Frequency of Biopsies for Gleason 6 Pathology

I looked online for studies on the frequency of biopsies for my pathology (see signature). The Cancer Care Ontario guidelines says, for Gleason 6 cancer, a serial biopsy should be done every 3-5 years. A Cleveland Clinic paper says that men with stable disease can wait at least 5 years. All other guidelines/studies aren't specific on the frequency of biopsies.

I'm sure each institution has their own guidelines. Two and a half years ago, a doctor at MSK told me that biopsies should be repeated every 2-3 years. I think my current PSA history should be considered as part of any recommendation/decision. I can't have an MRI because of my defibrillator.

One of the benefits of waiting is new studies, technology, etc. become available. I understand that John Hopkins is now using the Precision Point Transperineal Access System (instead of the standard TRUS) for all prostate biopsies. This new system significantly reduces the risk of infection and allows doctors to sample parts of the prostate that couldn't be reached using the TRUS.

As an empowered individual, I believe I have the ability to make the decision or at least have an intelligent discussion with my doctor on the subject. For me, decisions like these are difficult to make.

Any thoughts? Thanks.

mitchden4 said...


......As an empowered individual, I believe I have the ability to make the decision or at least have an intelligent discussion with my doctor on the subject. For me, decisions like these are difficult to make.

Any thoughts? Thanks.

If you have an informed physician and are willing to pay, out of pocket, for whatever tests you desire, there should be no problem.

Of course if I had your numbers, I'd be far too busy partying to concern myself with more biopsies. Different strokes, as they say.....

Good luck on your journey!

I was diagnosed in 2011. 3 of 12 sticks were positive for Pca - all 3+3 and 5% of the samples. Active surveillance assigned. My healthcare professionals had me return yearly for follow-up TRUS biopsies. #2 - 1 of 12 sticks positive for Pca. 3+3. 5% of sample. #3 - 0 of 12 sticks. No sign of Pca whatsoever. #4 - 2 of 12 stick positive for Pca. One stick 3+4. 25% of sample. The other stick was 3+3. 5% of sample. PNI identified. At that point I pulled the trigger and went for a DaVinci RALP. Final Path: 3+4, EPE, close but negative margins, no other adverse indications.

Chances are the biopsies prior to #4 missed the 3+4 and PNI. My prostate was about 60 grams extracted - and I was on finasteride - so that was a lot of area to cover with 12 sticks.

If I could turn back the hands of time I would've had the MPMRI at the very start after diagnosis, even if I had to pay out of pocket to get it. It was never offered. I inquired once. But the doc told me it had questionable value. Based on my personal experience, I'd recommend an MRI to those newly diagnosed w/ Pca who find themselves under a similar set of circumstances. Better to play it safe or at least as safe as one can with this confusing disease.