A Negative Prostate Biopsy but Concerning MRI?

I’ve had two prostate biopsies.  Both were negative.  Both were targeted MRI/fusion biopsies.  The first MRI had no lesion or tumor to target, but the second one did.  I had a PI-RADS 4 lesion about 0.5 cm in size.  The team at the National Institutes of Health believe they successfully sampled it with two targeted biopsy cores.  Neither one showed cancer, but clearly, something has become abnormal in that area of my prostate over the last 10 years.

Prostate biopsies can miss cancer.  The inherent flaw in a biopsy to search for cancer is a relatively high false negative rate because the biopsies can only sample a very small percentage of the prostate volume.  Even a targeted MRI/Ultrasound fusion biopsy can miss cancerous cells.  My prognosis is to keep with regular PSA and exams with my urologist and followup if there are any changes.  Clearly, I have BPH, and possibly a benign tumor as well.  With a PSA level around 5 at age 51, I have a few risk factors for future prostate cancer.

One thing I am considering is the ConfirmMDx test.  This test uses the tissue samples obtained during your prostate biopsy.  It checks them for certain biomarkers that are indicative of prostate cancer that might be lurking just outside the sampled cores of biopsy tissue.  I’m not sure if I will proceed or if my tissues samples are even eligible for this additional testing, but I am investigating it.  The results may affect how long I wait until I decide to get another MRI or biopsy.  Other blood and urine tests for genomic indicators and biomarkers of prostate cancer may also be indicated for high-risk patients with negative biopsies.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043739/

 

One thought on “A Negative Prostate Biopsy but Concerning MRI?”

  1. There is also the OncotypeDX and Prolaris but they are terribly expensive and I suspect a good proportion come back with people in the middle of the range which is not really much help given the outlay but one never knows. As I wrote in another post I have now had 3 MRIs and am unimpressed. The first very worrying [4/5] but after a biopsy nothing in the targeted area but ironically a 0.4mm 3+3 spot outside it so on AS. Routine one last year 2xPIRADS 2. I assume the knew of the existing spot but also knew it was low risk hence the insignificant PIRADS score. Then. just had another routine one: 4/5 in the existing spot and 5/5 in another area. After a 42 core targeted/fusion biopsy nothing in the 5/5 area, only the existing spot, which this technician obviously decided he’d better show as “significant” given he already had the information about it. The 5/5 reading caused terrible anxiety of course. It’s probably more down to the technician, but if they consistently get it wrong I think they need to be investigated given the capacity for mental harm to patients.

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