MRI or biopsy first?

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Joined: Sun May 01, 2016 3:54 pm

MRI or biopsy first?

Postby hodgkiss43 » Sun May 01, 2016 3:55 pm

I had a template biopsy in October and was given my diagnosis in November, Stage 2a. Gleason 3+3.
Recently had another blood test and MRI, which has shown cancer still contained within prostate, there’s been no spread to bones or lymph nodes.Which is good news!

However the MRI also detected a few suspect areas which were not sampled during the biopsy - so now I have to have a second biopsy to sample from these areas.
I don’t mind a second biopsy (discomfort wasn’t too bad from the first), but surely if the MRI was done first then only one targetted biopsy would have been needed. Is it always done this way or is it a matter of cost, presumably if the first biopsy finds nothing then an MRI is not done. Or is it the other way round. This was the NHS in Liverpool by the way.

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Joined: Sun Apr 24, 2016 2:40 pm

Re: MRI or biopsy first?

Postby professoreden » Sun May 01, 2016 5:26 pm

Hi, great questions.

From what you've told me it seems that you were placed on active surveillance following the detection of your low-risk prostate cancer (PSA less than 10, stage T1-2a and Gleason 6), which is the standard initial management. However, as your MRI scan was not done until after your biopsy not all of the abnormal areas seen on your MRI scan have been biopsied and a further biopsy is planned.

It is precisely for this reason that I would always recommend a pre-biopsy MRI scan. If the scan is normal in a man with a PSA of less than 10 and a normal rectal examination then prostate biopsy can be avoided knowing that he has a 80-90% chance of not having prostate cancer (the MRI scan's negative predictive value). However, if the MRI scan is abnormal the abnormality seen can be specifically targeted during the biopsy process, significantly increasing the detection of prostate cancer if it is present.

Cost isn't an issue here - it is more a question of what constitutes best practice. At present, there are large geographical variations within the UK, Europe and the USA regarding the order of the MRI scan and the biopsy but given the results of recent studies it is difficult to imagine that urologists won't all be ordering a pre-biopsy MRI scan in men under suspicion of having prostate cancer in the future as this is a much more logical, reassuring, cost-effective and accurate way of investigating them.

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