Howard’s Prostate Health Index or phi score is down …


… and so is his weight, and his PSA level, and his A1c, … but he’s still worrying about whether he needs another biopsy! This is life on active surveillance.

Howard Wolinsky’s latest article on the MedPage Today web site is entitled, “A patient’s journey: are two chronic diseases better than one?

Of course that’s an unanswerable question. It kinda depends on the patient and his (or her) doctors. But Howard’s spirits certainly seem to be “up” and his doctor has a big grin. So maybe for Howard it’s true.

The question of just how often a man on active surveillance really needs repeat biopsies remains an unresolved issue. It is also going to depend — on the clinical characteristics of the individual patient and the mindset of his physician. However, without in any way wishing to undermine Dr. Helfand’s clinical authority to make recommendations about what would be “right” for Howard, we would like to think that Howard could “pass” on another biopsy until at least this time in 2018 (unless there are some significant changes to his PSA level and his phi score next June).

A biopsy is still the “gold standard” for evaluating risk for clinically significant prostate cancer — but at least in men on active surveillance it is now usually a biopsy after a multiparametric MRI — and few experts think that such biopsies need to be done on an annual basis any more.

2 Responses

  1. Thanks, webmaster. Appreciate the forecast. I suspect that if all holds steady that I will not have had another biopsy by this time in 2018. I think I will have been on at least a 3-year biopsy holiday. Dr. Helfand recommended a targeted biopsy in 2016. That was after an earlier 3-year holiday. So I think Dr. H. probably will recommend 2019, maybe 2020. I hope I can have a 4-year holiday this time. Maybe 5 years. I once asked the doctor if I can ever get off the biopsy treadmill. He seemed skeptical in the short term. I’ll be 72 in 2019. Biopsies have their risks, And the more you have the greater the chance something will go wrong. If I live that long, surely I won’t be having biopsies in my ’80s.

  2. “Few” does not equal zero. But what they say and what they mean are — I think — sometimes two different things, at least here in the UK. For example, a very prominent urologist came at me with 26 needles before my first biopsy anniversary. But then he showed one of the reasons he is prominent by cheerfully enough settling for an MRI. This is on the UK NHS and I think the “standard of care” is increasingly at odds with where the medical profession is at. I probably should have another one at some stage but guidance from the MRI will be good.

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