Question about Being Diagnosed

Asking this for a friend.
He had a biopsyu about 2 years ago that showed G7 (4+3). Second opinion from Johns Hopkins resulted in downgrade to (3+4).
PSA had been stable at around 5, until just recently it jumped to 6.1.
A little backstory, when first diagnosed, pathology indicated cancer on one side of the prostate. But then MRI was done which also showed cancer on one side, but it was the OTHER side, vs the biopsy. Uro wanted another biopsy, but he didnt want to do it, preferred to "watch and wait".


Now, this PSA jump to 6.1 prompted another MRI. This time it showed cancer on both sides of the prostate including a lesion that was abutting the capsule. Pathology report stated "cannot guarantee microscopic cancer cells have not left the capsule. In addition, this lesion was at the apex.

So the Uro now wants to do another biopsy.
My question is ,why do another biopsy? He's already been diagnosed (2 years ago) and an MRI was just done showing he is close to escape from the capsule, if not already there. Sounds like he should go straight to treatment.

What am i missing?
My friend (who isn't ready to jump onto HW) is needless to say, freaked out, i had a good talk with him yesterday. But he doesnt want to do the biopsy, he feels its a money grab by the uro.
He is in the process of setting an appointment with a surgeon, and an RO that does Cyberknife. I mentioned Brachy to him, he is not keen on it.
I'm away on vacation but will get together with him when i get back. He is a long time friend from my college days.

The valid reason would if the URO had a real reason to believe the Gleason score has changed and that information would change the treatment type.

If he's decided to head for treatment, I am not sure a biopsy provides enough new information to be worth it - especially if surgery is being considered. You'd get a great pathology report after that.

Andrew

He was able to stay on active surveillance for 2 years with a GS 3+4? That's pretty good. But it sounds like he did not have a f/u biopsy while on AS, which is a definite no-no. Apparently, his uro was not following an AS protocol -- that can be dangerous.

I can think of a few reasons to biopsy (other than $$):

(1) If he wants to continue with AS, he needs to have a f/u biopsy. If any cores are ≥ GS 4+3, it's time for treatment. MRIs do not prove cancer.

(2) If he wants to have surgery, he might want to take cores where the suspected cancer is ubutting the capsule, while taking some tissue beyond it to see if the cancer has grown into the tissue of the bed.

(3) With 2 years since his last biopsy and suspicious areas and possible ECE, he might want a biopsy even if he is only considering radiation. That's because if the cancer is revealed to be a high risk one, he may want to pursue a brachy boost with ADT. If high risk, he might also want to have a bone scan/CT to check for LN and distant mets.

It's very nice of you to help your friend, but you should be scoping out bikinis on the beach.

- Allen

Prato,
When you say "watch and wait" I take it his age or health is a factor. In such case there is no need for another biopsy. F/U biopsies are for AS guys and not WW guys.

T

Thanks Tony, Allen, i may be using the wrong term. I would say, the way it was described to me, that he decided to do nothing for the moment other than monitor the situation. Sort of "on AS, but not really in a formal program, with a predetermined point of action". I disagreed with this, but his Dr agreed (same Dr that diagnosed me, pretty well known, and so i am surprised he was so relaxed about it, i figured maybe i was missing something. He is Chief of Urology at a major long island Hospital.) Well known for successfully "treating" Don Imus ,who i beleive remains on AS.

I am going to pass on all of your comments to my buddy. I hope he eventually feels ready to join us here, i think it would help him alot. But its too early to push that.

I'd forgotten about Imus and the chili peppers !! As far a surviving..we shall see. He sure looks like hell,though.LOL

Am I the only one who smiles when I see the term "F/U biopsy"??

Mel