When to Biopsy: Balancing Missed Cancer Against Overtreatment

None. PSA is the only one.

The most important contributing factor is genetics and family history. Researchers point to some role of obesity and possibly a non-vegetarian diet, but these risk factors are not firmly established.

Neobladder and ileal conduit are treatments for bladder cancer, not prostate cancer. A neobladder is an artificial bladder made from the patient's intestine, stitched together so the patient continues to pass urine through their natural passage. An ileal conduit instead diverts urine to exit through a different passage into a bag. On quality of life: what matters most in the long run is that the cancer comes out of the body completely; patients adjust well to either option over time.

About 10 out of 100 patients will require another TURP within the following 10 years. There is no fixed limit, sometimes the prostate regrows fast and requires re-intervention, and sometimes it's done in stages. The more times TURP is repeated, the higher the chance of complications. Personally, the doctor has done it twice at most on the same patient.

CT scan cannot be used to confirm prostate cancer diagnosis, only MRI can do that. But if MRI isn't available, CT scan is very useful for staging: once a cancer diagnosis is confirmed by biopsy, CT can tell you if it has spread outside the prostate.

Finding clinically significant cancer (aggressive disease likely to harm the patient) while avoiding unnecessary biopsy and treatment of clinically insignificant, indolent cancer.

For patients who are very old, very sick, or who don't want further major treatment, where the honest conversation is about the risks and benefits of not investigating further.