Possible unnecessary biopsy?

Hello, all. This is a follow-up to my first post, about going on AS with Gleason 7 (3+4), here: https://www.healingwell.com/community/default.aspx?f=35&m=3098668

So, my current status is this: I am scheduled to go to MD Anderson in September for another biopsy, as a prerequisite to formally joining MDA's AS program. My last biopsy, the one that was the basis of my diagnosis, was only in April, and MDA wants to do their own, less than six months later. My latest PSA dropped a whole point, from 4.8 at diagnosis, to 3.8 a few weeks ago. My local urologist thinks another biopsy is not necessary at this point, but the doctor in charge of the AS program at MDA insists upon it.

I could go with my local doc's suggestion, which is to keep watching the PSA, and do another MRI next spring, but I want to keep proton therapy at MDA as one of my options.

I would appreciate any and all advice from the (considerable) collective wisdom here.

Lefty, My feeling is evey Dr. wants to do their own biopsy. When I switched to an Oncologist 6 months after my original biopsy he wanted to do his own biopsy.

For what MD Anderson charges for proton, they would be happy to do proton regardless of when you get 2nd biopsy. They have to pay for their machine.
You might consider trying to stall MDA for a few months on biopsy.
Good luck.

Thanks, folks.

Tall Allen, I spoke with my doc about sending my slides to Bostwick or Epstein, but I haven't received confirmation of that yet. The slides were originally read at a lab in San Antonio, I think, and then were forwarded to MDA, where the G7 was confirmed.

The 3T MRI in March was without an endorectal coil; that scan showed an area of possible malignancy; the area in question was targeted in the biopsy I had in April, and the result was one core of G7 (3+4), 15% involvement.

The follow-up MRI at MDA in early June was with a 1.5T machine, but with an endorectal coil. This scan showed no evidence of a malignancy; that is one of the reasons why the MDA folks suggested I go on their AS program. I was a bit concerned, as I would have thought the 1.5T machine is less detailed than the 3T machine. I don't know if either of the scans was a mpMRI.

The MRI I had done at MDA in June took about an hour and 20 minutes... yes, it was a bit uncomfortable with the coil in that long. As I tell folks, this disease is all about people sticking things up your rear-end. My local doc doesn't like using a coil.

UPDATE:

Although I had to reschedule it a couple of times, I had a follow-up biopsy done at MD Anderson earlier this month. It was a general pattern biopsy, and not targeted to my earlier MRI.

The result was that none of the 11 cores taken had evidence of prostatic adenocarcinoma. So although I had one core of Gleason 7 (3+4), whatever I have does not appear to be growing very rapidly. I'll take active surveillance as long as I can get it.

Great news, Lefty!

Although we all tend to worry about upgrading between a biopsy and surgery, about 10% get downgraded, and in a (tragic) few, there is no evidence of disease in final pathology. A 5ari might help the body get rid of it if the amount was insignificant. Scholz proposed a trial of a short course of Xtandi for men on AS.

Lefty: Cograts but nevertheless a G7.