Biopsy Today- Looking for a quick response -Thanks

[pj1121]

#1 urologist checked my psa, 250, she ordered psma-pet, - metastasized to pelvic lymph nodes and suspicious node in back. DX Stage 4. The same Urologist ordered a Biopsy which she described in a message to me as taking 6-8 core samples, she then passed me on to an oncologist. I asked the oncologist why only 6-8 samples in the biopsy when most I had read about took 12-24 samples? She passed my question on to the biopsy-specialist/#2 urologist. Who then passed my question back to my original #1 urologist who replied: “That is all you need”. Not much of an answer in my opinion. Any thoughts or feedback please?

[Derf4223]

Once PCa metastises, a prostate biopsy is not likely to change treatment plans. Is a lymph node biopsy or 2-3 in the cards?

The PSMA-PET CT scan will tell a lot more about where and how big lesions are. And I have heard that and FDG PET CT scan can tell even more. I am not a doctor.

You should also look up trials for your type of cancer -- LATITUDE, PEACE-1 and ARASENS, etc. Mention them when meeting with your MO and you will have a lot of credibility and can ask intelligent questions.

[pj1121 in reply to Derf4223]

Was told the lymph nodes were too small and difficult to biopsy but will do genetic testing on prostate

[Hidden]

They probably feel like 6 is sufficient to obtain enough to get a sense of your Gleason grade/score.

[Tall_Allen]

If it's metastatic, what possible use is more biopsy cores from the prostate?

[pj1121 in reply to Tall_Allen]

gleason score - genetic testing. Maybe I misunderstood the concept. I’m new

[Tall_Allen in reply to pj1121]

Gleason score and genomics give the risk of metastases. All of that is immaterial if you are already known to be metastatic.

[fast_eddie in reply to Tall_Allen]

Gleason score gives the aggressiveness of the cancer. Hardly immaterial.

[Tall_Allen in reply to fast_eddie]

What do you mean by "aggressiveness"? Doctors mean that more aggressive cancers readily metastasize. If you know you already have metastases, you know it is "aggressive." You don't need a Gleason score to tell you the obvious.

[Benkaymel]

Did you not have a prostate biopsy when first diagnosed? I did and they only did 6 cores. Since you've had a PSMA-PET showing mets, there is little point having a prostate biopsy now. If they want to find out more about the mets, then a biopsy of one of them is needed.

[Bret5]

Consider getting yourself to a dedicated cancer center if there is one near you. This eliminates back and forth and delays. Your situation sounds somewhat similar to mine. I had biopsy then RP but then trusted urologist guidance way too long after that. Now on triple therapy at City of Hope.

[tarzan11 in reply to Bret5]

Dr Dorff was my oncologist back in 2007-2010 when she was at USC. My favorite Dr ever.

[hfl20 in reply to Bret5]

My thoughts exactly. I had a similar run-around with my local urologist and made the decision to start over and travel to a cancer center of excellence (MD Anderson in my case, but there are many) where I selected a team of urologist, MO, and RO to diagnose and offer treatment solutions. The idea of Dr's passing your questions around doesn't seem like the best way to handle your diagnosis and eventual treatment.

[Linebacker75]

My MO gave me the same response as TA. My diagnosis in 2012 found my Pc a Gleason 9 (5+4) and the cows had already gotten outa the pasture. My last PSMA showed uptake in 3 Supraclavicular nodes but they’re too small to biopsy. He said with microscopic G9 it’s better to monitor with PSMA/CT and PSA. until organ involvement at which time will require a biopsy. For now it’s the dreaded Lupron roller coaster.

[Seasid in reply to Linebacker75]

It is only my idea, question to you.

Would it be possible in your situation to SBRT on the PSMA PET scan visible mets with MRI guided Linear accelerator like Elekta Unity? Would it be better than just to wait until organ involvement in order to get the biopsy?

On which medication are you now? I am only on Degarelix injection and on my last PSMA pet scan end of the last year (2022) I didn't have any visible mets on the PSMA PET/CT scan nor on the FDG scan.

I am just curious about your doctor opinion about that possibility if it is safe to do?

[Seasid in reply to Seasid]

Just to let you know that I was also considering organ biopsy, lung biopsy because the Canon high resolution CT picked up a nodule In my lung which was only visible on the FDG but not on the PSMA PET scan. I was intelligent enough and requested antibiotics treatment and the node disappeared.

I was talking to one lady with breast cancer. She already had 6 operation and one brain surgery. She said that during her lung biopsy her lung collapsed and ended up in a hospital for 12 days.

I am just saying that in order to show you that waiting for the organ involvement is also not safer than the do the SBRT of the mets if it is safe to do.

Did you have a consult with a RO about that possibility?

[Linebacker75 in reply to Seasid]

I’m only on 3 month Lupron injections. On my follow up in Aug I will be asking about radiation to those nodes

[Seasid in reply to Linebacker75]

I don't go trough your profile so I can't comment properly but maybe apalutamide would get rid of the mets if you are still hormone sensitive or Abiraterone if you are castrate resistant. I am not a doctor. I radiated my Prostate because it was CRPC and it usually stops responding to global treatment. I believe that it is better to delay the radiation if you are younger as the radiation late side effects are not comfortable and we may and up in a hyperbaric chamber to mitigate the radiation late side effects.