In a patient diagnosed with prostate cancer based on a biopsy many years ago placed on surveillance now with rising PSA, do you require repeat biopsy prior to definitive radiation treatment?

This question raises multiple important points that I will discuss, but given that the question doesnt have patient age or numerous other important factors I will speak generally with multiple assumptions being made that he is ~65yo with >10 years life expectancy, etc:

1. The question is in fact wron...

Assuming the patient is still a candidate for active treatment, then the short answer is yes, I would re-biopsy. If the patient can have a multiparametric MRI, I would obtain one before biopsy, then proceed to a 10-12 core biopsy and, in addition, target any areas suspicious for clinically significa...