Bioposy or MRI?
Good Day
I am 52. During my last physical my PSA was 5.7 in one year it increased to 6.1
Bioposy was scheduled 3 months later. I convinced my urologist request a MRI with contrast. My results PI-RADS 2 (indicates a "low" probability of clinically significant prostate cancer). My prostate enlarged (BPH). I get up twice at night, my pee stream is weak.
With a PI-RADS 2 results do I really need a bioposy? My doctor said it will assure no cancer is detected. honestly, my opinion with a low PR-RADS 2 it seemed like its not necessary, yet!
Hi
. This is a great question and it is understandable that you are in no hurry to get the biopsy. The research, in all honesty, seems inconclusive. This paper notes that "men who choose not to be biopsied with a normal prostate mpMRI should be warned, as part of informed consent, that a clinically significant cancer could be missed in up to 10–20% of cases (depending on PSA density) and close follow-up should be recommended:" https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/bju.14901. Here is another study that discusses careful monitoring and serial MRI, finding that "Almost half of the patients with a PIRADS-2 index lesion were upgraded to PIRADS ≥3 when evaluated with serial mpMRI when a PSA increase of ≥25% was observed during follow-up. PCa was detected in half of the patients who underwent a biopsy:" https://www.sciencedirect.com/science/article/abs/pii/S1078143924005787. This would seem to indicate the potential to wait with follow-up testing, but a significant number did eventually discover cancer. In the end, the person has to make the decision for themself. I also want to share this article from our editorial team on second opinions, which might help clarify things for you: https://prostatecancer.net/living/second-opinion. Hope this information is helpful and please feel free to keep us posted and to ask additional questions. Best, Richard (Team Member)
