← Return to Good PSA/MRI active surveillance results still require fusion biopsy?

Discussion
Comment receiving replies
@handera

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/

Jump to this post


Replies to "Understand your concern regarding your urologist's push to schedule another biopsy. You may make him feel..."

handera, you're an amazing wealth of info!
We apparently have similar perspectives regarding avoiding a needless biopsy -I need my urologist to provide a very good reason to endure another before that 2-5yr NCCN timeline.
Your NCCN link requires creating an account -assume no privacy issue/etc doing that?
Also appreciate MPS2 test link. Rather than proceed with a biopsy with MRI/PSA results that don't seem to require one, I'd prefer more tests (ie: aforementioned free PSA/MiPS, etc.)
Hope that my urologist will adopt your urologist's requirement for "clear non-invasive evidence demonstrating the need for a follow-up biopsy". I like that policy.
You and jeffmarc have made me glad that I selected this forum after looking at my options.
Thanks-