Active Surveillance

In May 2016, I had a biopsy because my PSA had doubled to 4.0 over an 18-month period. I was diagnosed with Gleason 7 (3+4) in less than 5% of 1-core. Sent the slides to Dr. Epstein who couldn't confirm the diagnosis, however, he said the core looked suspicious and recommended a repeat biopsy. In July 2016, the biopsy was repeated and 1-core in an adjacent "quadrant" was a Gleason 6 (3+3). Dr. Epstein confirmed this as did another pathologist at MSK. The pathologist at MSK also said the first biopsy was a Gleason 6 (3+3). In summary, 3 different opinions on the first biopsy and 3 of the same opinions on the second biopsy.

My last 2 PSA's (Oct. 2016 and April 2017) were 2.5 and 2.9, respectively - both of which wouldn't have resulted in me going to a urologist. Notwithstanding that, I have low-grade prostate cancer. I know the active surveillance protocol is PSA's every 6-months and periodic biopsy's. I don't think the biopsy frequency will be dependent on the PSA - especially if it remains low. I think the active surveillance protocol is to have biopsy's repeated every year or two.

Based on the online MSK male life expectancy nomogram, for my age, health and prostate cancer stage, grade and PSA, at 10 years, 1 out of 100 people with the same health, etc, will die of untreated prostate cancer and at 15 years, 3 men would have died of untreated cancer. I believe the risk of complication of biopsy's is between 1 and 4%. If this is correct, I'm trying to decide if I should have any more biopsy's - especially if my future PSA's remain low. I had a heart attack 10 years ago and although my heart is strong, I have a defibrallator and can't have an MRI.

Thought on future biopsy's? Thanks in advance.
Mitch

No more biopsies unless something screams cancer.

Anyone could have anything.

you've had 2

minimally get regular DREs, right? And perhaps go to one of the composite blood test scores that is more cancer-specific than simple PSA?

naturally YMMV

Wilderness

Mitch, as I said to you offline, what if you were one of the guys that actually lived another 20 years.
Also, on the nomograms, I'm curious, how many of those 99 people over 10 years who didn't die of PC, did die of something else, but might have died of PC if they had not died of something else.

Just playing devils advocate, as always, I support whatever approach you feel most comfortable with.

Both of your biopsies were TRUS-guided, which can easily miss small foci of significant cancer. Since you cannot have an MRI-targeted biopsy, I think you can give yourself a lot of assurance by having a transperineal template mapping biopsy. That is the gold standard of biopsies. If it shows nothing more than you know now, you can safely wait several years before your next biopsy. The odds of dying of a biopsy infection are vanishingly small, especially if it's transperineal.

Remember that PSA is a lousy indicator of significant PC. Did you ever have a PHI test, or any of the genetic tests? It doesn't matter how this could have rolled if your PSA were lower then. The only thing you can deal with is what you know now.