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Biopsy for Provenge- Bone vs. Prostate?

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Posted 9/10/2020 11:15 PM (GMT 0)
I've gone quite a while without a biopsy as it's always been clear I had PC mets from a number of scans and rising PSAs since 2017. While I've just started Nubeqa (after XTANDI didn't work for me)--and while I wait for LU-177 to become available in the US--I'm considering a biopsy to bring Provenge into my TX possibilities. I have a rising PSA of 7.2, and my PSMA scan at UCLA showed bone mets, but nothing in organs or lymph nodes.

I know there's PC in my prostate and in my bones, so does anyone have any suggestions on which biopsy I should do? I have one doc saying bone biopsy is recommended as it's less painful and likely yields better info (as that PC has gotten outside the prostate). Another doc says prostate biopsy is less painful/invasive than one for bone. Any suggestions are much appreciated. THANKS!
Posted 9/11/2020 1:15 AM (GMT 0)
My wife had a biopsy to 4th rib earlier this year. Pretty much a non-event other than her being nervous and the doctor looked like he went to school with Doogie Howser. She had conscious sedation and local anesthetic. She was awake, felt pressure when the radiologist was taking samples, and was fine after she got home. I suppose it depends on who, what, and where they are sampling. My biopsy was worse than hers.

I think you would want to verify the type of cancer in bone, probably PCa, as you will be treating the bone I assume at some point.
Posted 9/11/2020 11:09 AM (GMT 0)
Steve, you should find a urologist and/or medical oncologist that has frequent experience using Provenge. They will know exactly what to do and whether a biopsy is needed.

For example, my urologist’s practice has one specialist that manages the Provenge process and they have used it with over a thousand men. Due to my high risk dx, they have me in a special group of high risk and advanced situations that are very closely monitored so they can get to Provenge at the earliest possible time for appropriate use and reimbursement. They have purposefully developed a close relationship with Dendreon, Medicare, VA and the major insurance companies to know from experience exactly what is needed for use and reimbursement.
Posted 9/12/2020 12:05 AM (GMT 0)

Hello, Steve55777 ~

Excellent insight and advice from comrade J.N.F. above ----

Have we heard that PROVENGE treatments require a bone biopsy? If so, I missed noting that, along the way ...

A side note --- from my ORIGINAL prostate biopsy, which led to official diagnosis --- tissue samples were saved in the lab.

In recent years, when I pursued a new genetic test, based on three generations of my family having prostate cancer (my grandfather, my dad, my uncle, and me) --- the original tissue samples were used for the new genetic test.

Should you ever decide to have a genetics test conducted, in consultation with your doctor, make certain you get pre-authorization from your insurance provider, as these genetic tests are often costly, my brothers!

Just a side note for fellows who had a biopsy --- your lab may have it "filed" in case you ever need to run these newer genetic tests, which can suggest newer targeted medications, for specific cases.

Keep us posted on things, Steve55777 ---- we all learn from each other!

My very best, from the great Midwest ~~~
CYCLONE ~ # Iowa State University
Posted 10/28/2020 6:36 PM (GMT 0)
Latest update: Biopsy was not required for Provenge approval. My insurance is Cigna PPO. While everyone's insurance ifs different, this is the info I received:

There is no need for a biopsy for Provenge authorization. The four basic requirements are:
1) Castrate-resistant - typically two rises in PSA while on ADT; i.e. Lupron
2) Radiographic evidence of a metastasis (old or new)
3) Recent testosterone test showing medical castration (<50 ng/dL)
4) Cannot be on narcotics for cancer pain
Posted 11/7/2020 12:41 PM (GMT 0)

Keep us posted, Steve55777 --- you are a loyal member here, and we all want the best for you.

You are getting your research done, and mapping out future treatment courses.

We'll keep the front porch light on, for your next visit.

Always thankful to hear from you here on the forum. We all stand alongside each other ...

With my best sent to you, from here in the Midwest ~~~
CYCLONE ~ # Iowa State University
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