Active Surveilance update 2021

xNTP

Prior discussions 

the new guy - a candidate      26 Oct 2016

first contact                             30 Oct 2016

initial resistance                      9 Nov 2016 

Primary tabs

1.5T vs 3 T mp-MRI rationale   4 Dec 2016 

Update (2018)                       28 Aug 2018

I got an insured 3T mpMRI in 2016. It came out PIRADS 3 (original scale, version 1).  I could not get a fusion biopsy.  I waited for a brand new fusion biopsy option that did not arrive even in 2017 nor did the p2PSA marker availability resolve for a better lab series.  I did not start the chemistry series I anticipated bench marking with p2PSA in late 2016 in addition to PSA and freePSA.   

I am prone to infections and hope to avoid dirty route biopsies vs an anterior biopsy with US MRI fusion biopsy when necessary. 

Insurance "lost" my second urologist that is the biggest techie in the area for 2017.   He hasn't pulled the trigger on an advanced   new fusion US system either. (2018)  By 2021 there is an advanced Koelis fusion biopsy locally available now.  I have ongoing insurance delays - in Jan/Feb 2020 had such a fight with insurance hung around a closer hospital with more crowds too many times and caught something.  By the time I was well, C19 Lockdown had occurred - no mpMRI for 2020.

Infrequent PSA increased to 12.7 in Feb 2018. Some serious worries there, riding the hump on getting an unwanted 12 core biopsy anyway.  Began some of the chemistry series in Feb 2018, PSA 9.7 in May, 2018, PSA 9.8 in Feb, 2020, .PSA 8.84 (after IVC) and 10.4 like earlier tests without IV vitamin C.

Size:  55 grams (2016), 72 grams (2018), 84 grams (2021)

Reran the 3T mpMRI in May 2018, PIRADS 2, still no advanced fusion biopsy option at preferred hospital.  Fingerwave ok. New urologist in insurance network, has an old manual fusion US rig, the only one in region, but says biopsy not indicated at PIRADS 2 (version 2.0).  Ditto with mpMRI for 2021.

This year a 1.5 T machine.

--- Latest mpMRI  May, 2021-----------------

HISTORY: PSA: 10.87 ng/ml (May 26, 2021), asymptomatic; for further evaluation

COMPARISON:Multiparametric MRI of the Prostate dated May, 2018 

TECHNIQUE:Multiparametric MR study of the PROSTATE in multiplanar views weredone using 1.5 Tesla MRI machine. Gadovist was given as contrast medium.

FINDINGS:Prostate gland size: 4.2 x 6.1 x 6.3 cm (AP x T x CC); volume: 84 grams (previously 72 grams)Peripheral zone: Thin peripheral zone with T2 and ADC linear hypointensities as before, likelyinflammatory changes/fibrosisTransition zone and central zone: Again noted is an enlarged transition zone with no significantinterval change in the T2 heterogeneous signal foci as well as the encapsulated nodules, likely due to BPH

Focus of concern: None

Seminal vesicles and vasa deferentia: Normal

Neurovascular bundles and rectoprostatic angles: Normal

Urinary bladder: NormalLymph nodes: No lymphadenopathy

Bones: No bone metastasis

IMPRESSION:

Further increase in size of the enlarged prostate gland with no significant interval change in theperipheral and transition zone findings (PIRADS 2)No evidence for suspicious or indeterminate prostate nodule

hopeful and optimistic

.

Did you have a biopsy? If what were the results?

 

hopeful and optimistic

.

What do your docs say about your high PSA. Have you had a FREE psa?

your age? If you are over 65 in the usa, suggest that you upgrade your insurance to medicare plus a supplemental. More diagnosis test will be immediately available. 

ASAdvocate

The PSADensity is too high

What I can say after reading your posts is that the urologists at Johns Hopkins would recommend a biopsy based on your PSADensity being .127, which is above their cutoff.

Also, can you see if the Precision Point transperineal biopsy system is available in your area? No infections, no antibiotics, no general anesthesia. My most recent biopsy used the Precision Point with real-time imaging from ExactVu's micro-ultrasound device.

I know several men who have had PSA of 8 or higher for many years. For all of them, their doctors have insisted on periodic biopsies, even though no cancer has been detected.

 

Clevelandguy

Biopsy needed

Hi,

Sounds like you need a biopsy to confirm if you do have cancer and also to find the gleason score, hopefully it's just BPH.

Dave 3+4

xNTP

hopeful and optimistic said:

.

What do your docs say about your high PSA. Have you had a FREE psa?

your age? If you are over 65 in the usa, suggest that you upgrade your insurance to medicare plus a supplemental. More diagnosis test will be immediately available. 

Most of my prostate work is overseas. under 65 right now,

Medicare in my state of residence is considered fairly broken, most drs avoid it. 

xNTP

ASAdvocate said:

The PSADensity is too high

What I can say after reading your posts is that the urologists at Johns Hopkins would recommend a biopsy based on your PSADensity being .127, which is above their cutoff.

Also, can you see if the Precision Point transperineal biopsy system is available in your area? No infections, no antibiotics, no general anesthesia. My most recent biopsy used the Precision Point with real-time imaging from ExactVu's micro-ultrasound device.

I know several men who have had PSA of 8 or higher for many years. For all of them, their doctors have insisted on periodic biopsies, even though no cancer has been detected.

 

Thanks, that's definitely the

Thanks, that's definitely the kind of new information I need to consider. 

My plan to present has been active surviellence with prostate supplements and off label drug use e.g. aspirin and metformin.  Although some parts of that are about as off schedule as the p2PSA, some chemistry I'm on track.