Do you know what type of biopsy you had? Was it a “blind” biopsy or a 3T (Tesla) MRI guided biopsy? If you had an MRI guided biopsy, most likely you would have an MRI and then the biopsy procedure the next day. This is CRITICAL INFORMATION and here’s why:
Most urologists do, what is called, a blind or random biopsy for the first time. We all agree to it because we do not know any better. The reality is that they are inaccurate as ultrasound does not discriminate cancerous tissue from noncancerous tissue within the gland. They are random due to a generic segmenting of the gland into which needles are directed in a hit-or-miss attempt to capture cancerous tissue. In a nutshell, cancer can be missed.
To have an accurate diagnosis, a 3T MRI guided biopsy is necessary. Simply put, blind biopsies are inaccurate and should never be used to decide on a treatment decision. In fact, it's not worth getting a 2nd opinion on the pathology of a blind biopsy. Biopsies should not be taken lightly as they are not without risks when it comes to seeding and ED.
MRIs are ultra sensitive and will show abnormalities where the urologist can target during the biopsy. Normally, the process is doing the MRI the day before the biopsy so that the urologist has time to have the MRI results.
- Warning: Be advised that medical providers will request that contrast be used with the MRI. The contrast used is gadolinium -- a very dangerous metal that does not leave the body. You can request to do the MRI without contrast but be prepared for push back. You will be told that "the MRI will be useless without the contrast." This is a false statement.
So what to do if you’ve had a blind biopsy? Wait 6 months, then find a radiology facility that has a 3T MRI machine and request a 3T MRI guided biopsy. If your urologist is affiliated with a facility that has a 3T MRI, even better.
Had a 3T MRI guided biopsy?
Great! Did you get a 2nd opinion on the Gleason score? Do not discount the importance of having a second set of eyes on the pathology. There have been many times that Gleason scores have been changed. Pathology is part experience and part science. The experience part is all human and humans are not perfect. It is recommended to use Johns Hopkins or Bostwick Labs and here are instructions on how to do that.
No biopsy, just a high PSA. Urologist wants to do a biopsy
Request a 3T MRI guided biopsy only. Be aware, most urologists will prescribe Cipro prior to a biopsy. It's in the family of fluoroquinolone antibiotics and is a very dangerous drug. Request an alternative. You can find Cipro alternatives here (see above for more information on the importance of the type of biopsy)
Do not panic. Panic will cause you to make an uneducated, fear-based decision. You want to make a fact-based decision and you can only do that if you research.
Here is a comprehensive informational page on Gleason scores and staging.
Before deciding on treatment, did you know there are genetic tests available? Look into them to see if there is a right one for you particular situation. Your urologist will not be able to help you as these tests are done at third party labs. In fact, be prepared for your urologist to not have any knowledge of these tests or to push back when you ask about a genetic test. Use all of the tools available to you to make an educated decision.
Here is a list of genetic and detection tests. If you need more information than we have here, you can call the company directly.