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Good PSA/MRI active surveillance results still require fusion biopsy?
Prostate Cancer | Last Active: Oct 25 2:40pm | Replies (30)Comment receiving replies
handera, thanks for your follow-up, details, and links-
I respect your engagement taking on your own research and exercise/diet program, and hope that you continue seeing positive results.
I'm aligned with your comment regarding quick decisions on surgery/radiation/drugs and the potential related profit motive. I do have a somewhat cynical nature. I've seen this urologist for 5yrs -have high regard for them but at the same time don't know to what degree they may be pushed to do biopsies for profit and/or malpractice protection.
As you say, the level of acceptable risk is ultimately up to me -I greatly appreciate the perspective provided here and plan to have a detailed discussion w/my urologist regarding the risk regarding postponing the biopsy.
I'm perfectly fine with AS -only think about this when appt's come up, and have had no panic from the start. I fear a diminished post-treatment life (if treatment ends up req'd) more than I fear death. Just how I am.
Thanks again-
Replies to "handera, thanks for your follow-up, details, and links- I respect your engagement taking on your own..."
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Understand your concern regarding your urologist's push to schedule another biopsy.
You may make him feel more comfortable with waiting on a follow-up biopsy, by pointing him to pages (47-51) of the NCCN Prostate Cancer guidelines Version 4.204 - May 17, 2024.
Specifically:
"Active Surveillance Program:
Patients who choose active surveillance should have regular follow-up, and key principles include:
◊ PSA no more often than every 6 months unless clinically indicated.
◊ DRE no more often than every 12 months unless clinically indicated.
◊ Repeat prostate biopsy no more often than every 12 months unless clinically indicated. While the intensity of surveillance may be tailored based on patient and tumor factors (eg, grade, tumor volume), most patients should have prostate biopsies every 2 to 5 years as part of their monitoring."
Note that every 12 months is the MOST often recommended and NCCN indicates that the majority on AS should have repeat biopsies every 2 - 5 years!
I could only wish my PSA level was down to 1.9 AND that only 1 of 18 cores showed 3+3 Gleason involving 10% of the tissue...that's amazing! I'm perfectly comfortable waiting another year (or longer) for another biopsy with my much higher prior indications...as you have seen.
It took 8 weeks for me to fully recover from my October 2023 biopsy to get back to my "pre-biopsy" performance. It was not a "minor procedure" and had significant impact.
Interestingly, in my last appointment, my urologist slipped in a comment that the reason he waits for clear non-invasive evidence demonstrating the need for a follow-up biopsy because of "increased risk"...I didn't ask for further explanation, but I appreciated his comment... he does not jump to do another biopsy simply because of the clock.
BTW: I have not (yet) had this following test, but it might be worth considering as an "up-and-coming" non-invasive alternative to biopsy. I plan to ask for this test before submitting to another biopsy.
https://www.lynxdx.com/my-prostate-score/patients/