r/ProstateCancer • u/tazidlu • 3d ago

Question 35-core saturation biopsy before brachytherapy?

Is it common to have a second transperineal biopsy, a 35-core saturation biopsy, before brachytherapy? I already have a 14-core transperineal biopsy (random + targeted) based on an MRI that was done in May. I had the biopsy slides examined by 2 pathologists at different locations to get a 1st and 2nd opinion. I got the info from my urologist about what the first pathologist found:

#1 pathologist - May 2025:

Gleason 3+4=7

2 positive cores:

1 core: 10% grade 4 in 6/15mm

I had a very good consultation directly with the second pathologist and he even showed me my actual biopsy slides on his microscope connected to a monitor and explained things:

#2 pathologist - August 2025:

Gleason 3+4=7

3 positive cores:

1 core: 10% grade 4, 6/15mm

1 core: almost all grade 3 and a very small amount of grade 4

1 core: 3+3=6

no cribriform

This week I met with a very experienced doctor who does brachytherapy (he has done about 1700) and has a very good reputation for long-term non-recurrence. He has all my medical data (MRI, 2 biopsy pathology reports, etc.). While there he did a new PSA check, did a DRE, and used a rectal ultrasound probe to check also. He scheduled a 35-core saturation biopsy for 11/27 -- 3 months from now. He said he needs this before brachytherapy. He said the results would be available at the end of December. Treatment sometime in 2026.

Is a 35-core biopsy common for this case? From checking it seems that he does this for everyone because he wants a much clearer picture of what is going on inside the prostate before treatment. Previously I had never heard of this sort of thing before though.

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u/Past-Oil1032 3d ago

I have not heard of this before. But it makes sense to optimize the placement of the seeds.

1

u/neener691 2d ago

My husband had it done again for his Brachytherapy that he's going to have Oct 6.

1

u/tazidlu 2d ago

Do you mean your husband had a second biopsy? And the second one was 35 cores?

1

u/neener691 1d ago

He's had two biopsies, I believe they were both 12 cores not 35.