant they find in your prostate. The second is the highest grade they find. So make sure that you get the detail and not only a single number. Because a Gleason 7 of 3+4 is different that a 4+3.