Just Got Diagnosed

bloomschool

Hello everyone,

I am 70, in generally good health according to blood tests. Had a Prostate MRI, now scheduled for a Biopsy. My PSA went from about 4.5 a year ago to 6.5 this year (2022) then jumped to 7.3 in a matter of a few months. Here is MRI radiology report summary:

"IMPRESSION: Overall PI-RADS 4: Clinically significant prostate cancer likely at the apical periurethral peripheral zone."

The nurse told me not to worry as sometimes upon biopsy, it turns out to be prostate inflammation.

Since I'm new to all this, I am wondering what it all means? Is an MRI radiology report accurate or not? Do I have prostate cancer, or could it in fact, be inflammation or something else?

And how fast does PCa spread?

How to proceed? Just follow and trust Urologist recommendations or perhaps seek out CyberKnife, etc?

Many thanks!

Clevelandguy

Hi,

The only time you can get a definite cancer diagnosis id with a biopsy. MRI’s detect suspicious areas that an experienced diagnostician might determine is cancer but not definite without the biopsy. After the biopsy your Urologist will grade your cancer as to it’s aggressive nature. 3 being not very aggressive and 5 being really aggressive. BPH(Prostate inflammation) can raise your PSA number if you have that condition. Time to wait until after you have your biopsy before you start discussing treatment protocols. If you do have cancer you will want to also consult a radiation Oncologist for their prospective. Second opinions from a different doctor and hospital network is a good idea depending on your trust in your current doctors.

Dave 3+4

bloomschool

Thanks Dave! This helps me quite a bit in getting some perspective on this situation.

Rob.Ski

Agree with Dave, MRI is not confirmation. See what your biopsy says. If results are positive, get second opinions, investigate your options.

bloomschool

Thank you! It's good to get support.

Old Salt

I second the above opinions.

Please tell us once you have the biopsy result; hopefully we will be able to give advice at that time.

bloomschool

I will let you know. It's on June 30th. The wait is giving me some anxiety, but I can handle it. Thanks!

Max Former Hodgkins Stage 3

bloom,

Welcome to you Sir,

As all have noted above, an MRI cannot confirm PCa, but the results and the way the radiologist summarized things, it is HIGHLY LIKELY that it is PCa. The vector rate of the PSA results agrees with this likelihood also. The biopsy will inform the doctor of your Gleason Score, as well as the extend of the tumor(s) ("volumetric involvement"). You will need all of this information to make an informed decision on curative therapy, but in most cases without likely escape from the gland, Cyberknife is usually a good and popular choice. If there is likely glandular escape, the choices then become IMRT/IGRT, which is a different type of radiation delivery from Cyberknife. Cyberknife itself is the brand name for radiation delivered as 'SBRT,' so if the urologist mentions SBRT, know that he is discussing CK, or an alternative brand of it (by 'brand,' I mean manufacturer of the radiation device employed).

As to how fast PCa advances, the truest answer is 'it varies' (based upon Gleason score), but in most cases, it moves quite slowly, and almost always, there is ample time to sit back and study the options.

max

bloomschool

Thanks for the response. Very much appreciated.

dale1k

https://csn.cancer.org/discussion/comment/1697473#Comment_1697473

I'm about a couple of weeks ahead of you... I just had my biopsy last Monday.. I also had a MRI that showed I had a Pi Rad 4 lesion.. My biopsy was targeted transperineal ultrasound guided and they took 24 core samples .. The procedure itself (which I was worried about) was painless... 2 out of 24 were graded as 4+3... Another 3 were 3+3 and the rest were benign.. I will see my urologist on June 27th for consultation and treatment options... I have no idea at this point what to expect... Best of luck to you...

bloomschool

Thanks Dale. I'm not concerned about the actual biopsy procedure, just worried about if I will be able to pee afterwards. Since I have an enlarged prostate and taking Tamsulosin to help me pee, I figure the prostate might become inflamed from the procedure and I might need a catheter. So that has me concerned. I am assuming that I have PCa. And worried about what the course of treatment will be and how to proceed. I have no family to help me and will have to rely on friends if I need any help. Thanks again and we hope for the best.

Old Salt

Dale: You can expect that your urologist will recommend treatment.

We don't know your age, but it is likely that he will mention, if not recommend, surgical removal of your prostate; it is probably his specialty. Perhaps he will discuss radiation treatments as well, but he may not be up-to-date and sufficiently knowledgeable about those. Let's see what happens, but make sure you evaluate all pertinent options before making a decision that is best for you.

Based on the biopsy results, it appears that you have time to do this.

dale1k

https://csn.cancer.org/discussion/comment/1697527#Comment_1697527

FYI.. I will be 68 in a little over a month… Based on the biopsy report, the tumor length of the 4+3 graded 2 cores in the left anterior lateral is 4mm and involves ~ 25% of the needle core tissue… I assume this will be the main driver of the options available and what he may recommend... I’ve done some research already and certainly won’t rush into any decision until I carefully weigh all options and am comfortable as to what is the best option for me… I’m not looking forward to it at all, but will do what I have to do.. Thanks for your input…

dale1k

https://csn.cancer.org/discussion/comment/1697526#Comment_1697526

Ok.. I also am very active.. My concern with the biopsy is that it would prohibit me from biking, etc for a prolonged period of time… I was “lucky’ in that I was able to bike 5 days after my procedure.. I didn’t have that much of a problem urinating, but I do have an enlarged prostate as well.. So I now know that I have cancer… 4+3 graded cores are not good… The question now is how aggressive is it and what do I do treatment wise… I hope your biopsy comes back negative for PCa… Best of luck to you..

lighterwood67

You are on the right track. You are getting advice from some of the most experienced and knowledgeable folks on this site. Good luck on your journey.

bloomschool

Hello everyone. I had the biopsy. They did 15 samples. Doctor said there was NO cancer. The prostate is inflamed which is probably why the MRI looked the way it did.

I go back in 6 months for another PSA. And if PSA is high, then probably another MRI and biopsy.

I asked the Doctor how I can reduce inflammation, waiting to hear back from him.

So, I don't know what to make of any of this. Maybe there is cancer in the areas that were not sampled?

Any advice?

Thanks for all your responses!

Old Salt

That's excellent news, of course (kudos to the nurse, BTW). Presumably, the (PI-RADS 4) area that was 'highlighted' by the MRI was sampled.

Of course, one can never tell that there was no cancer anywhere, but for the time being you can relax. As recommended by your urologist, test your PSA at regular intervals. Another MRI at the appropriate time is a good idea as well.

neilm

Great news Bloomschool , I have a similar condition with a Pirads4. Going for a MRI guided biopsy next week. PSA was 5.1 2 years ago then dropped to 4 for a year then jumped to 6.1 now its 5.1. Can only hope for results as good as yours. My 4/K says 27% chance of clinically significant cancer, nurse says 60% overall chance of PCA. Spending my time studying and hoping for no cancer or grade 6 cancer. Radiation? prostatectomy? Can't know treatment until diagnosis is in. However it is not in my hands! We will see, I am 66 so I am in the risk zone....

bloomschool

https://csn.cancer.org/discussion/comment/1698276#Comment_1698276

Neilm I hope you too will have good results. Please let us know how you're progressing.