I've been on AS for 5 years with Moffit had 3 biopsy's all gleason 6 except a second opinion on my first one 2 cores where changed to a 7. PSA has bounced around but highest was 6.43 this April last week 5.13. Because of my recent MRI shows growth on the lesion and possible extracasular extension. So I have made the decision to get treatment. Was leaning towards SBRT. I took suggestions from the group as to one of the most experienced RO with cyperknive. I had zoom with both RO's this week. Cyperknive RO is pretty much ready to start treatment placing markers etc. but Moffit wants another biopsy first and than proceed. I really don't want another biopsy and when discussing the results of my MRI my understanding was I would only need a biopsy to stay on AS. Are they being over cautious?
Tough decision: I've been on AS for... - Prostate Cancer N...
Tough decision
If you are committed to getting treatment, there is no reason for a biopsy - only follow your RO's instructions.
Thanks for the input I believe that's what I'm going to do
How old are you bc age has to be taken into consideration regarding radiotherapy
Have you considered a PSMA-PET scan ?
Second opinion on 3+4 cores and 3+3 cores. Gleason 6 doos not turn into 7. New occurance or subjective analysis variations?
I’m 67, waited 5 years after dx until my PSA climbed to about 8 and I had two cores that went from 3+3 to 4+3. I had a Muliti Parametric MR and it was negative. My pathology result post prostatectomy was a bulge in the outer perimeter that was deemed EPE, w/o lymph node involvement, that was 4 years ago and I’ve had no noticeable PSA readings since.
Your PSA went down but you had the suspicious EPE.
Extraprostatic extension EPE is of concern however, according to Peter L. Choyke, MD-who was a co-inventor of the multi parametric MRI, “One striking aspect of the EPE grading system is how poor multiparametric MRI is at predicting EPE. Even in the case of gross visible extension, only 66% of cases proved to have EPE pathologically. Thus, EPE should always be diagnosed with some degree of humility at multiparametric MRI, and referring clinicians should tune their expectations accordingly.”
This quote and more is from this pub: pubs.rsna.org/doi/10.1148/r...
This is a tough decision, but I’d second getting a PSMA-PET scan for confirmation and grade of the EPE. Best of luck.
What was challenging for me was being sure I was focused on the right tough decision.
As many criticize urologists for wanting to do surgery "right away" - seems this may be what you are getting from Cyberknife RO; whilst Moffit is recommending further investigation.
In reading your other posts (your bio history is lacking), there seems to be uncertainty as to what G score and actual risks you face. I had two biopsies - the first reported as 'benign'. Ten years later my second was initially graded 3+3; 2nd and 3rd opinions 3+4. Final G based on RP pathology was 4+3 and my cancer had spread further than all docs thought. Also, I had two mpMRIs and conflicting radiology opinions.
I would be more worried about the thoroughness, completeness, accuracy of the diagnosis than another unwanted biopsy.
IMO... When in doubt, move out!
Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
prostatecancerfree.org/comp...
It is best viewed on computer or just print it on paper. Not so viewable on phone.
To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.
Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.
Missing the Target: One biopsy for deciding initial treatment
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How long of a delay in treatment is too long? And how does weak urinary flow interface with RT?
Making a decision! 
46M, diagnosed in April, approaching decision
