First Post - Active Surveillance but treatment may be soon

Thanks to everyone for the very informative posts. I have been lurking since my latest PSA (10.5) a few weeks ago, but on this journey for several years.

High PSAs since 2013, but stable enough to make me comfortable with no treatment after extensive reading and research. I have no symptoms and am in very good health. Urologist told me about a new test (4k) on 12/2015. The 4K Score spooked me - 40% risk of high grade PCA. I got the Biopsy, which showed 4 positive cores, 20%, 10% and 2 < 5%, all G6. I chose Active Surveillance.

PSA continues to rise, and I have a fusion biopsy scheduled in 2 weeks.

Questions: My first biopsy had 12 cores, but I only got 6 scores. Is this unusual? It appears that the pathologist grouped them for scoring.

I will be getting a 3T MRI (new GE system - no endorectal coil) shortly. If the MRI is clear should I proceed with the fusion biopsy? My guess is yes, or this would not really be active surveillance. I think most treatment options would want to see a current biopsy, correct?

I did have significant pain on my first biopsy - last 3 cores felt like a taser. But I will do it again if I need to.

Thanks again to all of you.

They often take 12 cores from six sextants of the prostate. They usually distinguish one as medial and one as lateral. It's a good idea to have that fusion biopsy as confirmation - hopefully, you'll be able to stay on AS.

I've learned about biopsy pain and how to avoid it, having had three myself. Ask for a "pelvic plexus block" or a "periprostatic nerve block" (use those words). When I had that, I didn't feel a thing, and I wasn't groggy as when I had general anesthesia. You have to get a biopsy specialist who knows how to locate the correct nerves.

In my non-expert opinion, if you MRI is clear you cannot proceed to a true fusion biopsy since there will not be any signal to fusion.
But after 2 years since your initial biopsy and its findings and given your history , I would insist to have at least a systematic (random locations) biopsy even if mri is negative. In AS it is crucial to test if there is any disease progression along time. Again, this is a subjective advice only based in what I would do in your case.
Take care and good luck.

I can't answer your question about next steps, as my journey was a bit simpler. . . elevated PSA > 12-core biopsy > SBRT radiation.

I can, however, advise you to take Tall Allen's biopsy/nerve block advice seriously. I did, my uro did, and I had NO pain from the biopsy. Took my wife out to lunch right after, and then went back to work.

Good luck. You seem to be on a good path, and the folks here can help guide you whatever you find.

3-putt,

As just another data point for your info gathering, my Uro considered my Pi-Rads 3 mpMRI interpretation not a "strong enough signal" for a fusion confirmatory biopsy. Hence my next biopsy is scheduled to be another random 12 core. YMMV.

-Paul