On AS and not sure if I need another Biopsy

[JVARA]

Hi everyone, I was diagnosed with PCa just over 16 months ago. I am on AS and due to see my urologists next week. I was after some advice what people’s thoughts were if I needed to have another biopsy? My PSA has come down since being diagnosed 3.2 to 1.9, Free is at 21.1. I had a PHI test which was 27.2 (Medium risk) and my Testosterone was 37.7, slightly on the high side. I have attached my last MRI. Any feedback would be appreciated.

[Tall_Allen]

Have you had a confirmatory biopsy? If not, you need one.

[JVARA in reply to Tall_Allen]

No I haven’t , that was my concern . After the last MRI and PSA test my urologist says it’s not necessary.

[Tall_Allen in reply to JVARA]

Every institution has its own AS protocol. I know that at some places, you are not even considered to be on AS unless there is a confirmatory biopsy within a year of your first one. The logic is that it's too easy to miss higher grade PCa if there is only one biopsy.

[JVARA]

I think because the MRI come back with no lesions and PSA come down he didn’t think it was necessary. But i’m not very comfortable with it as everywhere I read it states a follow up Biopsy is standard before going on AS. I will see my urologist next week . I think I will push for one . What are your thoughts on the number of cores ?

[groundhogy]

there is one called saturation biopsy. One needle for each cc of volume. I had it because I didn’t want them to keep stringing me out on repeated biopsies. It worked. They were going to put me on AS also

But you don’t sound like you want to be on AS. Just the vibe i get from yournpost.

[JVARA in reply to groundhogy]

I actually prefer to stay on AS but just want to be sure nothing has been missed

[addicted2cycling in reply to JVARA]

groundhogy wrote -- " there is one called saturation biopsy. One needle for each cc of volume ... "

The biopsy that comes close to one performed on an extracted Prostate is Dr. Gary Onik's Saturation Transperineal 3 Dimension Prostate MAPPING Biopsy. Using a Brachy Grid + Ultrasound while positioned on a gurney similar to a *Stryker LD304 Birthing Bed* - ask me and I will confirm it, needles are placed at 5mm spacing and can sample 90% to 95% of the prostate leaving very little doubt about the presence of PCa and showing clearly the borders of the lesions if there.

My initial biopsy provided 100+ core samples and the 2nd biopsy 60+ sample.

[JVARA in reply to addicted2cycling]

Groundhogy Are you on AS?

[addicted2cycling in reply to JVARA]

Nope, 5+5, GL 10 and very early experimental cryotherapy plus immunotherapy protocol by Dr. O

[Tolekbalak]

What is an AS?

[allshallbewell in reply to Tolekbalak]

Active Surveillance.