Benign biopsy. Confirm MDX test results: 21%< =G6; 15%>=G7

Talking to your urologist seems the best plan for sure. I might even consider a second opinion from an oncologist.

First of all, it seems to me that the biopsy you have undergone is a very comprehensive biopsy, agreed though, it's possible to be a false negative.

You really have to factor in the other markers, your age and PSA history, those being pretty important factors in the decision making process. What was the result of the DRE, what did the MRI see?

As far as the MDX, I'd focus on the "You have a 64% chance of being cancer free" part of the equation for now.

I understand the biopsy was negative and the likelihood of finding cancer on the second go is 36% . 1 out of 9 men develop PC at some point in their lives. That number is the diagnosed, the number is likely higher if you include those not diagnosed that pass from something else prior to. Given this, 36% doesn't seem very high to me.

Also, what would be the time period between biopsies? Is the MDX test suggesting that you go right back to it because there's a 36% chance you have PC now, or does it include lengthy time periods in that percentage? Meaning 36% chance cancer will be developing sometime in your life?

The MDX test isn't 100% either. Again, I'm not sure if it's telling you that you have three times the normal chance of developing PC or there's a 36% chance the biopsy missed PC already there, either way, it doesn't sound very conclusive to me. Some very brief research seems to indicate that the test is really just an indicator of should be biopsy again as opposed to anything else because the dna marker is present. The study I found the PSA levels were 6.8 on average. The second biopsies were already recommended for them because of other factors and the MDX test was tested against that group. In the conclusion it doesn't give an accuracy that I can find, it just indicated that the second biopsy was performed earlier if the MDX was positive.

Out of all the MDX positive results, only 32.3% had a repeat biopsy in the 10 mos the trial was conducted. It doesn't sound like the docs put a great deal of weight in that result. I could be reading it incorrectly, I'm no scientist and there's some technical data I'm not 100% clear on...
https://ascopubs.org/doi/10.1200/JCO.2019.37.7_suppl.94#:~:text=ConfirmMDx%20is%20a%20molecular%20test%20clinically%20validated,cancer%20(PCa)%20in%20tissue%20from%20PCa%2Dnegative%20biopsies.
"It is recommending for a second biopsy" I'd consider making that decision with your docs based on all the clinical data as opposed to letting myself be guided by the one test. It's just one part of a big picture. Even if you find yourself in the 21% bracket there, you may very well find that the docs only suggest active surveillance at this point anyway.

Best of Luck to you!

Thank you for a very thorough analysis. My Urologist called me later yesterday and calmed me down a little. He said the Confirm MDX test only indicates a second biopsy is needed to determine if there is cancer. There is no cancer identified yet. The timeframe for second biopsy is do it in 3-6 months. He was going to schedule it with him again, then I told him I would like to do it in UCLA. He is fine with that.
So I called UCLA Interventional Radiology dept and have my medical ID created. I called my Urologist office to have all my records faxed to them. I went to imaging center to pick my MRI CD and will mail it today.
UCLA has a review board to review all my records. They will call me later for a consultation. They have the same MRI fusion transperineal biopsy. They also have an In-bore MRI guided target biopsy:
MR-Guided Targeted Biopsy - Prostate Imaging | UCLA Health
I read that the patient lies down inside MRI machine, and they do a real time scan to guide the needle.
I asked my Urologist to comment on the 2 types of biopsies. He said the transperineal is more comprehensive since it targets the lesion, as well as random needles for the rest of prostate, whereas the In-bore MRI guided biopsy only specifically target the lesions that they see from MRI.
I am not sure if that is the case. Once I get a call from UCLA doctor, I will ask specifically about the benefit of In-bore MRI biopsy and decide if I should choose that one, or go back to do transperineal biopsy. I will also ask about the timeline. Is 3-6 month normal for a second biopsy, or I can wait a year?
More to come, I guess.

I think they call 3-6 mos a minimum. I still don't see any other markers here, PSA etc.. but if you PSA is not all that high (I don't think it could be given the negative biopsy) and if it's rising very slowly, You have a plenty of time. Normally, particularly in the early stages, this is a s-l-o-w growing cancer. In your case there's a 64% chance it's not there anyway.

Best of Luck!

Thanks. My PSA is 5.3. MRI shows 2 lesions: (9mm, and 5mm). Both PI-RADS 4. Urine test shows ExoDx 18.77 (normal range is 0 - 15.6), so something is going on with my prostate. I use UCLA as a second opinion, I guess. I will see what their doctor says.