In a patient diagnosed with prostate cancer based on a biopsy many years ago placed on surveillance now with rising PSA, do you require repeat biopsy prior to definitive radiation treatment?

Topics: Radiation Oncology • Genitourinary Cancers

If a patient had biopsy proven gleason 6 disease 3-5 years ago and has had a slowly rising PSA to between 15-20 over the past year or 2, would you require repeat biopsy to appropriately risk categorize the patient prior to initiating treatment? If not would you empirically recommend concurrent ADT and for how long?

Answer from: Radiation Oncologist at Community Practice

This question raises multiple important points that I will discuss, but given that the question doesnt have patient age or numerous other important factors I will speak generally with multiple assumptions being made that he is ~65yo with >10 years life expectancy, etc:1. The question is in fact w...

Comments

Radiation Oncologist at Cedars-Sinai Medical Center
I agree with all @Daniel E. Spratt has to say...

Radiation Oncologist at University of North Carolina
Can you clarify when you think PSA can be an appro...

Radiation Oncologist at Case Western Reserve University/ University Hospitals Seidman Cancer Center
I too am curious to @Howard M. Sandler's comment o...

Radiation Oncologist at St. Anthony's Medical Center
@Daniel E. Spratt, If a rising PSA triggers multip...

Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System
There's also this paper: "Prostate-Specific Antige...

Answer from: Radiation Oncologist at Academic Institution

Assuming the patient is still a candidate for active treatment, then the short answer is yes, I would re-biopsy. If the patient can have a multiparametric MRI, I would obtain one before biopsy, then proceed to a 10-12 core biopsy and, in addition, target any areas suspicious for clinically significa...

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