Well, I had the biopsy and am now waiting for the results. The procedure was unpleasant but not really painful except when the ultra-sound probe was removed. That hurt but it was brief. My initial thoughts, assuming some sort of treatment will be needed, is to avoid cutting. There is facility near me that has a cyber knife and I’m an hour’s drive from Philadelphia where there are all kinds of options. Brachytherapy looks attractive, too. I guess I’m getting ahead of myself, not knowing the biopsy results. I did read about studies where focal(?) therapy was used. Some with heat, some with cold, some with lasers. All seemed to have good results when it came to side-effects but not enough time has passed to be certain on long term results. I gather these are experimental and not covered by insurance.
So this was a straight-up ultrasound biopsy? No MRI?
You should check into HIFU. At the time I had treatment, it wasn’t approved in the US but long approved overseas, perhaps it’s available now. I’ve heard good things.
I did have an MRI first and the doc said that he was going to take the standard 12 cores plus an additional one from each of the two lesions that showed up on the MRI. I didn’t count as he went along but after I left I got to thinking that it didn’t seem like 14 samples. I’ll clear that up when I go in for the results. I did see the HIFU as one of the options of the more targeted treatments and I’ll definitely explore all the possibilities if/when it comes to that.
So this sounds an ultrasound biopsy: while you’re awake they stick a probe in your nethers, shoot needles laterally into your prostate, and hope one cores the cancer.
I had three of these, no diagnosis.
What diagnosed me (after 4 years of trying) was an MRI guided biopsy. You’re knocked out and the cores are taken while you’re somehow in the MRI machine at the same time.
Biopsy results came back and there were 6 3+4 samples and 2 4+3. The urologist felt surgery was the best option. He didn’t even mention radiation until I asked. He felt that I wasn’t a candidate. He did refer me to a radiation oncologist and I’m waiting to meet with him to see if he agrees. I was hoping for the Cyberknife treatment but if surgery is the better choice, so be it. I was also referred to a doc who is supposed to be one of the best in the U.S., if not the world, on the Da Vinci robot. Being near Philadelphia has its advantages.
Man, sorry to hear you got that diagnosis. Yes, 3+4 warrants removal. I’d think HIFU and brachytherapy would still be in the mix though, since they would both destroy the prostate. But what do I know? - I went with robot surgery too.
I don’t believe brachytherapy destroys the prostate - mine was fine. But his cancer is more advanced than mine, so I don’t know if it would be warranted.
That sounds a lot like my father’s score - I think he was a 3+4 if I remember right. He had his prostate removed something like 10 years ago. He was rather overweight, and had lots of scar tissue in the area from past surgeries, so it was a bit more difficult. Ended up with some nerve damage that resulted in incontinence, so he had an artificial sphincter installed.
It may be worth asking if you’re at risk for something like that. But hopefully you haven’t had multiple metal plates inserted after separating your pelvis, and thus are much lower risk. 
Good luck!
I’d be really surprised if there is a type of biopsy that involves getting an MRI in real-time. You can’t have any metal near the MRI machine, and there isn’t room for a doctor to be fiddling around in there. I’m guessing you had an MRI fusion biopsy, which takes existing MRI images and “fuses” them with ultrasound images using software. This can be done under local or general anesthetic.
I had one last month and was awake for the procedure. They stuck the ultrasound probe in and scanned for ~10 minutes to get an ultrasound image. There was then another 10 minute pause while they merged that with my previous MRI images. I couldn’t see the screen while they were working, but I assume they were matching up waypoints from the MRI and ultrasound images. I could hear mouse clicks, they’d move the probe slightly, more clicks, repeat.
Once they had the complete 3D map, they grabbed the cores. They did the standard 12 samples, plus another 5 specifically targeted at lesions detected in the MRI. I had to stay completely still throughout the mapping and sample collection process, or it would mess up the map. I assume this is why general anesthesia is sometimes recommended.
As for my experience, I don’t think they got the local anesthesia equally distributed throughout my prostate. About half of the samples were as the doctor described - “a little pinch when they insert the needle, then some pressure when they extract the core.” Another few were uncomfortable. And about five felt just like what they are - a giant needle being poked into you, then a sharp punch as the core is removed. I was squeezing the damn stress ball they gave me for all it was worth. I made it through OK, but almost puked when I got home from a delayed reaction. Not pleasant.
Mine came back GS7 (3+4), so I’m currently evaluating surgery and the various radiation options. Welcome to the club, I guess.
