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When following active surveillance paradigm, what PSA increase will trigger prostate biopsy?

NCCN states that per an AS paradigm for low risk and FIR prostate cancer, a PSA should not be collected any more than every 6 months, with DRE, mpMRI and prostate biopsy no more than every 12 months. It also states that a repeat prostate biopsy should also be considered if the prostate exam changes, if mpMRI (if done) suggests more aggressive disease, or if PSA increases. What level of increase in PSA would you say merits repeat prostate biopsy per AS paradigm? If a patient has a mild increase from a level of 4.2 ng/mL to 4.4 ng/mL after 6 months of AS, would this be enough to prompt a repeat biopsy? Would you obtain a second confirmatory PSA level before biopsy?
1 Answer
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Radiation Oncology · Virginia Commonwealth University Medical Center
Answered on

When using PSA to aid in the decision to re-biopsy a patient on active surveillance, I think you have to consider that the non-malignant prostate tissue also contributes to the rise in the PSA and that there are limits to the accuracy of the test. In patients not known to have prostate cancer, a PSA...

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