Should I get an MRI scan for a prostate nodule?

I'd like to know if I should get an MRI scan. about 3 weeks ago a 5 mm nodule was discovered on my prostate gland. I consulted a urologist a week later and he said that at my age 80 I shouldn't bother getting an MRI. He told me about the slow growth even if it were to be cancer, the small size of the nodule, most of the time a nodule like this proves not to be cancer, my low PSA of 0.8, and the risk of prostate biopsy through the colon. My blood PSA was 0.8 . A second laboratory confirmed 0.8 . A second urologist stated that they didn't think I should get an MRI of the prostate.

My conflict is whether or not to get an MRI. The MRI scan in the tunnel is not good for my claustrophobia. What would you do? Get a third opinion?

Thank you.

Hello - you don’t have to get a transrectal biopsy. There is a newer perineal biopsy that samples from outside the rectal area and has minimal infection risk. You just need to find a place that performs them where you live or travel to a medical center that does.

https://www.mayoclinic.org/medical-professionals/urology/news/ultrasound-guided-transperineal-prostate-biopsy/mac-20473283

Djin pretty much covered the nodule issue.

The article I attached should answer your questions. The major medical centers are going transperineal now and it is justified by studies as being as good or better without the higher infection risk.

It can be done in the clinic or under sedation at Mayo.

I had transrectal in 2018 so cannot add much on transperineal experience. More are getting it recent years so hopefully someone will answer your question.

Positron said...
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What size nodule is too small to attempt biopsy?

Since the nodule could be felt on DRE, it should show up on ultrasound and not be a problem to biopsy. In addition, your doc will likely take an extra core or two in that area to ensure it is adequately sampled. But check with your doc about this.

Even when there are specific targets (in your case a nodule), a biopsy is almost always systematic, meaning that cores are taken in all prostate zones, precisely because lesions can be too small to show up on imagine or to be felt.

Djin

Post Edited (DjinTonic) : 9/12/2024 4:50:26 AM (GMT-4)

Ask yourself one question. If it is cancer, would you have treatment for it. You are to old for surgery so that leaves radiation. And radiation is a terrible thing for anyone to go thru. I'm 79 and that's the way I look at it.

62gal raises an important point. Is 80 years old really too old to have surgery??? Is any risk worth the reward? Because this isolated nodule is not getting larger, and one doc could not even feel it, and I can't see a super-specialist for as month, my PSA is low and free PSA 60%, I'm considering deferring the MRI until after the specialist checks me in three weeks and then maybe get the MRI. Don't know what I would do if the MRI were not normal. There are times when the diagnostics steps + treatment is worse than the disease.

Positron, I agree with Djin (I never disagree with him) its not age, its health.
I have always said, when I turn 80, I will stop testing PSA (for recurrence) because if I was diagnosed with recurrence I wouldn't treat anyway. But I know that when I turn 80, I will probably feel differently, I would want to treat if I recurred. There's always the chance of living well into our 90's (and beyond)

And yes, IMO, A biopsy of the nodule should be sufficient, especially considering your PSA being so low

Personally, I will make treatment decisions at the time they are appropriately presented due to the facts and circumstances at that future time. I can no more say today what I would or would not do at age 80 than I can declare what I will or will not have for lunch at the future time. Both my parent lived to age 94 in very good health. My maternal grandmother and her 4 siblings all made it into their 90’s at a time that few did. At 80 I will probably take the approach that I could expect similar lifespan, barring anything unforeseen today.

For all we know today, there may be a treatment breakthrough that will arrest PCa for most men with very mild or no side effects and it becomes like treating cholesterol or blood pressure as we effectively do today with little or no side effects for hundreds of millions around the world.

It appears that Positron is gathering the facts of his condition in a measured process and will be presented with options at the time the facts dictate. Then he can make appropriate decisions as to the actions to take, or not to take. Far be it from any of us to tell him now what he should or should not do in the future.

DjinTonic said...
When my uro found a new nodule when I was 69 he told me that a nodule turns out to be cancer about 50% of the time. (I don't know if or how age or PSA level changes the stats.) In my case the nodule turned out to be benign; however, the same biopsy found two lesions with high-grade cancer elsewhere in the prostate. You might say the nodule was a blessing (or booby trap??) in disguise

I would follow the advice re the MRI, but I would get the biopsy, especially if you are in good general health.

Djin

Djin, no doc around here will do a biopsy unless and until I get an MRI.

Positron, as I understand the DRE is more art than science and our body changes day by day as does the tactile judgement of the doc. It is good that the same doc performed both DREs, but I personally would be suspect about a reduction in the size felt over such a short period of time. What would explain that. Plus, have you looked at and felt the difference between an object estimated to be 5mm and 2-3mm? Particularly when there is a glove, rectal wall, some fat, and the prostate capsule tissue between the finger and the nodule? And 2-3mm is not one-third of 5mm. Just sayin.

For example, if it is a calcification, what would cause it to be reduced? Or a cyst? These typically don’t just reduce on their own. Obviously a cancerous nodule would be very unlikely to reduce absent treatment. Could your hydration levels have been different or some normal internal organ movement that slightly changed the orientation of the nodule causing it to feel different? Might the first estimate have been overstated?

I would put more stock in the evidence of a nodule and want to confirm what it is. I would be suspect of the doc that first says there is a nodule, but you don’t need to investigate due to your age, that then later says it has reduced. And, if the doc thinks due to your age there would be no reason to investigate and treat PCa, then why in the world is he performing PSA tests and DREs in the first place? It appears obvious to me that you have a real concern that isn’t being addressed to your satisfaction. In your shoes, I would be seeking a true prostate specialist urologist and get another assessment. Find the urologist that focuses or even limits practice to BPH and PCa and can demonstrate many years of such specialization.

Well-stated. Perhaps because by palpable nodule is isolated they refuse to get a biopsy unless both MRI and TRUS are done. I'd had four normal PSAs of 0.8 with a PVol of 125.

Thankfully the MRI reimbursement climate is very different from 10 years ago. When I was dx in 2010 MRI wasn’t at all in the mix except in fairly rare situations. We didn’t even discuss it. Now it is de rigeur. Mapping and fusion biopsies were only beginning to take hold. In a very few years, evidence began showing the value of MRI in the investigation stage and now is very common. Remember, commercial insurance reimbursements nearly always follow Medicare reimbursements.

I would trade my right nut for PSA .8 and free PSA 60%. I would even throw in the left one too. Not using them anyway.