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

My recommendation is to seek second and third opinions. Every case of prostrate cancer is different and so are the types, grades and whether low risk, intermediate or high. The biopsies I had where done under anesthesia and transperinal with NO issues from the procedure. It was done at Mayo Clinic Jacksonville.

Having MRIs, CTs can show problem areas but only biopsies can diagnose whether cancer or not and level of cancer. I had intermediate risk 3+4 (7) after biopsies that was downgraded to low risk after Decipher test. If you are not aware PSA levels above 4 are abnormal. The prostrate and prostrate cancer are the only organs/tissues that make PSA so a raised level should be addressed. You have already got results that it is cancer.

If you read others opinions they will mostly all recommend second and third opinions. If the opinions are the same at several providers then it will make you feel more comfortable. Just try to make it to really specialized providers for those opinions.

Watchful waiting is an option with low grade and low risk but is a matter of the oncologist/radiologist to determine and recommend to you. I got two consultations and opted for proton radiation treatment. Some minor side affects but finished back in July and now waiting for first PSA follow up tests.

I truly appreciate your response and advice. Best wishes for you and your health.

Hello,
Every case is different, that’s the only thing we all agree upon, I had 12-core samples taken. Six were 3+3, which is NOT cancer. The six other cores were 3+4. My PSA was 4.2. Based upon this information, I got three opinions: all recommended surgery, which wasn’t my first choice, However, I took their advice. The surgeon had to ”cut wide”, on one side, there was also a tumor growing and cancer was detected on one lymph-node. (Ugh)
Good luck with your follow-up process.

Thank you for sharing your story. This support group is just what I needed. I wish you the best.

Batsam10: I had 3+3 and 3+4 Gleason and after an mri, had a transrectal biopsy. Then I had radiation with the MRIdian linac machine. People say the transperinal lowers the risk of sepsis and other issues from 2 in 500 to 1 in 500. Obviously, transperinal does not involve the rectum so you don’t get the rectum infection risk but clearly your brother has identified his risks.

If it were me, I would go for a psma pet scan and then make my decision on treatment which is essentially what my radiation oncologist will do if my PSA rises too much. Not sure if your insurance will go for it or not but maybe.

Your biopsy material may or may not be too old to use in a decipher test which will give you and your doctors a “feel” for its aggressiveness level. I agree with jc76 to get a second and third opinion.

Inserting needles for a biopsy is important after an initial MRI but my feeling is the same as your brothers. If you do, do it again, try for the Fusion MRI guided one. Good luck.

Not negative to PAs, but after a positive biopsy, I would consult with a Urologist.

Batsam10, be very careful about postponing biopsies with a rising PSA. I've not heard of biopsies causing the problems your brother had. Sorry to heard about that.
In my case, I was tuned in to PC because my Dad had it. I'm 71 now, but when 70 my PSA had steadily risen over the past 5 years to over 5. I had the standard 12 core biopsi last year - revealed no cancer at all. When my PSA kept rising to 6, I was concerned - so I had a fusion biopsy - which means they did an MRI and combined that image with the ultrasound when they did the biopsy. I had 3 cores of Gleason 8 and 1 core of Gleason 7 (4+3). After considering my options, I chose Proton Radiation Therapy from UHFPTI in Jacksonville. Just prior to treatment, they did a PETSCAN and everybody was surprised and I was shocked to see that I had 7 lymph nodes with cancer. So my tidy little contained cancer was now Metastasized. And at treatment start, my PSA had risen to 11. Changed my treatment dramatically, but luckily I'm 67% through my treatments and Docs expect a great result.
The point I'm trying to make is that everybody considers Prostate Cancer to be slow growing and that we're all going to get it if we live long enough, and it's not that big of a deal. But the truth is it can be VERY aggressive and metastasize before you know it. I'm told the 12 core standard biopsy is like looking for a needle in a haystack. Having an MRI and fusion biopsy is better.
I chosen Proton Radiation Therapy because it's radiation stops at the tumor, whereas traditional Photon radiation radiates you all the way through the tumor and out of the body. Means less issues with side effects. Doesn't cost you anything to get a second opinion. ps. My Urologist never even mentioned Proton Therapy. You have to do your own research.
All my best to you - catch it early.
Tom

Can you do MRI targetted biopsy?
Dont mind me. I am just another layman trying to make some sense of the whole thing.

One thing you mention in passing is that your older brother has PC. This is a risk factor for you as some PC is familial. I mention this because it could be a factor in how long you are willing to continue active surveillance. (And yes, multiple mri's and repeated guided biopsies, whether now or after waiting longer, are definitely part of the protocol for active surveillance as opposed to the more passive "watchful waiting" once advocated.)

Since you had 18 cores taken, that was likely 12 systematic plus 6 guided by ultrasound/mri. If you take the same route, your next round would probably also be guided by mri. That mri will tell you if things have progressed. You might be, however, a good candidate for ablation (localized killing) since your cancer appears to be somewhat predictable. I was impressed by, but had too far progressed cancer for, a clinical trial of an ablation approach using magnetic nanoparticles. In addition to radiation, ablation can be done using HIFU--high frequency ultrasound, cryo--freezing, and a few other techniques.

The benefit of ablation is not requiring the risks of surgery, but the downsides usually relate to two aspects--the scarring of the tissue makes reading what's going on more difficult going forward (and it never gets all the cancer) and there is always some damage to healthy cells, either nearby or because the ablation is not tightly enough targeted.

There is of course much work going on to refine the techniques for ablation, as well as a lot of expensive equipment built and marketed for this purpose, so there's a lot of press about ablation techniques.
Let's just say that if any one technique was proven truly superior, some people would make a lot of money and a lot of people would get a better treatment option. I think as someone who already lost my prostate, I can sit back and say that things are not yet that clear.

Thanks @bens1,
I appreciate your input and have a second opinion set for next week. Getting great feedback from everyone. Glad I found this support group.