Biopsy Results - Seriously Considering Treatment Now

It depends on whom you ask.

If you ask Laurence Klotz (Sunnybrook), he will tell you that he's abandoned PSA increases as a reason to come off of AS, and the only benchmark he looks for is predominant pattern 4 (i.e., GS 4+3 at least).

If you ask Ballantine Carter (Johns Hopkins), he will agree that PSA kinetics are not determinative (in fact, they don't use a PSA threshold for entrance unless it's over 20); however, he would say that more than 2 positive cores is a trigger for intervention. JH has eliminated the percent of core involvement as an entrance criterion and as an intervention trigger. but JH would not have recommended AS for you in the first place because you had 3 cores involved, and you have bilateral disease.

If you are on the fence about this, you might consider a genomic test on your biopsy cores. The 3 main ones are Oncotype Dx, Prolaris, and Decipher. Check with your insurance before getting one of those, as they are very expensive ($3,000-$4,000).

3 putt said...
Apparently they grouped the cores by sector of the prostate (right base, right mid, right apex, left base, left mid and left apex)

I've been seeing that more and more. The thinking is that, say, 3 positive cores from a single sector really represent only 1 tumor there, so triple-counting it makes it seem worse than it is. This became an issue with mpMRI-targeted biopsies, where they took multiple cores from suspicious areas. Those that believe that the number of positive cores are a deal breaker, as JH does, didn't want to multiple count cores just because they oversampled.

When I was diagnosed in 2010, there wasn't a lot of info about AS, or if there was, I wasn't much aware of it. That was also before mpMRI/US fusion biopsies became prevalent. With hindsight, I think I would have chosen AS. Maybe I could have gotten a couple more years of ejaculate.

I wasn't impressed by the credentials of the LDR brachytherapists in my area. I would have had to travel to Northern California to be treated by someone I'd have felt comfortable with. But with Demanes in my backyard, and spectacular reported outcomes of HDR brachy, I saw no need to travel for brachy treatment. Besides, the reported ED rates are lower with HDR, and that was of paramount importance to me.