I forget the term (in bore?) but there is a biopsy that is done while you are in the MRI. Not all metal is prohibited, just stuff that reacts to a magnet. I’ve had a few while still wearing a gold ring. They said it was fine as long it was actually gold. So special instruments and specially trained docs, I guess. The more I read, the more attractive the Cyberknife seems to be. I can’t find anything on the internet that says “Cyberknife not recommended if (fill in the blank)”. I’ll know in a couple of weeks. One thing that seems to be true is that if radiation doesn’t work, surgery may no longer be an option due to tissue damage. Much to consider.
Well, today I learned. @squeegee, did you have the in-bore procedure?
I met with the oncologist last week, and it was very informative, but in the end I’m still left with no clear-cut answer. Different side effects, different risks short-term and long-term. In addition to surgery possibly not being an option after radiation, there is also risk that radiation can’t be used for future cancers in the same area (like rectal) if you had it for prostate. My doctor said “treat the cancer you have, not the one you might have,” but it’s still a consideration.
And there’s the (low) risk that radiation can actually cause a cancer that wasn’t there (according to him, ~1/300 chance over 10 years). Which on the one hand seems low, except it really isn’t that low, especially when I consider my hoped-for life expectancy.
No idea. I was just told it was an “MRI Guided Biopsy™”, which no doubt wasn’t the real name of the procedure. This was in 2017 so I don’t remember much except it was done in a hospital and I was under general anesthesia.
It sounds like “MRI-guided” is the general term for both fusion and in-bore. And from that article, both are comparably effective.
I agree with you, some form of MRI-guided is definitely the way to go.
I got my latest test results - .07 PSA. December number was .06. So with error bars basically the same number. I have an existing appointment with the NP tomorrow, will discuss.
So I discussed my PSA with the NP. Takeaways:
- We can’t really infer much from the PSA number being about the same, and (emphasis) this is a very small number.
- Over time if there’s a quick rise something can be inferred re the aggressiveness of the cancer, otherwise if it rises slowly we don’t know much.
- The number may stay under .1 for quite some time for some patients. The most common thing is it will slowly rise over months or several years to .2, at which point treatment will be recommended.
- For some men in some cases if the number stays below .2 for a long time (she threw out 2 years as an example), treatment will be recommended below the .2 threshold. To my question, she agreed there was a concern at some point about metathesis if left untreated even at a low level.
- In either case I would be referred to the radiation department. She had little visibility into what would happen then (different department) except to say there were a range of imaging options that might happen to diagnose where the cancer is, examples PET and MRI, then they would decide how to treat me.
- She reassured me a second time that it’s extremely, extremely likely that the cancer is only in the pelvic area at this moment. Though she did have a list of questions at the end trying to probe for unusual health issues like bone pain, so hmm.
- I will keep testing PSA from now on every 3 months.
@ThelmaLou who had asked after me in another thread
Wow, nine years I’ve been dealing with this cancer. It never ends. Which I guess is good news! 
Thanks for the heads-up (as it were…). This maybe isn’t The Very Best News in the Whole World, but it strikes me as Not Such Bad News, All Things Considered. Your doc sounds pretty sensible. I want you to have a good year, goddammit! 
I had a consult with the radiation oncologist today. He pointed out that pathology report noted cancer present in the fat just outside the prostate in one of the core samples. It did not appear in the MRI. He was a bit stymied as the report in another place said the cancer was limited to the prostate itself. he will be speaking with the pathologist for clarification. He also said that he has to assume the worst case and this puts me as a T3. He recommended radiation over surgery, and he thinks the surgeon will agree but isn’t certain. I speak with the surgeon in a couple of weeks. Hormone therapy would be part of the radiation treatment plan and, based on the side effects of that, I’m not exactly thrilled with the idea. I’m very active and fatigue for up to three years, (not to mention the other side effects) would drive me nuts. Have any of you guys undergone this combination?
Ugh, that uncertainty sucks. I hope the pathologist can clarify what’s going on. There was some question about spread for me, so I ended up having a CT scan and radiological bone scan, then a PET scan when those two weren’t conclusive. Fortunately, there ended up being no sign of spread. Along with the MRI that started this off, I think I’ve had pretty much all the scans available.
Coincidentally, I also had a consult with the radiation oncologist today. Given all my factors, I’m going with surgery. I have a consult with the surgeon tomorrow to validate the decision and get it scheduled. @MikeF I guess we’ll get to compare the processes is real time. 
Good luck with the process. I’ve reached the age where prostate screening and testing is considered superfluous, as something else is probably going to kill me before the prostate cancer does. I vacillate on whether this is a good thing or a bad thing.
I retired today. Good start?