Is this too long to wait for a biopsy?

Posted by yarddogman @yarddogman, Nov 22 2:19pm

My doc can’t do my MRI fusion guided transrectal biopsy til 1/27/26. MRI found two lesions of concern. Prostate 82cc. PSA 4.8. PSA density .06. I wish this could be done sooner. But maybe I will take this opportunity to change my diet some and basically get healthier. And mid January take another PSA. If it’s lowered substantially (2-3 range) maybe skip the biopsy and keep monitoring PSA. Do you think this is “fools gold”

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yarddogman | @yarddogman | Nov 22 2:57pm

Also,is that too long to wait on biopsy ?

jeff Marchi | @jeffmarc | Nov 22 4:13pm

Is there some reason you are not considering getting a fusion guided transperennial biopsy? That biopsy can reach more of your prostate than transrectal biopsy and it has a lower chance of infection. You might ask about that.

Waiting is usually not that critical. If you have widespread prostate cancer in your body and a very high Gleason score, it could make a difference, But normally prostate cancer is very slow growing.

bens1 | @bens1 | Nov 23 7:32am

If it were me, I would arrange for the Decipher test, https://decipherbio.com/ , to be part of the material collection when you have your biopsy in January so as to have a feel from the results, of aggressiveness. There are several genetic tests out there but I had MyRisk to look for brca gene and other gene issues that might affect my children or me.
https://myriad.com/genetic-tests/myrisk-germline-test/
I would also schedule a tele-health with a center of excellence a week or so after the biopsy so they can access the material and you get a second opinion.

Like many of us, knowing ahead of time that there is something there, allows you to spend some time looking at the different options for radiation machines and types of radiation plus removal options. That way when you talk to your doctor and he says radiation or removal...or AS, you will be able to ask some qualifying questions.

I may be a bit of an outlier here, regarding PSA, knowing that PSA is used as a guideline for next steps but my brother in 2022 had a PSA of 6.5 and around the same time, I had a PSA of 10.2. His risk level was higher as his had reached the lymph nodes. He had colon cancer 20 years earlier and was out of shape. He was treated with ADT and radiation. Then he got pancreatic cancer and passed a month or so ago. His was a complicated case. Mine was solved with radiation, no ADT and no spread even though my PSA was 10.2.

I question PSA alone and personally believe in catching things early and take multiple tests in a number of directions (Decipher, Genetic...) that can help you and your doctor, plus a second opinion doctor, if possible, make better decisions together for your treatment.

mjp0512 | @mjp0512 | Nov 23 7:53am

I'm sorry that I don't have any answers for you, but I know one thing. Waiting until the end of January would drive me absolutely nuts. My sincere wish that this is all a nothingburger for you.

brianjarvis | @brianjarvis | Nov 23 8:05am

(What were the PIRADS scores of your lesions of concern?)

A couple of options that I would consider:
1. If you do decide to wait until 1/27/26, (as others have mentioned) this would buy you time to collect additional information: e.g., % Free PSA, PSA Doubling Time, biomarker (genomic) test, and genetic (germline) test.

2. Can you get the biopsy done somewhere else that can do it sooner? (You can always find another urologist. Earlier this year my oldest brother had an elevated PSA; his urologist wanted to do a blind biopsy. I recommended to my brother that he find another urologist. That 2nd urologist also wanted to do a blind biopsy. I then recommended to my brother to have his family doctor refer him to a urologist at the local major cancer center near where he lives; that 3rd urologist got him in within a couple of weeks for an MRI and then a couple of weeks later for an MRI-guided biopsy. My brother has since already finished his radiation treatments. Another benefit of that path was that he basically got a 2nd opinion on the MRI.) I went with my brother when he saw that 2nd urologist; that place seemed to me to be a production line. We did see that urologist, but we left there with no intention of following up.

You have options.