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Posted 5/22/2022 4:04 PM (GMT 0)
Good Morning Guys,

AS since 2011, first time on site in several years. PSA increase since last BX 8.51 to 10.49 over four years. Time for another MRI after four years. Fell off the AS wagon, no excuses. Seems like a MRI is a no brainer. Wondering about another BX. I've had three biopsies 2011 - 2017 with no infections, only minor temporary chills. They were trans anal. Any thoughts on the trans perienal BX being safer? Thank you for this website and this group. Hope everyone is well or getting better. Advice please smile

2011, Age 72, T1c, No SYM, DRE OK. 8.51 DX 10/11, 54 gm, 32 bx, 2, 2%, G6, PSA 5.49, AS. DX 06/13, ? gm,
Posted 5/22/2022 4:53 PM (GMT 0)
Hello - Seems like time to start over with the exam, MRI, and biopsy. The creeping PSA probably needs a biopsy regardless of what the MRI shows to get back on a AS schedule. Transperineal biopsy is the safer method and can explore some different areas. Not many urologists are setup for it ($ investment and possible general anesthesia facilities) but it is getting common at the larger medical centers. Good to see you made it 10+ years of hopefully a peaceful life.
Posted 5/22/2022 5:31 PM (GMT 0)
Thank you for your reply. Your advice all sounds about right for my next decisions. Looks like 2018 was a very busy year for you. Your post ART results look great and stable going on 3 years. My first 10 years AS were learning years, I kinda got complacent, these second 10 years I gotta pay closer attention. Thanks again for your thoughts, stay well.
Posted 5/22/2022 6:01 PM (GMT 0)
TRUS biopsies do have a greater risk of infection, but since your others were without complication, you should be OK if you can't manage to get a transperineal. I would ask about having a few more than the usual number of cores needed for any MRI-identified targets + the systematic (random) cores in the other prostate zones. The purpose would be to decrease the chances of mising a lesion with your highest Gleason score--or, as the saying goes, in (literally) for a penny, in for a pound.

Djin
Posted 5/22/2022 6:13 PM (GMT 0)
Since I've not been a regular on this site the last few years I gotta research changes in treatments or trends the last few years. I imagine I can check on the google. Thanks for your input for the next BX. Stay well!
Posted 5/22/2022 6:23 PM (GMT 0)
Yes, 2018 & 2019 were RALP and ART respectively and wore me out.

Nothing you can do about the past, lookup recent GeetarMan posts if you want to see how AS complacency can turn out. He is doing ok now but a few bumps along the way.

MRI's are better nowadays so you will have the advantage of latest scan technologies. RALP and RT are both better as well if treatment is required. More varieties of RT as well. Good luck
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