Would you treat a patient with evidence of prostate cancer who refuses biopsy?
If a patient had a PSA > 15, PI-RADS 5 and lesions on MRI, would you treat without a biopsy?
Answer from: Radiation Oncologist at Academic Institution
No. I cannot think of a situation where I would treat localized prostate cancer with radiotherapy without biopsy confirmation.In the scenario provided above (PSA>15, PI-RADS 5), we cannot be positive the patient even has cancer. A meta-analysis (Barkovich et al., PMID 30807218) found PI-RADS 5 re...
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Radiation Oncologist at Mon Health And Alan Lichter's quote from the 1990s "No meat n...
Radiation Oncologist at The Oregon Clinic-Radiation Oncology West Another: "Tumor is the rumor, but tissue is the is...
Answer from: Radiation Oncologist at Community Practice
I agree with both Dr. @Anscher and Dr. @Seibert. The only way I would consider treating in such a scenario would be if the PSMA scan showed activity corresponding to the area of abnormality on the MRI. However, you can't order a PSMA scan if you don't have biopsy proven cancer (unless the patient wa...
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Radiation Oncologist at Prairie Lakes Healthcare System I had a patient with a PSA of >120 and the pros...
Radiation Oncologist at Mallory Radiotherapy, PLLC In a very rural setting where the patient is not w...
Radiation Oncologist at Kansas City VA Medical Center All responses are valid, there is no right answer,...
Answer from: Radiation Oncologist at Academic Institution
No.
The patient is "refusing" (as opposed to unable) to get a biopsy after having the reason for and necessity of having a biopsy explained to him. To me, that implies his supratentorial issues are probably more serious than his prostatic one, and treating him without proof of malignancy is just se...
Comments
Radiation Oncologist at Mallory Radiotherapy, PLLC I share your concerns, but treating without tissue...
Radiation Oncologist at Up Health System Marquette With lung cancers, there is generally a reason not...
And Alan Lichter's quote from the 1990s "No meat n...
Another: "Tumor is the rumor, but tissue is the is...