Would you ever offer definitive XRT in a patient with an elevated PSA (assume over 30) but who refuses prostate biopsy?  

Absolutely not! There are too many benign processes that can cause an elevated PSA. Furthermore, patient-specific treatment options would differ based upon pathology. Gleason scoring is a primary driver for categorizing AJCC and other risk classification schemes. Genomic classification also requires...

I agree with @Jeff M. Michalski. I would not offer definitive treatment without a definitive diagnosis. The key here is probably to understand why the patient is refusing biopsy and how that plays into his goals of care.

I had a patient who did not have a blood dyscrasia, although bled profusely on 2 occasions and required hospitalizations for hypovolemic shock. He refused further biopsies. If a DRE is c/w CAP and a mpMRI suggests PI-RADS 4-5, 4K suggestive, then I would treat him definitely and put aside all of the...

I recall two patients with "clinically obvious" prostate cancer, including PIRADS-5 MRI finding, treated without biopsy. Both had one thing in common - severe thromboembolic disease, with prior history of life-threatening complications with even brief withdrawal of their anticoagulation regimen (pu...

I agree completely with @Jeff M. Michalski. I am sorry for posting anecdotal stories, but I have had a number of men with markedly elevated PSA levels, some over 100 all due to having it drawn after a long bike ride (road bikes) who ended up with negative biopsies and normalization of PSA with avoid...

The illustrious @Michael J. Dattoli and @Donald B. Fuller describe a few situations where XRT without pathological confirmation could be considered. However, aren't these the sort of patients who are at higher risk for post-treatment bleeding, rectal ulcers, and an indication for biopsies that can l...

It is not going to be long before we will all be presented with this decision about forgoing a biopsy. The shove a needle in its kind. Suh et l., PMID 29230413