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

Posted by oct172024 @oct172024, Oct 17, 2024

Hi all -newbie here. Will be age 67 March 2025. History:
03/2023: PSA from 3.1 to 9.
04/2023 MRI: 1.9cm PI-RADS 5 lesion and 0.6cm PI-RADS 4 lesion.
07/2023 MRI Fusion Guided Prostate Biopsy: both lesion locations benign. Of 18 cores, (1) at another location was Gleason 6 involving 10% tissue.
10/2023 Follow-up GPS Report: GPS=18, "19% likelihood of adverse pathology at Radical Prostatectomy"
Urologist: "Great results, commence Active Surveillance".
06/2024: PSA = 3.7
06/2024 MRI: both lesions stable/unchanged at 14mos. after previous MRI. MRI was on a new/improved unit -told results are more accurate.
09/2024: PSA = 1.9
Regardless of the recent normal PSA result and unchanged MRI, my urologist wants another fusion biopsy.
My Question:
Based on my good recent results, is another fusion biopsy an unusually conservative decision? Why would non-invasive options such as free PSA test, digital rectal exam, MiPS test not be used to collaborate/confirm my results? The fusion biopsy seemed a foregone conclusion regardless of results, -seems very conservative based on no indication of advancement at 14 mos between MRI's, and low PSA. Appears to be very slow advancing, therefore assume a low risk to continuing active surveillance until next year's MRI. What is the chance of a slow-advancing cancer suddenly going zero to 60 over 1 year?
Thanks for your time.

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oct172024 | @oct172024 | Nov 26, 2024

OP with my fusion biopsy update:
As projected, the fusion biopsy confirmed my MRI -no change in 14mos.
18 cores, 16 benign. Result for core at same location that had a positive result for last biopsy:
Gleason 6 (3+3), Grade Group 1, Involving 5% tissue (vs 10% 14mos ago).
Another core reported "Prostatic tissue with focus of small atypical glands, suspicious for adenocarcinoma".
Extraprostatic Extension from 18% to 7%, and Seminal Vesicle Involvement from 1% to zero.
My urologist was happy with the biopsy result -based on that they plan no further MRI's/biopsies and will monitor PSA, with the first test 9mos out.
After this one, I hate prostate biopsies more than ever! Relieved to be done w/them for now at least.
Guardedly optimistic, since urologist confirmed that a baseline is now established for very slow advancement and that it's rare to go "zero to 60". He's satisfied that the two lesions (PI-RADS 4/5) aren't acting like it.
Had many Q's and discussion topics prepared but with the "great results" and my urologist's positive projection, I decided to thank him then get out of there to start enjoying putting all this out of my mind for now.
This is a great forum -I again thank handera and the others that responded to this thread, and wish everyone the best. I realize my journey can start again -thankful for every day.

monteshark | @monteshark | Feb 4 8:42pm

My PSA was 1.4 at age 54
Bounced to 3.5 on TRT at 57 injectable
Off TRT leveled off at 2.2
Did MRI at age 58, result PIRAD2
Stayed at 2.2 PSA for 5 years
Aug 24 PSA 2.3
MRI result PIRAD3 1cm lesion transitional zone
Urine test says positive for PC
Biopsy this week

I have extensive history of infections, prostatitis and BPH

It seems to me the Prostate is highly unpredictable and mysterious…

oct172024 | @oct172024 | Feb 4 9:33pm

Yes, agree based on my experience -and glad that it was unpredictable in my favor.
Biopsy unpleasant, but provided the confirmation my urologist needed to relax and go back to monitoring PSA.
Best of luck -hope your biopsy result also resolves mystery in your favor!