Active Surveillance

[ironmanburg]

Hello everyone, I have had 2 biopsies in the last 2 years (the last one was in January 2023) with the latest one showing 1 out of 12 cores positive for Gleason 3+3 and another core suspicious for cancer. It was also noted on my last MRI that I had a bladder outlet obstruction. My PSA went as high as 13 then back down to 11 the last time it was checked in July. My question is should I be getting any more biopsies? The second one was supposed to be to confirm the cancer and it showed less cancer than the first. I've been on active surveillance for about 2.5 years. Thanks.

[Tacker]

I have been in active surveillance for about 1 1/2 years. My PSA has consistently hovered between 10 and 11. My first biopsy showed a Gleason score of 3+3. My urologist recommended a second MRI at my 1 year anniversary. After the MRI showed no substantial change, he recommended a second biopsy. I just had that this week and am waiting for the results. I am not sure if this will become an annual thing or not, although I intend to ask. I would ask your doctor what he thinks. My guess is that it will depend on your PSA scores going forward, but I suspect that the one 13 score may point to more biopsies. Although I don’t enjoy the biopsy process, I guess it is better than missing a progression in the tumor.

[ironmanburg in reply to Tacker]

Thanks.

[cbreston]

There is quite a bit of variation in PSA assays and enormous variation in biopsy grading. The exact same biopsy may have different subjective scoring and different conventions on how it is reported, by different pathologists. That makes it hard to compare and discern progression.

I've now had three biopsies by age 62, all Gleason 3+3, but with apparently increasing involvement of regions (number of cores). Having consulted two urologists and an oncologist, I've settled on 6-month PSA monitoring and 2-year intervals between MRI-guided biopsies.

Oddly, the first urologist recommended bead radiotherapy, but the radiologic oncologist recommended against that therapy in favor of continued active surveillance. We'll use radiation when there is clearer sign of progression to something that could metastasize.

[ironmanburg in reply to cbreston]

Thanks. That’s the way I’m leaning.