How many biopsies?

@dwyermw
I assume your urologist is ordering more biopsies. With a 3+3=6 what I read is mostly surveilance.

You did not mentioned what your PSA was and how much climbing. That is what I assume is why your urologist wants more biopsies. When doing biopsies very hard to get every cell of prostate. So they usually do a lot but can miss areas or cells. So even with the 3+3 and then you get rising PSA is of concern.

The rise of PSA could be BPH or cancer.

When I had my proton radiation at UFHPTI I asked if going to radiate the biopsy areas or the whole prostate. My R/O says I radiate the entire prostate and margine to ensure we get all areas treated. He said very easy to miss an area that has cancer cells but were not biopsied. We are talking about alot of diagnosis at celluar level that there are no tumors.

Good idea to asked this question to your urologist. If in doubt you can always get a second opinion. If this was me and PSA still rising but had a 3+3=6 (mine was 3+4=7) I would see why my urologist wanted to go back in and take more biopsies.

Multiple biopsies are not unusual, unfortunately. It's sometims necessary for the reasons stated above. Knowing the PSA history would make it a little easier to answer though.

Yup I've had 2 biopsies so far. My PSA was 6 at the first one and 12 at the second one. The first one was benign and the second one found Cancer.

Before my Decipher indicated high risk, I was to be on active surveillance and my urologist told me that they would monitor the PSA and do more biopsies in the future. This may start to fade as more urologists utilize PSE tests to detect cancer.

I had three biopsies before they finally found cancer. If your PSA keeps rising, they will set you up for more biopsies because you may have cancer that raises that PSA.

It could also be BPH, Do you have any of the symptoms of that?

There was no such thing as a Gleason report when my PSA started rising slowly. After 2 years and 4 biopsy’s and the last one almost killing me do to infection they found my cancer. Multiple tests are normal. Good luck my friend

I had two biopsies as well. The first was clear and the second showed two cores of cancer, one at 7. Ironically, both MRIs prior to,each biopsy showed no cancer. Good luck.

Two biopsies for me - no big deal.

After bloodwork for a routine physical in March, 2023 came back with a PSA of 8.1, my primary care doc referred me to a urologist. He re-ran the PSA, and it was down to 6.5, and he ordered an MRI. After the MRI results came back, he ordered a TRUS biopsy - 13 cores. Either 6 or 7 cores came back positive, all Gleason 6. We settled on active surveillance. Next PSA, in October of that year, came back at 5.7 - so trend was downward.

Bloodwork for my next routine physical in March last year came back with a PSA of 9.2. When the urologist re-ran it, it was 10.9. Another MRI, another TRUS biopsy (saturation biopsy - 28 cores). This one came back with about half the cores positive - some Gleason 6, but a majority Gleason 3+4. He also ran a Decipher analysis, which said "intermediate risk."

At that point, we decided to treat it. Six months of ADT (Orgovyx) with 28 sessions of EBRT in the middle. Radiation wrapped up 12/31/24. Twelve more Orgovyx pills to go - not that I'm counting or anything. 😉

Don’t get a biopsy like many of us it may cause infection. Get an MRI. If there is a tumor you can get a targeted biopsy. If no tumors you don’t need biopsy.

But take note too of @kjacko 's post: 2 MRIs prior to each of his 2 biopsies showed no cancer. His 2nd biopsy showed cancer.

My first and only biopsy showed cancer, G7 (3+4), unfavorable intermediate. Bone scan and CT scan showed no evidence of metastatic disease, I can have either RP or RT treatment.