What is the utility of a biopsy in the setting of an elevated post-prostatectomy PSA and imaging noting a local prostate bed recurrence?

It would generally be reasonable to treat an imaging detected prostate bed mass without a confirmatory biopsy if one was going to treat the patient whether the biopsy was positive or negative.

Some radiation oncologists are escalating doses to higher that standard levels in the postoperative setting...

Good question. To begin with, I have been involved with care of over few thousand prostate cancer patients, and in those who I have seen that had "only" PSA recurrence (with negative metastatic work up -> bone/CT scans) I don't recall either of them having biopsy confirmation. Maybe there were but t...

I perform a DRE on all prostate cancer patients at the time of consultation, including the patients that have had a prior prostatectomy. In many circumstances I have discovered palpable nodules in the prostate fossa. In addition, some of these have been discovered with either CT or MR.

I place fiduc...

I recently had a surprising case that benefited from a biopsy. Several years after surgery he had a slowly rising PSA. I ordered an MRI which revealed a surprisingly large mass. On biopsy there was no evidence of cancer, only several cores of Benign Prostatic Hyperplasia.

Nice case scenarios.

I, too, perform DREs on "all" new PC patients I see unless they refuse.

For @Dr. First Last's case, it would be interesting to see what would have shown up on the prostate specific PET scan, if it was done. Still, it proves MRIs are useful in these regards. And, I suspect PET s...