Would you ever offer definitive XRT in a patient with an elevated PSA (assume over 30) but who refuses prostate biopsy?

Absolutely not! There are too many benign processes that can cause an elevated PSA. Furthermore, patient-specific treatment options would differ based upon pathology. Gleason scoring is a primary driver for categorizing AJCC and other risk classification schemes. Genomic classification also requires...

I agree with @Dr. First Last. I would not offer definitive treatment without a definitive diagnosis. The key here is probably to understand why the patient is refusing biopsy and how that plays into his goals of care.

I had a patient who did not have a blood dyscrasia, although bled profusely on 2 occasions and required hospitalizations for hypovolemic shock. He refused further biopsies. If a DRE is c/w CAP and a mpMRI suggests PI-RADS 4-5, 4K suggestive, then I would treat him definitely and put aside all of the...

I recall two patients with "clinically obvious" prostate cancer, including PIRADS-5 MRI finding, treated without biopsy.

Both had one thing in common - severe thromboembolic disease, with prior history of life-threatening complications with even brief withdrawal of their anticoagulation regimen (pul...

I agree completely with @Dr. First Last. I am sorry for posting anecdotal stories, but I have had a number of men with markedly elevated PSA levels, some over 100 all due to having it drawn after a long bike ride (road bikes) who ended up with negative biopsies and normalization of PSA with avoidanc...

The illustrious @Dr. First Last and @Dr. First Last describe a few situations where XRT without pathological confirmation could be considered. However, aren't these the sort of patients who are at higher risk for post-treatment bleeding, rectal ulcers, and an indication for biopsies that can lead to...

It is not going to be long before we will all be presented with this decision about forgoing a biopsy. The shove a needle in its kind. Suh et l., PMID 29230413