I only joined this forum a few days ago because frankly I was standing on the edge, but these guys talked me down and saved my sanity, something for which I will forever be in their debt. I'm very early in my story, may even yet dodge the bullet, but I too am staring the prospect of biopsy in the face. In the tradition of giving back, I'll share what little I know; which may help inform your questions to the URO etc.
I'm under the care of Johns Hopkins Hospital in the USA, a not inconsiderable stroke of luck. My PSA is swinging all over the place and my rectal exam (DRE) concluded 'enlarged' (but evidently still squishy, which is a good thing). Their automatic next step at this point is a 3Tesla MRI. From what I understand a 1.5Tesla MRI machine is not really up to the job of mapping the prostate (resolution-wise) and so the 3T is the 'ginormous magnet of choice'. These (newer) machines cannot be found everywhere yet, so you may need to dig into where in Aus' you can find one.
The 3T MRI looks for lesions (as far as I can make out this is a less scary way of saying tumor, a somewhat semantic difference). The outcome of this can be "yes we see a lesion (or more)" or "we see nothing". If the answer is yes then you are likely looking at Prostate Cancer, if the answer is no, then you 'may' be looking at prostate cancer as even the 3T MRI cannot spot the smallest of small.
NOTE: Prostate cancer comes in different flavors and levels of progression... not all of them are the scary monster by a long chalk.
Given this, a biopsy is pretty much automatic if they see something and may well be advised even if they don't, but PSA is up. As has been said, the most accurate (but still fallible) test is the biopsy. What the MRI does is help tell them where to stand the most chance of hitting the suspicious cells vs. (literally) stabbing in the dark. I liken it to the old schoolboy game of 'Battleships'. If you call a grid reference and get a hit, then you know where to keep firing!
BTW, Hopkins no longer uses a rectal coil (automatically), saying that with 3T, their folks are good enough to see what's going on without the anal intruder. Personally, I don't really care, if I'm going to go through this, I want the most expensive, high-tech stuff shoved up my ass that I can get!!!
The thing I can add here is the 'Fusion Biopsy'. In the Fusion Biopsy, a clever piece of software (by Varian I think), takes the MRI data/image and overlays the
location of any suspicious lesions onto the 'real-time' Trans Rectal UltraSound (TRUS) imaging used during the collection of the biopsy samples themselves. Essentially it overlays a map for them of where the battleship(s) are likely hiding so that they can target more accurately. They do also put some shots around the general prostate volume to get an idea of what the MRI 'may' have missed.
Your mission, should you choose to accept it is (IMHO) to try and find a 3T magnet and ideally a Fusion Biopsy in sunny Aus' ; if the URO sucks his teeth over your man's PSA and other data points when you meet. Fusion isn't the only way this can be done... but if you can find it, it helps.
If I have any of that tech' wrong the folks here will point you right for sure...
Hat's off to you Rainbird... you came here. If you can encourage hubby to join you here, it will help, these guys are strong and have broad shoulders, they will help to carry him (and you); sometimes even we 'men' have to wise-up and let that happen.
PS: There are a couple of newer, more specific PSA 'type' blood tests you could seek out. I was given one called the Prostate Health Index (PHI). This is really one entry point into Active Surveillance, if you score less than 27, you win and get AS, if not, you proceed to Biopsy, via MRI if possible. I scored a solid 47.5, lucky me!
PPS: I did a quick search, looks like 'Men's Health Melbourne' have Fusion capability (at least).
7/6/14 PSA: 1.07
7/6/15 PSA: 4.3 DRE: Negative (PCP)
7/17/15 PSA: 2.56
8/10/15 PSA 8.41
8/14/15 PSA: 8.5 PHI 47.5 DRE: Enlarged but no nodule (URO)
3T MRI next 9/18/15
Post Edited (Paul65) : 8/22/2015 9:09:26 AM (GMT-6)