Frequency of Biopsy

mrdezzy

I had my initial biopsy about one year ago, results where 3+3, 2 of 12 samples positive. My PSA tests have remained stable for the last year during my course of watchful waiting. My urologist is suggesting another biopsy. Is anyone aware of the "standard" practice on the frequency of repeating a biopsy?

Swingshiftworker

Standard Practice?
I don't know if there is any such thing as a "standard practice," but the UCSF Active Surveillance Protocol is to conduct a biopsy "every 1-2 years depending on other clinical findings."

See: http://www.ucsfhealth.org/newsletters/primary_care_connections/march_2008/prostate/index.html

See also: http://urology.ucsf.edu/pdf/Urology_2010.pdf

Given the risks involved in taking a biopsy and your stable PSA in the past year, I don't think you need to get another biopsy yet. However, if your PSA starts to rise w/in the next year, you would probably want to get one then. Otherwise, you can probably wait until year 2.

Good luck!

Samsungtech1

PSA
What is going on with your PSA? That is an indicator of what is going on. Is it rising? If so, How much?

Mike

mrdezzy

Swingshiftworker said:

Standard Practice?
I don't know if there is any such thing as a "standard practice," but the UCSF Active Surveillance Protocol is to conduct a biopsy "every 1-2 years depending on other clinical findings."

See: http://www.ucsfhealth.org/newsletters/primary_care_connections/march_2008/prostate/index.html

See also: http://urology.ucsf.edu/pdf/Urology_2010.pdf

Given the risks involved in taking a biopsy and your stable PSA in the past year, I don't think you need to get another biopsy yet. However, if your PSA starts to rise w/in the next year, you would probably want to get one then. Otherwise, you can probably wait until year 2.

Good luck!

Thanks for your response, I
Thanks for your response, I was also thinking that the PSA should be the major indicator for me and my next biopsy..I will take a look at the web sites you suggested...thanks again

mrdezzy

Samsungtech1 said:

PSA
What is going on with your PSA? That is an indicator of what is going on. Is it rising? If so, How much?

Mike

Mike, I have had 2
Mike, I have had 2 subsequent PSA,s and they have been basically stable.

hopeful and optimistic

mrdezzy said:

Mike, I have had 2
Mike, I have had 2 subsequent PSA,s and they have been basically stable.

frequency of biopsy and other factors
you did not mention the percent involvement of the two cores that were cancerous. Did you have a second opinion by a world class pathologist expert in prostate cancer.

There is also another indicator, the PCA3 that you might wish to get.

As you probably know the psa is an indicator only. My doctor main focus is on the biopsy. He doesn't look very much at the PSA.

In my case of the Active Surveillance protocol, which you can see details of what I have been doing by clicking my name, I have had an initial biopsy in March 09 showing 2 of 12 cores, 3+3=6, less than 5 percent involvement in each. A year later I was accepted to research program, and had a targeted biopsy( no cores positive); two years later I had another targeted biopsy(no cores positive): I did not have one last year. I am schedule for one June 2013. Lately my PSA has been rising at a 2.6 rate.

As Swing mentioned there is no "standard" for biopsy freauencies, however many institutions do one after a year, and semi annual psa's and DRE"s

My non medical profession lay persons opinion is that it would be of benefit for you to hve a biopsy at this point.

mrspjd

Active Surveillance Excellent Interview with Dr. Klotz
Dr. Laurence Klotz is well known & respected in the field of Active Surveillance (AS) for PCa. Following is a link to a recently published Q & A interview with him about AS, frequency of biopsy, etc. It's a pretty comprehensive discussion (7 pages) and Klotz addresses almost every aspect of AS, including his guidelines & protocol for monitoring. Some might find the info helpful:

http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Active-surveillance-an-evolving-approach-for-low-r/ArticleStandard/Article/detail/799211

mrdezzy

mrspjd said:

Active Surveillance Excellent Interview with Dr. Klotz
Dr. Laurence Klotz is well known & respected in the field of Active Surveillance (AS) for PCa. Following is a link to a recently published Q & A interview with him about AS, frequency of biopsy, etc. It's a pretty comprehensive discussion (7 pages) and Klotz addresses almost every aspect of AS, including his guidelines & protocol for monitoring. Some might find the info helpful:

http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Active-surveillance-an-evolving-approach-for-low-r/ArticleStandard/Article/detail/799211

AS and Dr. Klotz
Thank you so much for forwarding the link to this article. It really helped put several factors in perspective for me and hopefully others that are on or considering AS...thanks again

Kongo

PSA?
As others have suggested, another biopsy in the absence of any other changes begs the question: why? If your PSA is stable and there are no other physical symptoms then the repeat biopsies ought to be in accordance with the standard protocols laid out by the doctor supervision your active surveillance.

Biopsies taken "just to see" are, in my lay opinion, unwise. You run a risk of infection and my personal belief is that biopsies and other invasive techniques that penetrate the prostate can contribute to the spread of your prostate cancer.

At the end of the day you should follow your doctor's advice but I would be sure that I knew exactly what he is thinking and not blindly sign up for a money-making procedure that only benefits the physician's bottom line and does not answer any pressing medical question in your case.

Good luck.

K