Assessing repeat biopsy

I have been in a "watchful waiting" mode following a positive biopsy 18 months ago with results of two positive cores of 12 (4% and 22%), Gleason score 6.  Subsequent PSA tests(3)  have produced fluctuating levels(high 4.7/low 3.8). I am 76; health is otherwise good.  My next PSA is due in 2 weeks with urologist leaning toward repeating biopsy assumedly to compare results with the first.  Please first explain what your forum response to a biopsy question means in the context of my situation: "In fact, the yield of a positive biopsy for prostate cancer is less and less as each subsequent biopsy is performed." May I assume that if the core results are little different from my first biopsy, that this would indicate a relatively slow-growing tumor which I can continue to monitor with PSA tests and indicated biopsies?  What would your criteria be for a biopsy result that would suggest more serious consideration of active treatment?  Thank you.

[Ash Tewari, MD, M.Ch.]

Thank you for your question. I can imagine the anxiety you are facing with these repeat evaluations. You are a good candidate for expectant management with periodic PSAs, Digital rectal examinations, and biopsies is par for the course.

A repeat biopsy showing more than 2 cores positive and/or more than 50% cancer on any one core would be reason to seek out curative treatment either radiation or surgery.

Best of luck.

Ashutosh (Ash) K. Tewari, MD
www.cornellroboticprostate.org

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