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I'm starting to wonder about my urologist. I was diagnosed with PCa 10/13 after biopsy after months of high psa readings. It was clear though, that the psa was primarily caused by infection and bph. Gleason 6, 1 of 12 positive 10%. After Finasteride, spa dropped from 7.5 to now 2.15 after almost two years--and has consistently gone down. It's within 0.05 0f what it was 10 years ago before my diagnosis. My uro says still need a biopsy because it could be rare form that doesn't cause elevated psa. Wouldn't the biopsy have revealed if it was the rare form? Should I do another biopsy?
There is small cell PC, that doesn't produce much PSA, which is very unusual and very quickly fatal so you don't have that. Late stage PC may not produce much PSA which is why the oncologists look for symptoms of the PC and less at the PSA level in late stage disease. Yes, the biopsy would have shown the very aggressive form of the disease. I think your urologist is just practicing defensive medicine so his recommendation is neither right or wrong but the reason he gave you for getting another biopsy doesn't make sense.
On the other hand, his intuition may be telling him that you probably have more PC than the first biopsy found and so he wants you to get another one.
Keep in mind that your current PSA is actually double the lab reading do to the Proscar. I believe you would be better served by getting a 3T MP MRI. It should find any significant tumors that might be missed by a TRUS guided biopsy. If this MRI discovers a tumor you can have a fusion biopsy that will probably get a better sample of the tumor. If the MRI is negative, you can safely continue your Active Surveillance program with periodic repeat MRI's.