How do you manage favorable intermediate risk prostate cancer patients that have a PIRADS 5 lesion that was most-likely missed in the template biopsy?
For example, a patient that received an MRI after biopsy that demonstrates a PIRADS 5 lesion in anterior TZ which likely was not sampled on biopsy. Would you request directed biopsy of the PIRADS 5 lesion prior to commencing RT+/-ADT?
Answer from: at Community Practice
Yes, I'd suggest a repeat biopsy before treatment. In the case of radiation +/- ADT, a repeat biopsy may impact the dosimetry of radiation, whether or not ADT is used, and how long ADT is used as part of treatment.
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Answer from: Radiation Oncologist at Academic Institution
I definitely recommend a targeted biopsy of an anterior PI-RADS 5 lesion. The only exception that comes to mind is systematic biopsy already showed grade group 4-5 cancer in the posterior gland (i.e., a new cancer won’t change management).
Answer from: Radiation Oncologist at Academic Institution
I agree with Dr. @Sonn's answer. I'd also wait before sending a Decipher in this case, as the Decipher should, ideally, be performed on the tissue with the highest Grade Group score.
Answer from: Radiation Oncologist at Academic Institution
MR guided repeat biopsy
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Radiation Oncologist at Lafayette Radiation Center
2 ways to approach this common issue. Repeat th...
2 ways to approach this common issue. Repeat th...