Anyone against multiple biopsy’s for low grade prostate cancer?

@punz
A single 3+3 is something that you do not want to treat and is really indicating active surveillance.

Then there is focal therapy and how important it is. Here is some information from doctors at UCSF about focal therapy.

At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH Urologic Oncologist UCSF

What about focal therapy?
* The energy modality matters much less than the accuracy of the imaging - which is not there yet.
* Overall focal therapy is associated with minor side effects, but high rates of recurrence both in- and out-of-field.
* Focal therapy is not really a replacement for surgery or radiation; it is better considered an adjunct to active surveillance.

Af the UCSF prostate cancer forum on 4-17-26 Dr. Cooperberg had slides with this information

UCSF Results: first 135 HIFU patients

• 54% recurrence (41% in-field)

• 4% progression by 1 year, 16% overall

• IPSS (urinary obstruction) 6 before, 6 after

• SHIM (erection function) 16 before, 13 after (p=0.11)

• Major drivers of recurrence: GG3, high Decipher

Trade-offs

• Overall focal therapy is associated with minor side effects, but high rates of recurrence

• Inadequate energy delivery?

• Inadequate field of treatment?

• New cancer development?

• Others?

• Understanding the high recurrence rates and trying to improve them is a major area of research focus.

• Focal therapy does not burn bridges: RP, RT, even additional focal therapy are possible if necessary

Summary thoughts

•Focal ablation has a growing role for very carefully selected cases.

• Side effects rates are low but recurrence rates are high. GG3 and high Decipher are warning signs, as are high PSAD and bilateral disease.

• Focal therapy is an adjunct to active surveillance; additional treatment may well be needed down the road, but these treatments are still possible after focal.

University of California Consensus

1 Focal therapy must be acknowledged to be investigational

2. Focal therapy should be done under trial or research protocols as much as possible

3. Candidates should have at least 10 year life expectancy, GG2 or low-volume GG3, stage T1 or 2, and PSA < 10 or PSA < 20 and PSAD
< 0.15

4. Candidates need an MRI-guided confirmatory biopsy before treatment

5. Follow-up biopsy at 12 months is essential

@jeffmarc

Thanks for the info

@punz
It was never offered. I had my radiation back in 2023.

Is the focal therapy new. I don't know much about it. The thing back them was picking photo or proton radiation as both wanted to do long term low dose and no hormones as my Decipher came back low risk.

Here is an overview, they are using other sources of energy to destroy cancer cells
Focal therapy is a minimally invasive treatment for localized prostate cancer that targets only the tumor while preserving healthy prostate tissue, aiming to reduce side effects compared to surgery or radiation.
What is Focal Therapy?
Focal therapy is designed for localized prostate cancer, typically confined to one area of the prostate without spreading to surrounding tissues or organs

. Unlike radical prostatectomy or whole-gland radiation, which treat the entire prostate, focal therapy selectively destroys cancerous tissue while sparing nerves, muscles, and other structures responsible for urinary and sexual function

. It is considered a middle ground between active surveillance and radical treatments, offering cancer control with fewer functional side effects

.

Types of Focal Therapy
Several energy-based techniques are used to ablate prostate tumors:

High-Intensity Focused Ultrasound (HIFU): Uses concentrated sound waves to heat and destroy tumor cells

.
Cryotherapy: Freezes the tumor using argon gas delivered through needles inserted into the prostate

.
Focal Laser Ablation (FLA): Uses laser-generated heat to destroy cancer cells

.
Irreversible Electroporation (IRE): Applies short electrical pulses to rupture cancer cell membranes

.
Vascular-Targeted Photodynamic Therapy (VTP) and Interstitial Laser Therapy (ILT): Emerging techniques that use light or laser energy for precise ablation

.
These procedures are typically guided by real-time imaging, such as multiparametric MRI (mpMRI) and fusion biopsy, to accurately locate and treat the tumor

.

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Hello All:
I had 3 biopsies every 2 years, was on the monitoring program, and finally had a trans-rectal fusion biopsy after the MRI. I then had a PET scan and it showed that the cancer was confined to the gland. I opted for surgery 7-8 weeks ago now, am recovering my urinary functions. My PSA this week was at .02, so next week we will see what the dr. says about it, as I had hoped for .01 or lower.

@drcopp
The number they look for is <.1. You are way below that

Oh, thanks so much! I thought it was .01- I found this on an AI search:
Typical targets:

Undetectable PSA: <0.1 ng/mL on standard assays, or <0.03–0.07 ng/mL on ultrasensitive assays urologyandmenshealth.com+1.

PSA should drop to this level within 6–8 weeks post-surgery urologyandmenshealth.com+1.

Trace amounts (0.01–0.02 ng/mL) can be normal and may reflect assay noise or tiny benign tissue remnants at surgical margins scienceinsights.org.

@drcopp

Many labs like quest the PSA ordered after surgery you are hoping for a result <.04 undetectable. Mine has been <.04 undetectable for the past 18 months except for a PSA test 12 months post surgery my non Hodgkin’s oncologist happened to order in his battery of blood work I get and it was .02 so I think you are looking good right now. Many don’t realize minuscule PSA is produced by another gland compared to the amount your prostate produced so I think there is always something.

I had a transparaneal biopsy.In two thousand twenty five labs came back three plus three gleason Score six, and I was put on active surveillance. I had a follow-up MRI this year and a second lesion showed up, which required another biopsy.
The second biopsy showed some sixes a couple of sevens and one 8 out of sixteen cores.
I will be staging for radiation treatments. Starting next month, luckily, none of it has spread beyond the prostate gland and my decipher score is low. So I'm very optimistic about the radiation, and maybe limited ADT. Had I not done the second biopsy I would have never known active surveillance can be tricky.You have to follow up.