Hi Vic. I think, as your sig. shows, you meant to say a PIRADS 1 lesion was seen on the MRI -- not a 5, which is the highest score and indicates PCa is highly likely.

Your uro should be following a specific AS protocol. It establishes when to have routine tests and what should trigger a biopsy. I would follow the protocol and your doc's advice-- after all, active surveillance is just that -- active. Some protocols require a confirmatory biopsy within the first 12 months of AS.

Men are advised to leave AS not only if higher-grade lesions are found, but also if the estimate amount of their G6 (the "tumor burden") becomes too large. You can discuss this aspect of AS with your uro.

I believe there is very little evidence to show that a biopsy needle will spread PCa within the prostate -- or that it happens exceedingly rarely. In any case, what's important is finding any existing PCa, and currently only a biopsy can make the diagnosis. No one dies from prostate-confined disease. It's been established that with specific regard to prostate-confined disease, the number of lesions and their location has no relationship to outcomes. That is the reason the latest (8th) edition of the TNM staging guide has done away with letter subdivision of the pT2 stage for those who opt for a prostatectomy (the letters indicated the extent of the PCa observed within the prostate) .

Hope that helps,

Djin

The confirmation biopsy at 1 year is an necessary part of AS and a MRI does not replace it. A biopsy can easily miss some more aggressive PCa cells so a “double-check” on the first biopsy is typically done. Your MRI will give the urologist something to aim at this time as well. Once you make it through this with hopefully good results then everyone can back off a little and watch PSA, DRE’s and additional MRI’s for a while.

An MRI and a biopsy can each miss cancer, but the a 12-core biopsy plus cores in MRI lesions graded PIRADS 3 to 5 lowers the false negative rate. Again, an MRI can miss small lesions that a random core can happen upon. Not even all PIRADS 5 lesions turn out to be PCa. I would follow my uro's advise, but also do some googling about the AS protocols at the major PC centers. Johns Hopkins has one of the strictest protocols.

Another step would be getting a second opinion on your next positive biopsy slides from Dr. J. Epstein at Johns Hopkins. He's the gurus' guru on prostate pathology. It's not that expensive, your uro can have your slides sent directly, and you'll know with confidence what you are dealing with and whether or not you are a good AS candiate.

I myself would not opt for AS without first having a genomics test, like OncotypeDx or Decipher done on my biopsy slides. While G6 CANNOT metastasize, some men's G6 has genetic markers that make them a high risk of developing higher-grade lesions that can metastasize. This is another topic you can bring up with your uro.

Djin

Post Edited (DjinTonic) : 1/13/2020 9:24:27 PM (GMT-7)