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Posted 1/17/2021 5:05 PM (GMT -5)
Hi all havent posted in a while and appreciate the valuable inf I have gotten off this site so far

Can see my sdetails in profile. to summarize I have been on AS for bout 3yr with annual biopsy and MRI and PSA every 3 month. PSA has generally bee trendless mostly running between 3 and 3.7 but have had a spike up to 4.3. MRI has been pirads 2 with no focal lesion. Also original urologist found a nodule but at Penn the dre was described as a slight induration(no specifict) on a portion of prostate cannot remember portion.

biopsys as follows
first 1/12 5% G6 right apex
2nd 15 neg
3rd 1/15 <5%G6 left apex, several cores showed chronic inflamation

have urinary issues but with original flow at 3 but with flowmax up to between 10 and 13. They did a urodynamics study,ultrasound on kidney and upper urinary tract. as well as regular post void residual. Nothing of concern other thane the previous mention flow issue. any better recomendation besides flowmax. there are SE but advantage out weighs disadvantage

Big question here is does it make sense after 3 biopsy with no meaningful change and no pattern 4 finding to spread biopsy out to every 2 to 5 years(dont know which is best).and rely on MRI and what is a recomended frequency. PSA every 3 month is ok with me. I had brought this subject up at an appt in aug after my last biopsy and got a noncommital response said lets wait till Jan after. the mri. so hopefully they will recommend a change that includes spreading out biopsy. I have been told by some to not even bother monitoring cause G6 is not uncommon for someone my age. Not sure I want to go that route but reduced biopsy makes sense. There are risks to biopsy and wonder whether biopsy may aggravate the inflammation issue. So would like commnets and any info on what other programs are like
Would like to have some perspective ahead of an appointment on Friday so I can giv an intelligent opinion to any recommendation they make..
Thank in advance for any comments
Posted 1/17/2021 7:30 PM (GMT -5)
No expert on AS so just a thought. Have you had a transperineal biopsy yet? The risk of infection is less and it can sample areas that the conventional biopsy misses which may provide more peace of mind.

You have small amounts of grade 3 which is a good sign. Annual biopsies seem overkill but what do I know.
Posted 1/18/2021 12:09 PM (GMT -5)
I'm told that the trend is to spread out biopsies to every 2 years or so. I'm in kind of the same boat but I am looking at another biopsy since my last in 2018.
Posted 1/18/2021 2:41 PM (GMT -5)
Formal AS programs hone their protocols so that they catch indolent PCa that either progresses in Gleason grade or in quantity of G6. It's best to follow the protocol. After all, we don't ask our dentist to space out our checkups because no cavities were found. AS protocols vary. My uro refers to some AS programs as being "loosey goosey" -- I would stick with one of the stricter protocols. There may be some wiggle room within a protocol -- in other words, if it requires MRIs and biopsies within respective time ranges, you might push it to the end of those ranges, but beyond that seems to be flirting with danger. Remember what the financial commercials say to the effect that past behavior is no guarantee of future performance. If you do catch a progression to something clinically significant, you don't want to do so after having lost a few years and the great advantage of early diagnosis. Both MRIs and biopsies can miss clinically significant cancer; routine repeat testing is the countermeasure.

On a separate, but related note, if I were contemplating an AS program, I would have a genomics test OncotypeDx or Decipher) done on my biopsy tissue to make sure I wasn't in the small group of G6 men (perhaps 10%) whose cancer is at high risk of forming higher-grade lesions that may metastasize.

Djin
Posted 1/18/2021 2:46 PM (GMT -5)
I’d think 5 years is a stretch. No expert.
Posted 1/18/2021 9:17 PM (GMT -5)
DJin, as usual, has offered sound advice.

Any genomics test is a worthwhile additional data point. If you have insurance coverage, or don’t mind the expense, they can give you more confidence, or an alert.
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