Biopsies

[Dan087]

As mentioned in a previous post, I was diagnosed in August 2018 with intraductal prostate cancer. Low PSA (1.3) and no Gleason score on biopsy as the report indicated it was "non invasive". Have met with several physicians since (urologist/surgeons, radiation oncologists, etc) who seem to all be recommending surgery. Recently sent my biopsy slides to Dr Epstein at Johns Hopkins for another opinion. His pathology report also noted intraductal cancer which was non-invasive and actually said the following "whether these lesions represent cancerization of ducts and glands by invasive carcinoma or a de novo lesion arising within the ducts,... definitive treatment is recommended". Spoke with the doctor afterwards and, in summary, this is my situation - based on the small (12 core) biopsy sample, something was found that either could be associated with a very aggressive cancer or maybe is just a precursor lesion. Not a lot of helpful data to base a treatment plan on in my opinion.

Has anyone had experiences with re-biopsies? It's only been 5 months since my initial biopsy but I feel obligated to find out what exactly is going on as the "aggressive cancer" possibility is kind of freaking me out. Has anyone done saturation biopsies (where they take 36, 48 or more samples) or mp MRI biopsies? Is mp MRI the same as "fusion" biopsies? Which one would be better in my case? Are there any risks associated with multiple biopsies? The doctors I have spoken to mostly just want to send me directly to RP (surgery). I also have to worry about whether a second biopsy would be covered by insurance. Would love to hear anyone's thoughts on this.

[Tall_Allen]

I've had 3 biopsies. An mpMRI-targeted biopsy can be either in-bore (in the MRI machine) or later, where they fuse the MRI image with real-time 3D ultrasound guidance. If you only have non-invasive PC, it is not likely that anything will show up on the mpMRI. A transperineal mapping biopsy should provide a definitive picture about whether there is a high grade component that was missed. Insurance should cover a re-biopsy and the mpMRI because suspicion remains after the first negative biopsy, but you may have to appeal. With the mapping biopsy, there is increased risk of nerve damage, but the risk is still low. There is more blood in semen, which may take some weeks to clear out.

There is also a test of epigenetic methylation done on the biopsy cores called ConfirmMDx that will tell you the probability that negative biopsy was indeed negative.

ncbi.nlm.nih.gov/pmc/articl...

[Dan087 in reply to Tall_Allen]

Thanks Tall_Allen, I will look more into the mpMRI biopsy procedure. My urologist offers "fusion" biopsies but I'm not sure if they are one in the same. Do you know anything about saturation biopsies which would cover more of the prostate? This was mentioned to me during a consult with Dana Farber cancer institute in Boston last fall but it sounds very painful. The initial 12 core biopsy was one of the worst experiences I can remember ..

[Tall_Allen in reply to Dan087]

Fusion means as I explained above: the image from the mpMRI is "fused" with real-time ultrasound images. Template mapping biopsies are often called "saturation" biopsies. They will give you a nerve block, either way, so you should not feel a thing.