I have become more concerned about having a biopsy, given the alternatives I have found, like PCA3 and ultrasound.  I continue my search for information and options.  I found a couple websites where I was able to contact other urologists, who basically shared the same view. One suggested I might consider an extended course of antibiotics to see if I had a chronic prostate infection (Prostatitis) before doing a biopsy.  When asked about the PCA3 test or other possible diagnostics, he thought they would be interesting, but not conclusive, and would not be as reliable as a biopsy.   My question still remained.  Could a combination of other non-invasive methods be used before an invasive biopsy to reduce the number of unnecessary biopsy procedures done on men like me, with no compelling indicator for cancer?

Enter Dr. Wheeler of the Diagnostic Center For Disease.  He had a website that came up on a search, www.mrsiusa.com .  He’s a licensed urologist with a private practice dedicated to the prostate.  He’s also skeptical of unnecessary prostate biopsies.  He uses a newer, high field MRI scanner that gives more detailed images of the prostate.  For others, he apparently uses a color flow ultrasound.  For some, he uses both.  I emailed him with my history and asked for more information.  In a response over the holidays, he told me (in bold print) to cancel the biopsy.  That was pretty clear.  That was added reason for me to postpone my biopsy that had been scheduled for last week, at least until I could investigate my options.

You can read his website and practically read many of my own thoughts.  He is using the same MRI technology in an effort to diagnose prostate cancer that other centers would only use to verify the extent of cancer, after a positive prostate biopsy.  Sounds like a no-brainer to me.  Problem is, the overwhelming majority of urologists and radiologists don’t believe that any imaging tool is any more reliable than a biopsy.  Even Dr. Wheeler’s website says this test isn’t a replacement for a biopsy.  So, there is some doubt, which I know.  Still, worst case, it appears to be another non-invasive test I could have to get more information, even if it can not 100% confirm or rule out the presence of cancer.  Even a biopsy can’t rule out cancer, and it’s a lot more invasive with scarier side effects.

The catch?  You might have guessed.  It’s expensive.  Close to $5000 and a good portion of that is for the spectroscopic enhancement of the MRI, something that is not currently covered by most insurance plans.  At the beginning of the calendar year, I essentially have to pay it all up front because of the way our insurance plan works.  Plus, there are travel expenses to fly to Florida and stay overnight.  The only upside might be that the part that is covered by insurance might fulfill my deductible for the rest of the year, at least.  Still, it’s a lot of money and there’s not a single piece of research I can find that shows if there is any proven diagnostic benefit for the added cost over a biopsy.

It’s a big decision.  In the mean time, if you’re looking for alternatives, you should definitely check out Dr. Wheeler’s website.  There isn’t much for peer-reviewed research from major medical journals, but it still makes a lot of sense.  I’ll report next week after my telephone consultation.