After a year on active surveillance following an initial biopsy that showed intermediate favorable level of pc, a more recent biopsy showed all samples to be Gleason 6 (3+3).
My urologist is very supportive of continuing with active surveillance. I will have periodic psa testing and probably an annual MRI.
He seemed to think it might make sense to wait 3-4 years for another biopsy - depending on what we learn in that time frame.
Looking ahead a few years, I am uncertain if it will be wise to have another biopsy - or if I should only do so if there is a cause for increased concern from the MRIs and PSAs.
I welcome your perspectives.
Thanks!
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allshallbewell
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As a recall it was 37 if I have the right test in mind … have to look at it again. I later did very thorough genetic testing through Dana Farber given family history and this showed no genetic link.
my first year MRI showed changes and “concerns” Followed by a biopsy, changes were from 3+3 & 3+4(4 less than 5%) in the original diagnosis, to 6 3+3s. 4 not found. Decipher low. 6 month’s later MRI showed no changes. Suggestion is AS. Plan is for PSA in January. I might ask for another MRI to check. In NYC with MSK.
Patients who choose active surveillance should have regular follow-up, and key principles include:
◊ PSA no more often than every 6 months unless clinically indicated.
◊ DRE no more often than every 12 months unless clinically indicated.
◊ Repeat prostate biopsy no more often than every 12 months unless clinically indicated. While the intensity of surveillance may be tailored based on patient and tumor factors (eg, grade, tumor volume), most patients should have prostate biopsies every 2 to 5 years as part of their monitoring.
◊ Consider repeat mpMRI no more often than every 12 months unless clinically indicated.
◊ In patients with a suspicious lesion on mpMRI, MRI-ultrasound fusion biopsy improves the detection of higher grade (Grade Group ≥2) cancers.
◊ Patients should be transitioned to observation when life expectancy is <10 years.
◊ Repeat molecular tumor analysis is discouraged.
◊ The intensity of surveillance may be tailored based on patient life expectancy and risk of reclassification.
◊ A metastatic staging evaluation (PSMA PET, bone scan, CT scan, or whole body MRI) should not be performed
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