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Cancer: Prostate Message Board


Cancer: Prostate Board Index


Hello everyone, this is my first post, and my first reach out to community. My question is about the value of repeat biopsies on mild forms of PC.

My father and his brother were both diagnosed with prostate cancer in their early 50s (Dad now 89). Dad elected to have his removed and is a survivor with incontinence and ED, his brother elected radiation seeding and died. So, I have a family history. Both diagnosis were Gleason 7 as I recall, although Dad's was pervasive throughout the prostate.

At the age of 60 in 2017, I was diagnosed by biopsy after 4 years of PSA scores that meandered from 4 to 5 and back to 3, then back up to 4.6. Primary care doc said see a urologist, who set me up with a biopsy based on the family history.

Procedure went fine, not pleasant but manageable, and other than the following day with severe discomfort I was fine except for blood in the urine and semen for about a month. Nothing wack.

Diagnosis: twelve cores taken, 6% of one core, Gleason 3+3, others clear although BPH noted in one other core.

I was told that I would likely die of something else over my lifetime, and was put on active surveillance. The definition given me was get concerned if PSA exceeds 10 or the digital exam was no longer smooth.

Last month my urologist calls and says I should get follow up. I asked why and he said to be "sure". I couldn't get a clear answer about sure of "what". So I delayed a bit, thinking it through (the risk of infection is my biggest concern).

Any thoughts on this, based on my original diagnosis? I'm thinking of getting another opinion outside his practice.

Thanks in advance.
Hi GoingFor Broke and welcome to the Board!

Your diagnosis back then would today be viewed as very low risk prostate cancer, which is a really favorable situation.

What your doctor put you on back in 2007 is better termed “watchful waiting” rather than “active surveillance,” the latter term being quite well defined (though still evolving at the edges) and thoroughly researched as of 2019; back in 2007 the term was still evolving and was often confused with watchful waiting, even by some doctors and researchers. The first research paper had been published only five years before in 2002; while research continued to accumulate at an increasing rate every year, by 2007 it is fair to believe that the majority of doctors were still managing patients like you with “watchful waiting,” which involves no or scant surveillance, often not even follow-up PSA and DRE testing/exams.

AS, in contrast, typically involves a follow-up second biopsy one year later, and, depending on the center or doctor, further biopsies probably 3 to 5 years apart after that, the interval depending in part on other findings, such as prior biopsy results; PSA testing, often with a DRE, is done typically at 6 month intervals. These days, multiparametric MRIs often supplement this testing, and may soon be replacing the biopsies for many patients; obviously, the risk of infection is a biopsy thing (though still very low risk) and not applicable for mpMRIs. These days, infection caused by biopsy has been researched and prevention/management techniques have improved (such as testing rectal swabs prior to the biopsy, especially where certain types of infection are fairly common in the population). Other testing, such as certain genetic tests (e.g., BRCA-1 and BRCA-2) are often also done.

I’m thinking that your urologist has been influenced by the mountain of evidence supporting AS and is now concerned about managing you with watchful waiting, which essentially amounts to waiting to see if you get clobbered by the cancer before you open your eyes to be aware of what might be happening. It looks to me as if he or she is doing the right thing. The next step might be a biopsy, a multiparametric MRI, a PSA test, a DRE, some other testing (including genetic), or a combination.

You can get a free look at brief descriptions (sometimes complete papers) on AS by going to www.pubmed.gov and searching for - prostate cancer AND active surveillance ; I just did that and got 3,172 hits. You can click on the blue hypertext for each listed paper and see the brief summary (“abstract”). If you activate the filters on the right for abstracts, humans, and the sequence of show additional filters-search fields-choose-title-apply, you “narrow” down the results to “just” 560 papers. If you also activate the top filter, for clinical trials,
you really do narrow down the list to just 39 papers. AS has been studied at a number of leading cancer centers around the world with consistent and highly favorable results.

You can also research multiparametric MRI and prostate cancer on PubMed. I or others can help if needed. You might want to ask your doctor about mpMRI, especially if the “update” suggests increased risk compared to 2007

You probably have not been paying much attention to prostate cancer over the past decade or two. Technology has improved a lot, and both your father and uncle would likely have had a better course and outcome if their cases had been managed with modern technology. Ten year survival versus age-matched peers is now about 99% (!!!) for all prostate cancer patients, though those with distant metastases at diagnosis still have a rough time and are pulling down the success figures (only slightly, as there are fairly few such patients these days, largely thanks to effective screening). At 15 years after diagnosis, the number is about 95% to 96% survival!

Good luck! :wave:
Thanks for the feedback. Just a note, you mention "2007", my post reflected the diagnosis in "2017". That said, I was a bit surprised after getting put on Active Surveillance and then the suggestion one year later for a second biopsy, based on the good prognosis received after the first one. I think I'm hearing from you that this is a normal part of AS--I just assumed AS meant no more biopsies for a while (until PSA increased over 10, and/or the prostate was lumpy under digital exam). Again, my concern is that even though it's a low probability, infection after the biopsy can be a pain to treat and thus my current hesitation to pass this year. But, I've gone ahead and scheduled it for mid February. Thanks again!





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