Pirads level 5

Ian,

You will be aware that the NHS is struggling due to shortage of clinicians. This means that they do not have the time to discuss in detail with each man after he has an MRI why they feel it shows possible cancer and the need for a biopsy to try to confirm this. So you then progress to biopsy with a bone scan also done where considered appropriate. Where cancer has not been found in a biopsy where strongly suspected, on occasion men are asked to have another biopsy, perhaps a Template one, When the MRI, and bone scan (where done) along with biopsy and histology are all available, the case of an individual is considered with others at a Multi Disciplinary Meeting. The patient is given his diagnosis and where cancer has been found told his options to dealt with it. The type, extent and positioning of cancer will be some of the factors for these choices. In some circumstances a recommendation may be made for a particular form of treatment but this is often left to the patient to decide as there are pros and cons for each type of treatment including after effects. These are all detailed in the excellent 'Tool Kit' on this site. At this point and where there is doubt or you just wish to obtain another opinion before adopting a particular form of treatment (which includes doing nothing but just being monitored until treatment is advisable, ie Active Surveillance), you can do so. But I don't see any advantage of getting a second opinion until this point. It should be noted that sometimes a biopsy is done prior to an MRI, This is gradually changing as the reasons for doing the MRI before biopsy outweigh doing it the other way round.

To put it frankly, hospital Consultant's time is at a premium so they may not give detailed explanations and reasoning before and between each scan/test, of which the technicalities would be lost on most patients anyway.

Another thing to bear in mind is that often the administration is poor in many hospitals but the quality of treatment overall is very good.  Also, don't assume that because your clinician is someone of few words that he/she is not highly competent.  Ultimately, early diagnosis and appropriate treatment affords a better chance of beating PCa or at least significantly slowing it's advance.

Well Ian, you are aware how the system works and that you are not being treated differently to others, so it's really down to you to consider whether indeed this is really your objection or if you won't have treatment regardless.  It could be like a situation I have with my wife now.  She says she won't fly any more because of all the waiting at airports but when pressed agrees it's really more because she is afraid of flying now having previously enjoyed this for many years.

I wish you well.

Edited by member 02 Jan 2020 at 01:48  | Reason: Not specified

Good luck Ian. It'll be a little uncomfortable and inconvenient, but that's all. If you're lucky they won't find anything. 

Mine was TRUS, I had to lie on my side whilst the doc shoved every bit of hospital equipment he could find up my arse, meanwhile a nurse sat on the other side i.e. facing me making small talk, about what I had for breakfast, to try and distract me from what the doc was doing. Poor little me with my aspergers; I hate small talk, I just wanted to count how many small yellow tiles were on the wall behind her.

Keep us updated. 

Delighted to hear it, Ian. Good decision. It sounds too as if you've established a level of trust with the people who'll be treating you, and that's absolutely essential.

Very best wishes,

Chris

Edited by member 09 Jan 2020 at 12:04  | Reason: Not specified