Biopsy but to what purpose?

Had my deferred Template Biopsy last week but think it unlikely this will prove of any significance.  I will explain why.

I saw the surgeon prior to the procedure who was aware that the PSMA scan I had a few months back had only shown PCa in my Prostate but none outside it.  A subsequent MRI at UCLH had also shown a small tumour of about 2mm within the Prostate.  However, their team were puzzled why this was producing rising PSA at each test.  They thought there must be some PSA being generated elsewhere which had not been shown on the scans.  I accept this could be a possibility but migrated cancer cells are not going to be found from a biopsy. The surgeon said he would be very lucky to hit the 2mm tumour and when I asked whether it would be a 'Fusion' biopsy which would have helped, he told me they did not do them there.  I assume the purpose of trying to obtain a core from this small tumour is to assess how aggressive it is.  I was surprised to be told that only about 12 needles would be used in total of which most would be aimed at or close to the aforementioned 2mm tumour.  I would have thought that that whilst I was anesthetized they would have done a much more comprehensive coverage to check whether there were other tumours within my Prostate that may be adding to my PSA.  Perhaps I should have pressed for this but I felt disinclined to argue with the guy who was about to stick needles into me!

I did ask whether I would be given repeat HIFU for the 2mm tumour identified but was told this would be highly unlikely as it was in a position where it might cause "a hole in your bum that  might need one or two operations to rectify."  (I am aware that there is a risk of a fistula forming but this is more rare nowadays with HIFU).  I then said how about Cryotherapy?  I was told this would not be suitable.  So I then asked if there was another focal therapy that could be used - what about FLA? He said he hadn't heard of that. (Should a Surgeon at least know about treatments that can used for PCa if not in detail as an Oncologist?).

So what has all this achieved? I had to pay to have a PSMA scan privately which showed PCa in my Prostate but the MRI UCLH gave me was only done on a 1.5T scanner rather than the more definitive 3T scanner.  Then whilst the opportunity was there, a more comprehensive  template biopsy was not done to help establish whether there were other tumour(s) in my Prostate which may or may not have been significant.  I believe UCLH will only want me to be treated with HT which I don't want to have unless all other avenues have been pursued. I am of the opinion that UCLH only gave me the minimal biopsy because the Royal Marsden asked them if they could give me some further Focal treatment. which, from what the surgeon told me is most unlikely anyway. Whist I will have to wait to see what UCLH have to say, I get the feeling that I will have to seek a further opinion and possibly more aggressive treatment elsewhere. My philosophy is to eradicate known tumours within the Prostate and only then and in need treat systemically.

Any thoughts?