More Testing

Almost 10 years ago, I headed to the National Institutes of Health, National Cancer Institute for an MRI/Ultrasound fusion Biopsy. You can read about it here:

Since then, despite knowing that PSA is a poor indicator of prostate cancer, I have followed my physician’s suggestion to continue to monitor it yearly. It has increased roughly linearly, about 10% each year. It was just over 5.1 when it was tested early in 2018, and my physician referred me back to my urologist. All my digital rectal exams had been negative in the years since, and the new one was also negative, thankfully. Even so, he suggested it was time for more testing, starting with a newer 4KScore blood test, possibly followed by an MRI and biopsy if indicated.

It seems the 4KScore test is not covered by all insurance as it is not universally accepted as a good predictor of prostate cancer yet. With my high deductible insurance, it would have cost over $400.  So ,I sought a second opinion with the physician who treated me at the NIH 10 years ago.  He had no opinion on the 4KScore, but offered a followup MRI/biopsy like the one I had previously through a trial.  As there is no cost in these trials and most travel expenses are also paid in full or part, my cost for both procedures would be less than the 4KScore blood test.  So, it seemed like the way to go since MRI/biopsy is the only way to be more sure anyway.

I still think prostate biopsies are a draconian test.  Piercing the rectal wall to take random tissue sample that can’t sample some areas of the prostate and may miss a cancer even in sampled areas seems like 1950s medicine.  Risking sepsis, urinary retention, urinary infection and other side effects for a test that has a legitimate false negative potential is also concerning, and the risks are increasing.  What used to be a 1-2% risk of an expensive ER visit for possibly fatal infection may now apparently 3-5%, in part due to E Coli bacteria resistant to the preventative antibiotics used prior to the procedure. Unfortunately, there still isn’t a better way, though MRI technology has improved, in part due to the trial in which I participated.  So, back to Washington DC I go…

Fusion Biopsy Study

About 10 years ago, I had an MRI/Ultrasound fusion biopsy done at the National Institutes of Health under a study developing this technology. The hope was that it could not only improve the detection of prostate cancer from the archaic random sampling method, but eventually lead to effective non-invasive testing. This newer study of the results shows that the technology is improving. There is also an indication that the technology may help focal therapy techniques to avoid the radical and sometimes unnecessary major surgery to completely remove the prostate.

Among men undergoing biopsy for suspected prostate cancer, targeted MR/ultrasound fusion biopsy, compared with standard extended-sextant ultrasound-guided biopsy, was associated with increased detection of high-risk prostate cancer and decreased detection of low-risk prostate cancer. Future studies will be needed to assess the ultimate clinical implications of targeted biopsy. “