Dr. Claire de la Calle

Sometimes I do do every three months if I'm worried or if I really want to get a better idea of what their PSA kinetics are.

I think a confirmatory biopsy is key, especially intermediate risk patients.

And timing of that confirmatory biopsy is really going to be on how

How worried I am.

So if I worried, like I said before, the piece density is high, maybe they haven't been adequately sampled yet.

I'm going to do the biopsy either pretty much immediately or within the first six months, basically.

Otherwise, most of my patients are going to get their confirmatory biopsy at one year.

So one year after their initial diagnosis.

Then the frequency of this, what I would call surveillance biopsies, so all the biopsies after the confirmatory biopsy, that really is going to depend on the patient.

And so for my intermediate risk patients, I tell them it's going to be anywhere between every one to four years.

to start and will decide based on other factors like the PSA, the kinetics, the PSA density, the MRI.

And eventually, if they really don't have progression for many years, I think it is completely reasonable and in fact important to consider de-intensification of that protocol.

And because a lot of these grid group 2 patients do have very small volumes of pattern 4

and have cancers that are essentially biologically similar to low-grade cancers, it does happen that de-intensification needs to be considered.

A baseline MRI, like I said before, is definitely needed.

The use of serial MRIs and the frequency, that still very much needs to be clarified.

You personally like starting with MRIs every two years.

A lot of the guidelines do say that we really shouldn't be getting MRIs more regularly than every 12 months unless clinically indicated.

I think it's rare to see a major difference in such a short time frame.

And I also de-intensify that frequency, meaning I get them less and less regularly if the cancer is clearly not progressing regularly.