Hi , I was wondering what group thinks
We have a RO consult on Monday, My husband will likely need radiation. He will also in the coming days get a prostate biopsy with tissue samples sent for testing
I want to wait for testing dna, rna etc is back. He is confused about what to do. Any help on this would be most appreciated Btw, he’s starting Abi/Pred this week.
I'm not sure what decision you intend to make based on molecular tests or why you would postpone his therapy for that. Why is the poor guy being subjected to another biopsy?
The MO wants to send the tissue samples to see how much Cancer is still in his prostate and maybe that info /testing will show or guide his treatment? We see a RO Monday , choices were more chemo or radiation, I thought we were on the right track with adding Zytiga but they don’t want us to wait I guess
Maybe a liquid biopsy could help in treatment plan
I don’t think anyone had suggested that , will do more research on it! Thank you for your reply
With a metastatic PC the biopsy of the prostate will not add much info since the mets could have a different genome. Liquid biopsy are unreliable in the absence of bone mets and PSA of 5 or higher.
If he already had biopsy of the prostate, they could use the slides to do the genetic studies of the cancer in the prostate.
We were hoping to use the 2018 tissue samples from his original biopsy , however the clinic no longer has them which is why they want him to do a new one, so frustrating, thanks for your input Tango65
I think someone suggested biopsy the mets?
Yes, biopsy of the mets, if possible, it is important since they may have a different genome than the original tumor.
I concur. What is the data of potentially spreading the bone met from a bone biopsy?
I think it is difficult to determine and I have not find definitive data about cancer dissemination caused by bone biopsies.
is it risky to do a prostate biopsy? I’ve read where there may be more spread of cancer cells
I’m so confused! They scheduled a prostate biopsy for in 2 weeks, which will give us time to review with MO and RO
it’s possible but prob low probability but they really need to do a prostate biopsy to determine Gleason score
Would the Gleason score change? He was G9 at dx, after all his treatments, would be great to be less
Does not make any difference now
I also asked to do a biopsy again before radiation of the prostate and the MO said no for a prostate biopsy now.
that’s very interesting! We were told he needed one to get that genomic and molecular testing done, so we r on hold with everything till that comes back , then we can make treatment decisions
Are they going to biopsy the limph nodes?
Hi Seasid, nope just prostate
They could spread the cancer to your rectum if the cancer in the prostate is CRPC. At least that would be my nightmare.
Can you ask for second opinion and try to avoid the biopsy?
I am not a doctor and i should not advice you but I should still say what I think.
Where are you getting treatments?
As tango65 already said. The genome of the mets could be different but you are going to hopefully SBRT them soon.
The PSMA PET scan could say from the SUV max value how agressive is your cancer.
Find a good doctor and don't let them to experiment with you.
we never got an SUV value on his PSMA pet scan , a previous FDG scan showed 8.7 max value
Not sure what that means
My prostate had an SUV max value on the FDG PET scan of only 4.5.
On the PSMA PET scan the SUV max value of my prostate cancer was 14 almost a same time as the FDG PET scan.
I don't know either what all that means but a higher SUV max value probably indicate more aggressive cancer.
If you are now on Abiraterone plus Prednisone and going to SBRT your prostate and visible mets (pelvis) than you don't need a biopsy now.
When Abiraterone plus Prednisone fails then you could have a liquid biopsy when your PSA will be above 5 or even better 10.
In couple of years on Abiraterone plus Prednisone your cancer will mutate further and when your therapy fails you could think about a biopsy either tissue biopsy or liquid biopsy in order to make a treatment desission. You want to see if Olaparib or Keytruda could be deployed.
I personally for myself would get the radiation of my prostate and visible mets as soon as possible.
I don't have any visible mets at the moment.
My MO was talking about not to biopsy the prostate.
Maybe years later you could biopsy any visible mets but not the prostate. The genetic mutations will probably change and you would like to know that as the cancer always reinventing itself.
Therefore do the liquid biopsy or the biopsy of some future mets in the the future but not now. You don't really want biopsies without a good reason.
I would have a nightmare that they could spread a CRPC by biopsying the limph nodes now. Better just to radiate them.
Hi Seasid,
thank you for your thoughtful response.. We do have some time to check with the MO as to the value of doing a prostate biopsy now........ After what you described.. maybe the proactive approach of doing the SBRT and ADT++ is what he should do and delay doing a prostate biopsy at this point...
I was originally multi metastatic an I was never considered curable.
I am radiating my prostate as I believe i could simply continue with Firmagon injections alone and save the Abiraterone plus Prednisone for later.
I am doing the high precision SBRT MRI Linac to my prostate only as i don't have now any visible mets. And we hope that i could continue with Firmagon injections alone after prostate radiation.
RO Advice for Salvage Rad
Wait for a PSA rise or Radiate Now- how did you choose?
Wait time for radiation is 6-8 weeks in BC Canada; will this cause an issue with triplet approach?
No more PSA tests until 6 months post radiation? 
Radiation followed by zytiga or Zytiga
