Transperineal biopsy options & location recommendations

Hi @rsun,
I had two MRI after many years of relatively consistent PSA, mostly 4, once 5, and thought the first was a mistake, in Jan. 2023. I followed up the PI RADS 5 reading with a second confirming MRI in Mar. After researching biopsies, I saw no need to take the infection risk of TRUS and Dr. Sonn performed TPUS in June. I tolerated the procedure mostly without concern, except for getting faint, which I believe was due to contact with the vagus nerve, that I'd experienced before with a sigmoidoscopy. All of my cores showed 3 +4 =7 except: Left Posterior Apex Peripheral Zone (PIRADS 5) Prostatic adenocarcinoma, Gleason score 4+3=7, hence my overall GS is 4 + 3 =7. I then followed up with a PET Scan, which was negative and a Decipher Grid. I had previously done some genetic testing that was of no value for PCa.

After consulting a variety of Urologists and ROs, I decided on a tri-modal of Orgovyx/ADT (4 months); Cyberknife boost @ UCSF; EBRT @ Stanford. One consultation was 'off the record', with a retired Urologist and current CMO, that provided a candid view of alternatives. I had planned to consult with Mayo, however, laws prohibited a video visit and I was content with my regional facilities. Mayo mostly uses Proton radiation vs. Photon and I can't find any convincing evidence that Proton is superior, albeit there will be a great deal of debate on this topic. According to the PCF, "Protons are similar to photons (traditional x-ray
radiotherapy) in many ways. However, proton beam
therapy has not been shown to improve cure rates or
quality-of-life outcomes over other forms of radiation
therapy, and may actually increase rectal side effects.
There have been no completed head-to-head trials
comparing proton beam radiotherapy to either surgery
or traditional x-ray (photon) beam radiotherapy"

I am about to begin EBRT soon at Stanford and have fared well so far. The worst bit has been weak urinary stream and greater urgency that is helped by Flomax, I am managing on one per day and pray that continues.

Best of luck!

Take your time and do your research so that you are comfortable with whatever decision you make for your own individual case and numbers. PC does not kill you quickly, so you have time to ruin your eyesight reading articles first.

rsun, not familiar with Phoenix Mayo just Mayo Jacksonville. I think Collen (MCC monitor) could probably help with some web sites and contact information for you.

I was already a patient at Mayo Jacksonville when my PCP referred me to urologist with a rising PSA (but still normal at 3.75). I did a consultation first and that took only a week. He ordered a MRI with a contrast that had to be a special one as I have a ICD/Pacemaker. That took about a month to get as requires a special MRI and some things done to my pacemaker prior to and after.

A biopsy was recommended as was necessary to get a biopsy of problem areas found. That took about a month to get as Mayo urology is very busy. My urologist wanted to do trans-rectal and a lot quicker but I wanted transperineal with anesthesia. I had to get my heart failure doctor involved to agree that having in done transperineal with anesthesia was not a risk for me above normal risk every one has with anesthesia.

There is a major facility out in California that does proton radiation treatments for decades. I don't have their name but many have mentioned it and was in many books about proton radiation. They should be or have referrals for those needing the biopsies. Wish I could be more helpful with Phoenix Mayo but live in Ponte Vedra Florida and I am 25 miles for Mayo Jacksonville where I have been a patient since 2006.

I, like many others, will suggest what every your diagnosis is to get second opinions and consultations for best treatments for you.

Why cyber knife AND sbrt?

Cyberknife is a brand name of SBRT. At UCSF, they also offer Versa HD and there are several other brands as well. To make things more confusing, you can get Linac or proton SBRT.

I belong to Mayo AZ as my main health care provider. When my PSA started to increase in mid 2022, my urologist tried the DRE, then a mri. Both showed negative results, so she recommended the next step, which was the trans perineal biopsy. All occurred within a few months. The biopsy discovered my cancer. The doctors and staff were great.

I also had Dr. Frendle, great experience.