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Prostate Cancer

Frequency of Biopsy

07/29/2010

Question:

I had a Biopsy 14 months ago. I had 2 DRE`s since then, the last just 30 days ago. There has been no tumas or lumps detected on my prostate in none of the DRE"s. My PSA has gone from 5.56 to 7 (Free PSA o.7)since the last biopsy. I am scheduled to begin Proton treatment in 4 weeks. I am also scheduled for MRI, Bone Scan, and CT in 5-7 days. The hospital is pushing me to do a second biopsy. I do not think it is necessary and am resisting it.

Question: How often should biopsy be repeated if Cancer has already been diagnosed and graded (cT1c, Gleson 3+3 +6 Scale)--- given my set of facts listed above do you think the 2nd biopsy is necessary for me?

Answer:

Based upon your note, I would presume that your first prostate biopsy was positive for prostate cancer and that you have delayed treatment or were put on "active surveillance" program. The delay in treatment would make repeat biopsy reasonable to re-stage your cancer given the time that has passed since diagnosis.

I am not a radiation therapy expert and can not comment on the standard of care for proton beam therapy with respect to treatment guidelines. However, proton beam is intended to treat the prostate only and therefore the MRI and CT scan and bone scan might provide information regarding extent of disease which may alter treatment plan (MRI regarding capsular penetration, CT to assess any lymph node enlargement, bone scan to rule out bone metastasis). It should be the responsibility of the treating physician to answer your questions regarding these tests and their significance with respect to treatment. Hope this helps you.

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati