Just got my MRI Results. Am I Doing the right thing?

confusedintexas

I had the follow up from the advanced MRI I had last week  

I had Gleason 3-3 cancer show up on the pathology results when I had a TURP this summer.  They waited for me to heal before doing the MRI  

The MRI did not find any lesions/spots to biopsy.  (This is good news).  It is possible that the MRI, as advanced as it is, missed a higher grade cancer than what came back from the pathology lab from when I had surgery in June. (This is the scary part).

The Urologist/Oncologist said that doing a blind biopsy would stand only a very small chance of hitting a higher grade cancer than my Gleason scale 3+3 that was reported from the lab.  People do die from infections from prostate biopsy.  It is rare but it happens.  A 3+3 cancer grows very slowly so unless a more aggressive cancer is lurking (which is possible).

Since my blood work (PSA levels) are so low, and there is nothing to guide a biopsy, my specialist recommends we wait six months and check everything again.

The alternative would be to treat it anyway or remove the offending body part and frankly unless it is going to kill me I'm a tad attached to it.  I have read a lot of comments from those who have had it removed and it seems to cause serious issues.  I understand if your life depends on it that is one thing.

Am I doing the right thing by waiting?

lighterwood67

Active Surveillance

Looks like you are a good candidiate for Active Surveillance.  Remember this is your decision.  Keep the Quality of Life issues in front of you.  I am assuming you had the TURP (A transurethral resection of the prostate (TURP) is surgery to remove parts of the prostate gland through the penis. ... TURP is most often done to relieve symptoms caused by an enlarged prostate) due to some issues you were having.  I know little or nothing about TURP, but did they remove some of your prostate during this procedure?  Also, looks like you have plenty of time to research what options.  Do what your doctors tell you.  Wait 6 months and see what is going on.  Based on what you have said and your doctors,  I certainly would not gut or nuke the prostate at this time.  Good luck on your journey.

Tech70

Sounds a lot like my situation

Two years ago my PSA jumped from low 2's to the high side of 3.  Out of caution, my PCP referred me to a urologist.  The urologist said the only way to be certain if there was a problem was to do a biopsy.  The biopsy was essentially painless and revealed to cores out of 12 with less than 5% of the core positive for Gleason 3+3 Pca.  As a followup, the urologist requested a 3T MRI which showed no lesions of concern.  I had genomic testing done on the positive biopsy tisse, and Oncotype DX showed very low risk for progression.  Had a confirmatory biopsy done several months later and again 2 positive samples from different areas, with less than 5% of the sample involved.  Second genomic test again showed very low risk Pca.   Had a third biopsy about a year later with same results.  My urologist and I agree that I have some cancerous cells within my prostate that would be analogous to seeds in a passion fruit, small and widely dispersed.  I have been on Active Surveillance since my initial diagnosis and have no plans on changing unless there is a significant change in future biopsy results.  My PSA's have all stayed below 4 throughout this whole experience.  I would suggest that you eventually have a biopsy and if positive, have genomic testiing of the positive samples.  If this shows 3+3 Gleason and low risk on the genomic testing, I would seriously consider Active Surveillance to avoid the potential side effects of more aggressive treatment.

As an aside, don't be too concerned about the biopsy.  If your urologist is good at administering a prostatic nerve block (mine is) you should feel almost no pain.  As far as sepsis risk, my urologist prescribes two pre-procedure enemas, one the night before and one the morning of, and prophylactic antibiotics prior the procedure.  The risk of compliations is very small.

Georges Calvez

Active surveillance

Hi there,

I think you should consider active surveillance, you should go through with a biopsy, maybe with genetic testing as well, but you could put off doing anything drastic like having your prostate hooked out for many years, maybe indefinitely.
A biopsy is a walk in the park compared with a prostatectomy and the side effect level of the latter is pretty high.

Best wishes,

Georges

MK1965

TURP and RP equals disaster

Confusedintexas,

I had exact same. Had bladderneck resection ( mini TURP) and was incidentally diagnosed with prostate cancer 3+3. Few months later, I had TRUS biopsy and it came back Gleson 7 (4+3) where 4 was 55%. One core of 12 was positive with 10% of total length. 

I was 51 and surgery was strongl recommended. I wanted brachytherapy but RO was against it because of TURP and unstable prostate shape after TURP. My wife was pushing me to have surgery and I did it. 

In regards to SE, surgery was disaster So from my personal experience TURP and RP don’t go well together. After surger, Gleson was downgraded to 3+4 with 40% of 4. I had multI focal cancer ( multiple locations in prostate).

MK

ASAdvocate

Every medical association

Every medical association that issues guidelines for the treatment of prostate cancer recommends active surveillance for low risk men. Every one of them.

I have been on AS for over ten years with no progression, as shown on MRI and by biopsies.

Removal is the most radical treatment choice with the worst side effects. I have yet to read any study that shows that surgery can match the non-recurrence rates being shown by the two advanced tyoes of radiation, SBRT/Cybeknife and proton beam. Not even close.

I would recommend that you buy Dr. Mark Scholz' new book The Key to Prostate Cancer. He interviewed 30 prostate cancer experts and presents their descriptions of the treatments that they provide for men at different risk levels.

 

VascodaGama

PCa does not spread overnight

Texan,

This is your second entry in this forum. You have shared some details of your case but not enough to give you any particular suggestion that could fit your inquire to your particular case. In your previous thread (in here; https://csn.cancer.org/node/319993) you said being young (49) which condition took your urologist in recommending "taking out the entire prostate". This time you got added information from a MRI scan that did not identify cancer at all. Surely that could be a false negative result but one can't dismiss the possibility that TURP managed to dissect the bad flesh freeing you from the cancer. Apart from that your Gleason 6 is low in aggressivity which would turn your case into a  sort of indolence. I think that you should wait as recommended by above survivors. PCa does not spread overnight even if a more aggressive Gleason rate existed.

I would like to know of your PSA histology since the beginning of your troubled prostate issues.

Best wishes,

VGama

ufknkidding

What is the right thing?

The right thing is very individual and almost always comes down to what is the risk versus benefit. You are doing the right thing seeking as much information medically (from MDs, labs, pathology, radiology, etc) and input from those that have gone before you. Because you are "young" like me, the risk/benefit profile leans more towards treating (if/when GL>6) on the basis we could live much longer.  But, you also have to consider if you want more kids (yes, could use a sperm bank), want to retain current sexual funtion, don't want to have to go through regaining continence, etc. etc.  Also, consider your family history for cancer, genetics, diet, health, etc.  Every decision is individual and we all place value on different things.  At my last support group, one guy was low risk (GL 3+3=6) but absolutely wanted the cancer out of his body so had surgery.  Currently, active Surveillance is a good option if you are low risk and you will need to follow your urologist follow-up requirements to monitor for any changes.

Clevelandguy

Waiting isn’t bad

Hi,

Vasco has a good point, maybe the cancer was removed with the Turp. Taking more time to study the various treatments if and when you do need them is not a bad thing. Knowledge is a good thing. If it was me I would have my PSA monitored and see if it changes & if it does go up have more biopsy's to grade the cancer.  Sounds like AS if the best plan for now, if you need radiation or surgery at a latter date due  to an aggressive cancer you will have done your homework to make the rights choice for you.  Just remember surgery and radiation both have side effects, sometimes bad and sometimes not so bad depending on where the cancer is inside of your Prostate and the skilled doctors and facilities you choose to remove or kill it.

Dave 3+4

confusedintexas

My PSA was very very low like

My PSA was very very low like .05. Honestly because of my age it isnt somethig AI have been having checked but I will now every six months.  

VascodaGama

Surprise Suprise

Texan,

This post of yours took me off the guard. Your PSA of 0.05 ng/ml indicates remission. I wonder what have been the levels before TURP.

I also do not understand the reason that took your doctor back in July to recommend you surgery in spite of such low levels of PSA. He may be one of those that believe that young people should dissect their gland even if at remission. In any case, the American Urological Association guidelines do not recommend surgery based solo on the age of the patient.

This PSA is very low and it is another point reinforcing the idea that you can wait to check how things develop in the near future. In regards to the timings of PSA after positive diagnosis, commonly one gets it done every three months during the first two years moving up to six months if nothing has changed.

Best,

VG

 

Georges Calvez

PSA
Hi Texas,
Are you sure about that PSA result?
As I understand it you have had a TURP which removes some of the prostate tissue , not a prostatectomy which removes the whole thing, so you still have a substantial amount of your prostate gland in place and producing PSA.
I would expect you to have a PSA somewhere between one and five ng/L based on the amount of residual prostate tissue, etc.
http://www.brazjurol.com.br/january_february_2008/Fonseca_ing_41_48.htm

Best wishes,

Georges

Clevelandguy

Psa level?

Hi,

I would think even with no cancer and BPH(I assume you have this) your Psa level should be roughly around 2. Remember it's not so much the number but how high the number jumps after every Psa test. My Internest told me he had a guy with a rapidly increasing Psa in the high two range over several tests and he was diagnosed with cancer.

Dave 3+4

Max Former Hodgkins Stage 3

Level

Confused,

Like most or all of the writers above, I would say that an ACCURATE PSA of .05 is for an adult male with the gland intact (and not on active hormonal therapy) virtually impossible.  In most labs, it meets the criteria for 'Undectable,' and does not even meet the definition of clinical relapse following R.P.

While it is good that your DRE and MRI showed no tumors, that does not disprove anything, given the poor resolution of MRI verses the often tiny size of PCa tumors.   Conversely,  there is obviously no reason currently to indicate curative treatments, especially not surgery.   I do not believe that most surgeons would do an R.P. on you, even if you requested it.

What was your PSA at the time of your TURP ? And double check your current result.     Waiting six months for another PSA draw is reasonable and shows all due diligence on the doctor's part.

I've known many men who've had prostate biopsies, and NONE of them even got an infection.   Infection from this biopsy is very rare, but a few guys here have reported such.  The benefit verses the risk dramatically suggests getting biopsies as necessary.

max

 

max

icemantoo

Listen to your doctors and/or get a second opinion.

I had  my Prosstate out 60 days ago and a Kidney out 17  and 1/3 years ago.My Gleesojn was 5-3 so really no choice. The Prostate surgeery is nothing  compared to the  Kidney. My PSA ias unsetectable for at 6 weeks. Wearing depends for the near future I am still a young 76. Took antibiotics for 3 days bedore the  biopsy and an antibiotic shot at the time of the biopsy.

 

 

 

icemantoo

Max Former Hodgkins Stage 3

icemantoo said:

Listen to your doctors and/or get a second opinion.

I had  my Prosstate out 60 days ago and a Kidney out 17  and 1/3 years ago.My Gleesojn was 5-3 so really no choice. The Prostate surgeery is nothing  compared to the  Kidney. My PSA ias unsetectable for at 6 weeks. Wearing depends for the near future I am still a young 76. Took antibiotics for 3 days bedore the  biopsy and an antibiotic shot at the time of the biopsy.

 

 

 

icemantoo

Semper fi

You're a trooper iceman.....I hope it stays undetectable.

 

confusedintexas

Okay I know it's been a bit

Okay I know it's been a bit but I pulled the PSA lab work and here is what it said

total PSA 0.2

free psa <o.1

free PSA below detectable limit. 

It isnt a test test I have had done often because of my age.  I will now every 6 months. 

VascodaGama

Some data missing

Texan,

I believe that you are still looking for answers to the questions in your other thread. However you have now the results of a negative MRI and a PSA of 0.2 ng/ml, done in December 2019 (can you provide info on previous test with dates?). My opinion is still the same; wait and gather more evidence identifying that PCa still exist in you.

When evaluating your case, one needs to think that you got still the prostate gland in place producing PSA serum. Surely the quantity of prostatic cells has been reduced by the TURP but the ones in place are alive and are the ones producing the 0.2 ng/ml value. In such regard one can take it as within the normal PSA range for a 50 yo adult. Surely we should take into account any PSA taken before and after TURP which you commented above (PSA=0.05) but you haven't provided dates and values, and are not sure if 0.05 is a real value.

In regards to the free PSA, this is less relevant as a prognostic tool in your case because when calculating its percentage the whole gland volume isn't incorporated anymore and this makes part when validating the free PSA test in cancer prognosis evaluation. Free PSA would have been a good tool before TURP.

Accordingly, this PSA test of December is just your first step toward the final conclusion. You need more tests to check the PSA behavior. Constant increases could signify that you got more cancer. PSA increases followed by decreases could signify that you got benign hyperplasia which was your initial problem that took you to do TURP. You will need more periodical tests (every three months due to the positive PCa finding Gs6) and probably more image exams as the time goes by to identify the situation.
Please give us the results and dates of previous tests done before and after TURP. I doubt that your doctor did TURP without a PSA and image study in hand. Moreover, the initial issue of BPH is linked to high PSA volumes.

For the moment enjoy the season's festivities.

Merry Christmas

VGama

Georges Calvez

Free PSA

Hi there,

Your result for free PSA is essentially meaningless because your total PSA is so low that the free proportion is below the limit of detection.
Bearing in mind that the cancer that was found was Gleason 6 (3+3) I think your best course of action for the moment is to wait for the result of your next PSA test.
What was your PSA before the TURP?

Best wishes,

Georges