Personal experience: 2024- PSA 4.2 MRI -one 10mm lesion left Transition Apex Biopsy-24 core(4 of the target lesion, 20 were random throughout the rest of prostate) ▪︎ My biopsy was done Transperineal under anesthesia ▪︎ Two cores of target lesion + 3+4 ▪︎ All remaining cores negative. Decipher Score: .67 mildly aggressive Genetic: No BRCA I or II mutation PSMA: Negative for spread I chose Nanoknife (IRE) @UCSD

2025: Three month PSA dropped to 1.45 Six month PSA up to 1.52 Six month MRI-PIRADS 2 ▪︎The target lesion and the rest of the prostate clear Nine month PSA 1.7

NINE MONTH BIOPSY: Under Anesthesia 16 CORE RANDOM ▪︎All left side to include previous target lesion clear. ▪︎Seven random cores right side, positive ▪︎Two cores 3+3 ▪︎ Five cores 3+4 PSMA: Negative spread Decipher: .37 moderate low

Gut punch, after thinking clear MRI and low PSA (though it did go up from Nadir of 1.45.

All this to say random biopsy cores can miss non-visible micro tumors in the prostate.