New Additional Tumor

PIRADS 4 is more likely to be cancerous and considering that you’ve been on active Surveillance For two years, the transperennial biopsy is a great idea. They can get to areas of the prostate that cannot be reached from a transsrectal biopsy. You could come up with still having a Gleason of 3+3, But with a new tumor, you definitely want to do another biopsy.

The only way to figure out what treatment you would get is to know what the results of the biopsy are. If you are a 3+4 with no spread outside the prostate and no other findings, then you have many choices, Radiation, surgery, HIFU , Cryoabalation , NanoKnife , TULSA PRO, HoLEP. If a higher Gleason score more treatments are needed.

That’s a lot of biopsies in just 2 years. There’s always caution about turning your prostate into a pincushion.

You should collect more information:
> % Free PSA
> PSA Density
> PSA Doubling Time
> Biomarker (genomic) test
> Genetic (germline) test

With all that, you’ll be able to decide what’s next.

Are they doing an MRI before your next biopsy or just going in blind?

(I was on active surveillance for 9 years, over that time my PSA going from 4.2 to 7.976; my 4th biopsy was a Gleason 7. It was then that I had 28 proton radiation treatments. I’m now 4 years out from treatments. PSA now ranges from 0.35-0.55; most recent PSA was 0.478.

Ask for Decipher test also. You need to know how aggressive your cancer is to make correct decision. It is good that you have transperineal biopsy this time around - it provides better sampling and less possibility of infection. If it is done with robotic assistance and ultrasound guidance than it is even better.

The MRI is done. That is what triggered this biopsy. A fourth tumor was found and that is the target. Each biopsy has been preceded by an MRI - annually.

3 biopsies in 3 years by the time it is done (late June). I have the PSA information you note. I do not have the genomic or germline tests.

History: very little cancers in my immediate family (parents, one grand mother with breast cancer, and one uncle (my mother's brother) with level 1-2 prostate cancer at age 73 - now fine 6 years later.

Thank you for information.

Thank you for that suggestion. I have that now in my notes to request.

@jonathanack, I am repeating another post I made today but it still applies, ...The Decipher test takes biopsy material tests for aggressiveness and treatment options. The doctors DO use this test to adjust treatment options, ie adding androgen deprivation therapy, as one example.

If you do radiation, request spaceoar or bioprotect gel spacers a week or so ahead of time. This helps create additional separation between your prostate and rectum and therefore limits healthy tissue exposure, which impacts side effects and quality of life.

I had the mridian sbrt radiation machine which has a built in MRI real time imaging vs fused images. You want real time images, if possible, as what they see they can treat and they can dynamically change the treatment mapping in real time. The Elekta radiation machine is another built in MRI machine. They will treat your whole prostate PLUS margins. The Mridian and Elekta use 2 mm margins while other types of machines use 3-5 mm margins, including Proton.

Centers of excellence are usually the way to go. You also might want to do a telehealth with an oncologist from a center of excellence, as a second or third opinion. I was 69 at the time of treatment. I had slight urine restrictions after the 3rd of my 5 treatments. Flomax took care of that overnight. Other than that, no side effects and am back to normal. I was treated February 2023.

Thank you very much. Sincerely appreciate the time you took to explain this to me. I have it all in my notes. I hope you are well and your treatments are helping.