Some questions nine months after Dx



I am new to this forum, so I apologize in advance if I don't follow all the protocols.

I had my first biopsy last November, and I was diagnosed with PCa as a result of that test (specific results listed below). I have decided on AS (for now), and it is almost time for my second biopsy. This time, my doc wants me to do a pre-biopsy MRI, and I am a bit nervous about it. I was wondering (a) what to expect from this test; and (2) whether it means he suspects bad news.

Also, I am nervous about continuing on AS, so I was wondering if anyone can share his thoughts about AS vs. some alternative such as surgery.

Finally, has anyone had any experience with the TULSA Pro treatment?

Thank you.

Diagnosed at age 51 (Nov. 2019)
3 of 12 cores positive (all 3+3)(33%, 11%, and 4%)(3 mm (discontinuous); 1mm; 1/2 mm)
1 of 12 cores "atypical"
8 of 12 cores benign
Stage T1c
PSA Numbers: 2.52 (4/19); 2.21 (8/19); 1.92 (8/19-retest); 1.79 (2/20); 1.63 (8/20). All done with Access 2 Beckman Coulter Chemiluminescent Method.


  • Clevelandguy
    Clevelandguy Member Posts: 1,039 Member

    Hi Dutch,

    Welcome the the group of Pca survivors.  Before I had my first biopsy an MRI was done to guide my Urologist on where to take his samples which from what I know is pretty routine.  With AS you will need to have biopsies done every so often to check on your cancer growth.  If you choose you can stay on AS until your cancer gets more aggressive be it months or years.  If you do decide to kill your cancer you can choose surgery or some form of radiation.  Both work well if the cancer is within the Prostate. In my opinion you need to make sure the cancer does not grow outside the Prostate which gives you the best chance for a cure. Once the cancer gets outside the Prostate it can spread to other areas of your body which is not good.  Just make sure you study all the side effects of what you intend to do so you know what to expect.  Pick the best doctors and hospitals to-get the best results even if it means travel.  Davinchi robotic surgery and external beam radiation(Cyberknife or Proton) seems to be the treatments of choice for most and each have there own side effects so choose wisely if you want to go down that route.  Links below to help you decide:

    Dave 3+4


  • ASAdvocate
    ASAdvocate Member Posts: 193 Member
    edited August 2020 #3
    Stay the Course

    All the medical associations that issue guidelines for the treatment of prostate cancer recommend active surveillance for low risk men.  Every one of them.


    I have been on AS for eleven years with no progression. Why risk the possibly life-changing side effects of treatment if you don’t need it?


    But, surveillance must be active, and that means following a regular testing protocol.


    I recommend that you buy Dr. Mark Scholz’ new book The Key to Prostate Cancer. The book clearly explains how your biopsy report can be understood in terms of risk categories, to which he devotes separate chapters. Scholz interviewed 30 prostate cancer experts and presents their descriptions of the treatments that they provide for men in those different risk categories.

  • Tech70
    Tech70 Member Posts: 70 Member

    I have been on AS for 2 1/2 years.  Urologists generally order an MRI for patients on AS.  Sometimes it can pinpoint suspicious areas where the Dr. might want to take additional biopsy samples.  However, your MRI may show NO suspicious lesions if the cancer cells are diffuse and in small areas.  I have had two 3T MRI's ( last one 3 weeks ago) which showed no lesions of concern.  The MRI is just another way of obtaining the maximum amount of information necessary to make an informed decison about what type of treatment would be best for you.  I would also strongly recommend genomic testing of the BX samples.  I have had this done for 2 or the 4 BX's I've had (my test was Oncotype DX) and both showed very low risk PCas with very low probabitly of metastastes or dying from PCa.  Other than regular BXs (which should be relataively painless if the urologist is a good one) and PSA's there are no side effects from AS. That can't be universally said for surgery or radiation.  

  • Clevelandguy
    Clevelandguy Member Posts: 1,039 Member
    A better test?


    Another diagnostic test that Vasco talks about is a PET scan which is good at picking up smaller suspicious areas from what I understand.

    Dave 3+4

  • VascodaGama
    VascodaGama Member Posts: 3,668 Member
    edited August 2020 #6
    Pre-biopsy MRI


    I wonder why you are nervous for doing a pre-biopsy MRI. This test is similar to the CT scan, that I believe you have done during the diagnosis process, but with higher capability in identifying suspicious areas, which will be targeted in the next biopsy. The main goal is to detect malignancy. Those samples will then be analyzed by the pathologist under the microscope.

    Above survivors have given you good opinions. I also think that AS is the best choice if one can opt for that choice by standing within the parameters required in AS, and surely if he has the courage in sleeping with the bandit on the same bed.

    Looking into your PSA histology; I see it as absolutely normal for a guy of your age. Gleason rate 3 (low aggressive type) produces loads of PSA serum. Yours are acceptable for a regimen of AS. You should do what gives you the most comfort but in your shoes and in view of the above status, I would stay away from radical therapies for the time being. PCa takes years to grow and affect the patient. Therapies prejudice the quality of life we are used to.

    Regarding the TULSA Pro treatment, I think that it is still immature. Why choose a TURP (Transurethral resection of the prostate) style therapy if traditional surgeries can achieve the same benefits as claimed by the TULSA corporation. TULSA is still a pilot therapy and has not enough number of results to be compared with other effective treatments.

    Best wishes and luck in your journey.




  • JJO
    JJO Member Posts: 22 Member
    edited August 2020 #7

    No need to be nervouse about the MRI, and it does NOT mean the doctor suspects bad news.  MRIs are a standard part of AS surveillance.  Indeed, it would be very odd if the doctor did not want you to have an MRI before doing another biopsy.  Note however, that you may need a biopsy even if the MRI is negative, and if the biopsy shows some areas of concern, they will likely biopsy both the areas of concern and aslo take random samples.  All of this is standard treatment.  

  • Dutchman90
    Dutchman90 Member Posts: 2
    edited August 2020 #8
    Thank you!

    Thank you to all who responded.  I appreciate all of the information and suggestions!

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,339 Member

    Every day that you are doing Active Surveillance instead of selecting a radical treatment, is great day. 

    I've been enrolled in an active surveillance protocol since March 09. I have not had any side effects from any radical treatment such as surgery or radiation, etc during the last twelve years.

    I am confident that in my doctor, and if the cancer does progress and I need treatment, I will still be able to obtain a treatment that I might have initially choosen when I was diagnosed. Additionally, there have been techonogical advances since I was diagnosed which will improve the outcome of any treatment. However I doubt that the cancer will progress in my lifetime.

    There are various types of biopsies: one is random, that is usually taking twoelve cores, which you have had in November. This procedure is not as good as a targeted biopsy that is done in conjunction with an MRI. The biopsy is guided by an MRI, and more often finds more aggressive cancers than the random biopsy.

    Where I am treated, first a 3T MRI is done ( the 3T uses the most powerful magnet in clinical use, and is more definitive than a 1.5 MRI in finding lesions. Next, a radiolgist ranks any suspecious lesions found by aggressiveness. Where I am treated, the doctor is able to lock the results into a three dimensional biopsy machine (the brand name is Artemis...other facilities use another brand Uronav). These biopsy machines are different than the two dimensional machine used in the random biopsy that you had. If a cancer is found the doctor has the ability to go back to the exact same spot, in a future biopsy. These machines are more likely to be found in teaching hospitals. ...There are doctors not associated with teaching hospital, who do not have a three dimension biopsy machine available, who use a two dimensional machine, and estimate where the agrressive lesions may be in order to obtain a core.

    Ditto to Dr. Mark Scholz’ new book The Key to Prostate Cancer.. It's the best book that I read on the subject.