3T mp MRI at Duke was clean.

No target for Fusion biopsy, according to how I read this.

With the PCA3 as high as it is at 49 I probably need to go ahead with blind biopsy in order to be reasonably certain.

Thought about going to local facility for the blind biopsy. However, Polescik said he had not had any patients with infection after introducing a new protocol several years ago. They did a swab to ensure I was not resistant to cipro, not sure if there are other parts to the protocol.

Any comments?

______________________________
MRI of the Pelvis with and without Contrast

Indication: Prostate cancer

7/20/05-outside PSA 2.0
5/4/11-outside PSA 2.2
8/2011 outside PSA 1.9
7/14/15 outside PSA 6.7
8/13/15-outside PSA 6.1
9.2.15-outside PCA 3 -49
9/17/15-outside PSA 4.5

Comparison: None

Technique: Multiplanar, multisequence MR imaging was performed of the
pelvis using the Prostate protocol following the uneventful insertion of an
endorectal coil. Imaging was performed prior to and following the
uneventful intravenous infusion of 18 mL of MultiHance contrast material
(most recent eGFR was >60 mL/min/1.73 sq m), in order to improve detection
of prostate cancer. If IV contrast material had not been administered, the
likelihood of detecting abnormalities relevant to the patient's condition
would have been substantially decreased. 1 mg of glucagon was administered
intramuscularly at the beginning of the examination to reduce rectal
peristalsis.

In addition to multiplanar MR of the pelvis, additional 3D postprocessing
and image rendering was performed on a separate workstation, including
perfusion analysis. This was performed to improve sensitivity for
detection of prostate cancer and for pretreatment planning.

Patient is allergic to contrast and was premedicated with steroid.

Findings:

The prostate gland measures: 5.4 x 4.8 x 5.1 cm. The volume is 69 mL.

Peripheral zone: Heterogeneous wedge shaped peripheral zone hypointensities
at the base on series 12, image 18 related to prior prostatitis. No
suspicious index nodule.

Central gland: Enlarged with multiple stromal nodules

Prostatic capsule: Intact

Neurovascular bundles: Intact

Seminal vesicles: Unremarkable

Lymph nodes: None

Bones: No aggressive bone lesions.

Extraprostatic findings: Diverticulosis of the sigmoid colon without
diverticulitis noted.

Impression:
1. No index lesion.
2. Enlarged prostate with multiple stromal nodules consistent with benign
prostatic hyperplasia.
3. Changes compatible with prior prostatitis.
4. Diverticulosis of the sigmoid colon without diverticulitis.

Electronically Reviewed by: Sanaz Javadi, MD
Electronically Reviewed on: 12/16/2015 9:40 AM

I have reviewed the images and concur with the above findings.

Electronically Signed by: Rajan Gupta, MD
Electronically Signed on: 12/16/2015 12:21 PM

Glad to see that your MRI was negative. As to the biopsy, Polascki did a fusion biopsy on me after Gupta found suspicious finding of seminal vesicle. Fortunately it was negative. As I've said before, Polascki is probably a fine doctor. He certainly has great credentials and education. I will say though that his bedside manner is terrible and the biopsy was the most uncomfortable of the three I've had. I had to wait 2.5 hours past my appointment and was told to drink until my bladder was full and to hold it. Since I was delayed, I was going to the bathroom every 15 minutes followed by more drinking. By the time I got in there and went through the prep and I was about to burst. It was extremely uncomfortable. My two biopsies prior to Polascki were nothing like that. No instructions to fill my bladder at all.

If I were in your shoes and felt I really had to have a biopsy, I would go to my local Uro. However, the bigger question in my mind is why have the biopsy. Since you have a negative MRI done at a leading medical center, and evidence of prostatitis and BPH probably explaining your PSA increases in 2015, why subject yourself to a biopsy? I don't see your age on your signature, but the older we are the more likely we have some prostate cancer. If you have any, it's probably small and Gleason 6 or else it would have been seen on MRI. Do you really want to keep looking until you find a small, indolent cancer and have to deal with all that follows that finding?

Good advise from TA! Believe the MRI results and absolutely no need to subject yourself to a random shot biopsy. The one I had missed aggressive nodules and came up negative anyway.