Just got my MRI. PSA rising slowly for 3 years from 4.0 to 5.1. The MRI indicates a pi-Rad level 4 lesion 10 ml, well defined with no infiltration. Either base peripheral zone 11 to 12 o clock or transitional mid gland zone 11 to 12 o clock. Will get the location cleared up.
I have an MRI fusion targeted biopsy scheduled in late May.
Is the waiting period for this lesion appropriate?
Being seen at University of Wisconsin Hospitals and clinics by a urologist.
PCa is usually an extremely slow growing cancer so waiting until May for the biopsy is not an issue. Hopefully you are getting a transperineal biopsy rather than a transrectal biopsy. Best of luck to you. Keep us posted on your results.
ty CarverD
You were wise to get a MRI before biopsy! But, May seems like an awfully long time to wait. I waited one week at the UNM Cancer Center in Albuquerque, NM. You may want to ask a different urologist to get an earlier appointment.
But, to answer your question, you do have time, given your relatively low PSA and no extra capsular extension (ECE). My PSA went from 5 to 10 in 8 months, which is relatively fast. My MRI indicated a PIRADS 5 tumor 1.3 cm long. I plan on getting SBRT treatment (5 days of irradiation). Radical prostatectomy has too many bad side effects, even with the DaVinci robot.
If you're desperate to have a biopsy sooner, you can have a traditional transrectal biopsy with "cognitive targeting". That works well in the hands of an experienced Urologist. He/She uses the MRI report to help him target the dominant lesion, but doesn't "fuse" the ultrasound image with the MRI image. The Urologist should have done thousands of biopsies before considering cognitive targeting, though.
I recently got a cognitive transrectal biopsy and it went well. I did ask for an extra shot of Rocephin antibiotic, which is sensitive to e-coli (Cipro is resistant to e-coli), and I had no problems with infection.
Alternatively, you may want to ask for a Urologist to do a transperineal biopsy, which has greatly reduced risk of infection. Plus, it can reach other zones of the prostate that a transrectal approach cannot. Transrectal is the new Standard of Care for biopsies.
On the horizon is the MicroUltrasound machine, that operates at 3X the frequency as older US machines. The MicroUltrasound machine provides a spatial resolution almost equivalent to a MRI machine (and is a lot cheaper). You might ask your Urologist about this new option...
You're relatively close to the Mayo Clinic in Minnesota or University of Chicago. You may want to go there for a transperineal biopsy with a MicroUltrasound machine. Be proactive, and ask for the best equipment and techniques.
Bob
I would be at Mayo if they were in my Medicare Advantage network. The Urology Dept at UW is actively looking for an earlier date. Maybe another staff member doing the TRANPERINEAL biopsy. Coliform bacteria in this case are not my friends.
Janebob, thank you for relaying your experience and wealth of knowledge!
I am on board in reserving the surgery cure for the final solution. Prolaris sequencing and possibly PSMA PET are both on the table once the biopsy results are examined.
My current favorite equation? 3+3=6!
They do have an interventional radiologist on staff at UW Urology and Rad Dept. I believe they are doing fully MR guided biopsies and ablations in-bore as of late 2022. You should check into this.
Thank you tsim. Good advice I shall follow up on.
Thanks for the advice.
I now have a March 29th TRANSPERINEAL fusion biopsy. 2 months earlier. The late May biopsy was going to be transrectal. Was not interested in seeing the antibiotics given before the enteric bacteria inoculations were going to be effective. And the urologist is quite proficient in focal HiFU. Great if we go that way!
It pays to be patient, do your research, and be a bit lucky! I stayed within my network too!
The Doctor has quite an extensive research history. He asked me to forward the other institution's multiparametric 3T with and without contrast results. He wanted to read the images HIMSELF. A free 2nd opinion.
The targeted and patterned biopsy will be done to optimize the decision of focal or entire treatment options.
I was all smiles during the initial consult!
MRI Results - Advice Requested
Second opinion on Biopsy
Forgoing Regular Prostate Biopsies
Biopsy 2 years post treatment 
