i was diagnosed in 7/06 with pca.My gleason was 6 and psa at that time was 4.2. I had 1 core positive 5%,1 millimeter of cancer. I chose to do active surveillance. I have my psa checked every 3 months . It has been going down steadily.My last psa was 0.88 (in fact, 1.76 since I take avodart). I should also tell you that 5 months after I was diagnosed I had another biopsy (14 hits- all samples negative). I had an MRI in 10/06 which showed very little cancer in prostate-no indication that cancer had spread beyond the capsule.Does it make sense now to have another biopsy 31/2 years after being diagnosed when my psa is not doubling but in fact halving. According to research done a few years ago by the National Cancer Institute the best predictor of which men will die from pca 20 or 30 years after being diagnosed is the psa velocity.Please advise as to wisdom of doing another biopsy in my case 31/2 years after being diagnosed with this medical history. Thank you.
I would not be a fan of doing a blind biopsy. However, it would be reasonable to have a repeat endorectal MRI and if a cancer is detected you could have biopsies done that concentrate on the area with cancer in it. I also often send patients for a color Doppler ultrasound as it sometimes identifies cancer missed by the endorectal MRI, as I mentioned in my two recent newsletters on Active Surveillance, Prostate Forum Vol. 11 # 9 http://www.prostateforum.com/back-issues.aspx?id=3011#9 and Prostate Forum Volume 11 # 10 http://www.prostateforum.com/back-issues.aspx?id=3011#10 At AIDP, we typically send patients for these imaging studies every 1-2 years, but some go less frequently.
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