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?

4 Answers

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Urology · Stanford University, School of Medicine

Answered on

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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Radiation Oncology · UC San Diego

Answered on

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).

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Radiation Oncology · Columbia University Medical Center

Answered on

I agree with Dr. @Dr. First Last'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.

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Radiation Oncology · University of Florida

Answered on

MR guided repeat biopsy

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