Please see earlier post.
Grateful for all replies
If I decide to proceed with treatment, I feel it is important to obtain biopsy of the nodule to help guide treatment (if any) doing additional genomic testing and repeat Decipher. Focal treatment may be a consideration.
Would newly approved FoundationOne Liquid CDx test provide additional useful information in treatment decision?
Liquid biopsies rely on metastases to release their DNA into the blood. Sometimes they do, sometimes they don't. If they do, it is like a weighted average of tumor genomics. A biopsy sample provides the definite DNA, but only of the tumors biopsied (provided the tumors are large enough to provide adequate tissue). The two methods are poorly correlated.
The other advantage of a tissue biopsy is it provides cells for histology and IHC. Genomics usually does not provide useful info.
Decipher now provides a GRID analysis, which may provide guidance for treatment.
Is oligorecuurence considered metastatic regarding liquid biopsies?
Yes
it would seem nothing would be lost with a liquid biopsy at this point, as it’s noninvasive, other than cost and may provide useful information.
Nothing lost except $$$......bvut I wouldn't waste them unless some decent studies as to real-world effectiveness in providing actionable information?
From their website for PCa diagnostic indications.......
Biomarker detected FDA approved treatment
BRCA1, BRCA2, ATM alterations LYNPARZA® (olaparib)
BRCA1, BRCA2 alterations RUBRACA® (rucaparib)
Also, my reading is that tissue based Foundation One test would be the preferred method, and liquid used only when tissue unavailable or some problem presents when analyzing the tissue sample.
Is there a reason that a tissue biopsy can't be done?
Are you diagnosed as metastatic......ie incurable??????
My approach has always been to take whatever quality attack at my cancer I can get. Not always offered, but put it all through your (and this site's) filter and if you feel you can get better from them, once they are actually wanting to help you, push hard. That is the key to life and death.
My take on you is that you fer actual biopsy more than the possibility of a progressed diseas.Looking up liquid biopsy I find, other than it's a simple blood test, the following: Liquid biopsy has emerged as a complement to invasive tissue biopsy to guide cancer diagnosis and treatment. The common liquid biopsy biomarkers are circulating tumor cells (CTCs), extracellular vesicles (EVs), and circulating tumor DNA (ctDNA). Each biomarker provides specific information based on its intrinsic characteristics.
Get them both done. Seek a guided transpriennel biopsy. Less infection risk and done with local injected pain meds. Go into the biopsy with a determined positive attitude that there will be no side effects.
Thanks mind is a powerful tool. Expect no SE issues yields none.
The best test that I know of is a PSMA Pet scan.
Factors for consideration in making decision:
Age 82 with life expectancy perhaps late 80s to early 90s. Five uncles lived to late 80s, early 90s. Grandmother and great grandmother lived to 96.
Consider noninvasive micro environment manipulations. Currently on 5 aRI in hopes it may be retarding cancer growth/advancement by reducing DHT, currently <2. It appears my use of 5aRI raised testosterone by about 20%. Countering that with use of low dose statin which lowered cholesterol and appears to lower my testosterone by 20%. Testosterone currently running 450-500. Supplements?? Medications that may impact or slow the cancer growth without making things worse.
My free testosterone is extremely low but that may actually be helpful in regard to the prostate cancer progression and since I have no symptoms I am not concerned of it being low.
If Bx or liquid Bx shows increased risk or aggressiveness compared to earlier data may be more inclined to aggressive treatment
Seven years since treatment. Favorable intermediate 3+4=7, GG2. SV neg as were 24 lymph nodes. Some question of small 1 mm area of positive surgical margin.
Feeling well with good QOL.
Heterogeneity of prostate cancer and the unusual anterior pituitary hormone picture unexplained after five endocrinologist consultations.
Lymph edema could be made worse with focal treatment
Nodule 2.6 mm from rectal wall and higher risk of rectal damage with focal treament
PSA 0.347 with pattern suggesting increasing rate of rise. Two negative PSMA PET scans. Nodule essentially unchanged on two prostate MRIs one year apart.
Appreciate any thoughts or suggestions. My goal is to leave with the prostate cancer and not from it or shortening my life or making matters worse with hormone treatments, medications, or invasive treatments. I accept there is no right answer. I consider pros and cons within my context and then make an educated choice (guess) and feel that is all I can do and live confidently with that decision.
