MRI before biopsy?
Hi -
I have a PSA of 4.26, free PSA of 13%, an abnormal suspicious DRE, and my father died at 59 of prostate cancer.
My primary care (VA) has referred my to urology, and my appointment is May 13.
Question: Should an MRI come before a biopsy? If so, and the urologist wants to proceed directly to a biopsy, should I try to insist on an MRI first?
I hope this is an appropriate use of this forum.
Thanks to anyone who might want to weigh in.
Hi
. Considering the exam results and family history it is good that you are being proactive in going to see the urologist and in seeking information in preparation for the appointment. It is a great question about the MRI (and absolutely appropriate for this Forum). I want to share with you this article from the Journal of the American Medical Association which states that "National and international guidelines currently recommend that MRI be performed before a decision is made whether to perform a prostate biopsy:" https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808559. The research discussed in the paper also found that the MRI before the biopsy resulted on fewer biopsies and when a biopsy was then done "detection of fewer Gleason score 6 cancers, and detection of more Gleason score 7 or higher cancers. Considering what this paper notes, it seems that the standard of care is now for the MRI to come first. Hopefully this information can help inform future conversations with your doctor. Hope your appointment goes well and please feel free, if you like, to keep us posted on how you are doing and to ask further questions. Best, Richard (Team Member) Will do. Thank you so much.
: I was in a similar situation and underwent an MRI ... before undergoing a biopsy. I was told that while the results were not 100% conclusive, doing so offered better insight into what the next steps might look like. Dennis 
I would recommend MRI and then do an ultra sound guide MRI overlay transperineal biopsy. This is the best protection for your erection nerves. Also find out if you urologist owns a Da Vinci surgical system? If the answer is yes DO NOT agree to a Radical Prostatectomy before requesting a second opinion from a qualified radiologist.
If they own the robot system they have to pay for the robot system. This gives a great incentive to skip less invasive procedures that would leave you pecker limp for life and your bladder weak so every time you squat down you need to change you pants.Hi
. There is a possibility of multiple factors being at play at once. Research has found that Vietnam veterans exposed to Agent Orange besides having higher rates of prostate cancer, also are more likely to have more severe cases. This article from our editorial team goes into more detail on the topic: https://prostatecancer.net/living-coping/veterans. It is possible that your father did have a predisposition to prostate cancer and that Agent Orange exposure led to a worse case. This could account for you potential having the genetic predisposition and your father still being impacted by the Agent Orange. Of course, there is no way of knowing and it is also true that one in nine men will develop prostate cancer at some point. Best, Richard (Team Member) if you get a biopsy ask for foundation 1 genetics and PD-L1 which usually comes with the foundation 1 work.
