Editing Biochemical Recurrence (section)

=== Biopsy after radiotherapy ===
* '''Strongly recommended to document local recurrence before offering salvage treatments.'''
** The goals of biopsy after definitive radiation are to identify the presence or absence of residual or recurrent disease and to identify the grade of remaining disease.
*** Diagnosis and grading may be problematic due to radiation induced histological changes and treatment effect, with a high false-positive rate the first year after RT. Nevertheless, histological grade serves as an important prognostic factor for salvage and systemic treatment responses.
** '''The information from prostate biopsy will guide further treatment strategies and should be reserved for patients in whom salvage local therapy is considered.'''
* Multiparametric-MRI directed biopsy should be considered.
** If there are no MRI detectable, ie PI-RADS (Prostate Imaging Reporting and Data System) score 1, or image enhanced lesions, standard systematic biopsy should be performed.
** For a MRI detectable lesion, a standard 12-core systematic biopsy plus at least 1 MRI guided core obtained from each target of interest is recommended.
* Before widespread use of MRI targetting, biopsy of the seminal vesicles was recommended as prostate cancer invasion had been reported in up to 42% of cases