Hi there LotT, We will follow each other for the journey.
My story is that my primary care doctor noticed a jump in my PSA last year from 4.5 to 9 in a few months. She suggested a visit to a urologist.
In short, a biopsy, 6 cores at Gleason 9 on right side, one at 6 on left, rest benign. Cancer is very aggressive with perineural invasions and Cribiform histologies. Level is Tb, and a risk level of 5. CT and MRI did not detect metastasis any where which means any there are under about 5 mm diameter.
I started Orgovyx Androgen Deprivation Therapy (ADT) on January 27. I think this could be called chemical castration, but whatever. My Cyberknife radiation treatment is planned for mid to late April.
My side effects so far are as expected which include fatigue, mental confusion, hip and shoulder pain, and occasional hot flashes. These so far are relatively mild but definitively present. I take a hour and a half nap every afternoon and still sleep my normal routine at night.
Many who have posted here strongly recommend frequent weightlifting and cardio. I have done these all my life and am continuing with a vengeance. The forces help to mitigate bone loss from the ADT. This concerns me as I have a heart stent and noticeable plaque on my heart veins. I am in touch with my cardiologist.
The mental confusion is suggested to be relieved by playing music. I am a completely amateur pianist and have agreed to play the preludes and postludes many Sundays in my little church. My wife and I are headed (I think) to an independent living facility. the ones we have seen so far have nice grand pianos in the lobbies. Kawai piano, here I come.
Further for mental stimulation, I am writing historical fiction adventure stories. I am on my fourth so far. They are listed on on-line book sellers under my name of Clifford Farris.
This said, I am down. Postings on this website indicate that treatments can maintain a person for many years. There is, however, the balance of quality of life versus quantity of life. I am leaning on the quality side. My family and others are more on the quantity side. At eighty-four and a half, I am doubtful that I will ring in the 2028 New Year celebration.
My care givers seem excellent here in Denver and are upbeat. However, the body language of my Urologist seemed to indicate otherwise.
Todd1963 posted that we need to let go and live each day the best possible. I can see the sun peep over the horizon each morning and give thinks for the gift of a new day. I promise the Great Spirit that I will make the most of the give that I can.
Good future, friend. Remember j_o_h_n. "Good luck, Good Humor, and Good Health
Just saw your reply from a month ago. Sorry I missed it earlier.
I'm 82 soon to be 83.
Long complex history detailed in my postings. Involves hormone issues, statin intolerance and yet I am on statins to lower my T but it also does a good job with my Cholesterol which runs around 130.
RARP at age 76 for 3+4 in unusual location. Prostate was 78 gm. Posterior midline surrounding the ejaculatory duct with extensive EPE which was not visible on two MRIs. SV -, as were #24 ePLND.
Been watching uPSA closely partly because of the unusual hormone abnormalities and use of TRT. Was on TRT for about two years which was begun nine months after surgery due to low T symptoms which much late were believed to be due to high dose statin.
One and a half years ago when uPSA reached 0.1 range a new enhancing nodule in L prostate bed appeared. Since then followed by three negative PSMA PET and repeat MRI was essentially unchanged. Have been offered SR and +/- ADT by two ROs.
If I did not have longevity in my genes, one of the ROs would probably not recommend treatment. Grandmother and great grandmother both died at 96 from broken hips and uncles lived into late 80s early 90s.
I'm presently in pretty good health. Swim 1/2 mile three times a week. Have had 3-4 episodes of AFib over past ten years but well controlled on anti arrhythmic and Mg and K.
uPSA reached 0.35 and has fallen to 0.25 maybe as a result of various modalities including low dose statin, 5 ARIs, supplements, etc.
I'm currently in holding pattern.
BTW I also have bilateral lymph edema from the ePLND which is controlled with support stockings so double concern of making that worse should I proceed SR.
Also, osteopenia with last BMD reaching osteoporosis both femoral necks. But my Z score is not that bad which I think is the more important.
A hypothetical question regarding going castrate resistant. 
Update on my father and questions regarding liver mets. 
PC treatment question
Question Regarding Biopsy
NEPC Treatment Question
