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Active Surveillance Biopsy Frequency

Tech70
Posts: 64
Joined: Nov 2017

I was diagnosed three years ago as a low risk PCa patient.  First biopsy was two cores of 12, <5% of each core, Gleason score 3+3.  Oncotype DX testing incidates low risk of progression.  A confirmatory biosy and a third biopsy a year ago yielded the same results.  Throughout, my PSA has remained stable to 3.5-4.  I just had a 6 month checkup with my urologist and she wants to do another biopsy in 6 months, which would be about 1 year since my previous one. 

The NCCN Active Surveillance guidelines call for annual biopsys, while all other cancer care societies recommend biopsys at 3-5 year intervals.  Overall I have great confidence in my urologist; she is very thorough in expainling all options and respecting my opinions regarding treatment.  

Any thoughts from other members who are on AS would be appreciated as to whether annual biopsys are perhaps excessive or justifiably cautious.  Also, the frequentcy of biospys recommended by your urologist.  I am 71 years old.

JJO
Posts: 14
Joined: Sep 2017

I had a urologist who insisted upon annual biopsies for AS patients.  He also required quareterly PSAs.  At the time, I went regularly for second opions to Dr. Eggener, a renowned expert at the Univerisity of Chicago.   He said that annual biopsies were generally not needed, and reflected a program of overtesting, which often lead to over treating.  He said he does biopsies every 2-3 years, I believe.  The doctor I switched two does them every two years.  

Thiis, however, assumes that there are no material changes.  If the PSA rises, or an MRI shows something new, of course you need a biopsy at that time.  

ASAdvocate
Posts: 139
Joined: Apr 2017

Things have changed over the ten years that I have been in Johns Hopkins' AS program.

After the confirmatory biopsy, the plan is for psa/PHI at six months, DRE annually, MRI every two years, and a biopsy every two to four years. That biopsy schedule assumes that the ooter tests are not suspicious. 

JH is now using the Precision Point transperineal biopsy system, which does not cause infections, or require antibiotics.

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