New To This Group
Just had an MRI and now waiting to schedule MRI-Ultrasound Prostate Fusion Biopsy
Here are the the results of MRI. Seemes like sytrong probabllity of cancer looking for an input
IMPRESSION:
1. BI-RADS 5 lesion in the right posterior lateral peripheral zone at the
base.
2. Mild BPH
3. Enlarged right pelvic sidewall lymph node and right external iliac lymph
node. Borderline sized left external iliac lymph node.
Index PI-RADS Category: PI-RADS 5
Prostate gland segmentation and lesion marking available in DynaCAD.
FINDINGS:
Prostate Measurements: 4.4 cm transverse, 4.2 cm AP, and 5.0 cm in
craniocaudal dimension. Prostate volume approximately 46.2 cubic cm.
BPH Changes (PR-2): Mild.
----------------------------------------------
Prostate Observations:
PROSTATE LESION #1 (series #/image #): 8/21
PI-RADS CATEGORY: 5
Axial Location: Right posterolateral peripheral zone.
Craniocaudal Location: Apex.
Size: 2.0 x 1.6 x 1.7 cm
T2 Signal: Hypointense.
Diffusion Signal: Markedly hyperintense.
ADC Signal: Markedly hypointense.
Enhancement: Hyperenhancing.
Evidence of Extracapsular Disease: None.
----------------------------------------------
Comments
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Hi,
The MRI will pinpoint areas to sample on your biopsy. The biopsy samples will be reviewed and checked for cancer, only the biopsy can determine if you have cancer. The samples will be graded from a 3 to a 5 with a 3 not being very aggressive to a 5 being aggressive. The first number will be the majority of cancer cells seen in the sample and the second number is the least amount of cells in the sample, ex: 3+4. A 5+3 is far more aggressive than a 3+4. Good luck on your biopsy………..
Dave 3+4
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I received the results of the biopsy today and they are 4+3. I have an appointment to discuss options on October 27th. The doc mentioned radiation or removal briefly on the phone today and said we would talk more in depth when in person.
Fromn all the reading I have done combined with my score I really want to avoid the RP and do that as a last resort. That leaves me radiation and or some type of hormonal treatment.
Just looking for any input this group might have.
Thank you in advance!!
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Hi,
As Dave above comments Gleason score 7 (4÷3) is more aggressive than 7 (3+4). In fact yours (4+3) could have the risks associated with Gleason score 8 (4+4) if it refers to a voluminous case.
Can you describe the details on the pathologist report. How many positive needles, location and volume (%) in each sample.
Also any other detail regarding the type of cancerous cells.
Your wish in radiotherapy may be correct but I recommend you to research on the various options in RT treatments as some are prefered to others depending on the information gathered from the biopsy and MRI.
I would think that the field for radiation will take into consideration the lymph nodes identified in the MRI. Probably a combination of two modalities would be a better choice. For instance, HDR + IMRT.
Prepare a list of questions for your meeting on the 27th, and get second opinions on the suggestions given by your doctor.
Best wishes and luck in this journey.
VGama
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Thank you for your information.
Here is the pathology report....
A. Prostate, right base, biopsy:
-Adenocarcinoma of the prostate, Grade Group 2 (Gleason Score 3 + 4 = 7/10), in 2 of 2 cores, involving 45% of tissue.
-Gleason pattern 4 comprises 10% of tumor.
-Perineural invasion is present.
B. Prostate, right mid, biopsy:
-Adenocarcinoma of the prostate, Grade Group 3 (Gleason Score 4 + 3 = 7/10), in 2 of 2 cores, involving 85% of tissue.
-Gleason pattern 4 comprises 90% of tumor.
-Perineural invasion is not identified.
C. Prostate, right apex, biopsy:
-Adenocarcinoma of the prostate, Grade Group 3 (Gleason Score 4 + 3 = 7/10), in 2 of 2 cores, involving 95% of tissue.
-Gleason pattern 4 comprises 90% of tumor.
-Perineural invasion is present.
D. Prostate, left base, biopsy:
-Benign prostatic glands and stroma.
E. Prostate, left mid, biopsy:
-Benign prostatic glands and stroma.
F. Prostate, left apex, biopsy:
-Benign prostatic glands and stroma.
G. Prostate, region of interest, biopsy:
-Adenocarcinoma of the prostate, Grade Group 3 (Gleason Score 4 + 3 = 7/10), in 3 of 3 cores, involving 70% of tissue.
-Gleason pattern 4 comprises 70% of tumor.
-Perineural invasion is not identified.
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Hi again,
I wonder the reason that took you to do the initial MRI. Did you experience pain or was it urination issues. What is the PSA histology?
From the info you provide, your case should be dealt as Gleason score 8. There are 9 positive cores out of 15 (voluminous) with high expression of rate 4 (above 70% of cancerous tissue), all at the right lobe.
I would think that the extra three needles (region of interest) were directed to the lesion identified in the MRI, at the right base (next to the bladder).
In my lay opinion, it seems to be a solid tumor, less prone to micrometastases, with high probabilities for a successful RT treatment. The presence of Perineural invasion at the apex (Ģ-rate4 95%) may suggest high probability of existing extraprostatic extensions. Surgery alone wouldn't do the job.
In your shoes I would try a combination of two radiation modalities. One aggressive for the gland and IMRT for zinping the iliac lymph nodes and the surrounding tissues at the apex (attached to the colon). Check on gels to avoid coleteral damages in the colon walls.
Please note that I am not a doctor. I am curious PCa patient doing researches since 2000 when I was diagnosed with the bandit.
Discuss the matter with your doctor and get second opinions from radiation specialists.
Involve your family in the decision process.
Best,
VGama
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Thank you so much for your in put Vgama!!!
It all started with annual physical in December my regular doc said he felt something while doing DRE. Sent me to urologist who said she didn’t feel anything of concern thought maybe just blood vessel. My PSA in December 2021 from the annual visit was 3.58. The urologist said let’s do another PSA and it was 4.78 (July 2022). Not that the number was overly high (I was 63 at the time) she was concerned that it jumped so much in 6 months and that my numbers were trending up quickly in her mind My PSA was 3.28 in Dec 2020. My urination had slightly increased but I never had to get up during the night. I am feeling very fortunate that the urologist suggested the MRI instead of just looking at PSA because in the grand scheme of PSA in my opinion 4.78 wouldn’t be to much to worry about.
I am still in the freaked out stage and am trying to gather as much information as I can. My first treatment consultation with the urologist is on Oct 27th she said well will talk about radiation and or surgery treatments . Everything I have read so far and my interpretation is I want to avoid surgery and do some form(s) of radiation. I just read about the gels last night so you helped answer one of my questions.
Not sure I really understand all the Gleason score results.
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Hi again,
Well, your judgment on the PSA was wrong. At 63 anything above2.68 becomes suspicious in asymptomatic situations.
Constant increases, even small ones, are serious. In any case, you doing well in investigating treatment options. Try to reach a concensus in getting cured but keeping quality of life. Even in radiation modalities some present lesser risks in terms of the side effects.
Your inquire on Gleason results, is no more important as your diagnosis has ended. Surely higher rates of 4 and 5 represent a worse scenario as these cells tend to be more aggressive (alive and kicking) but producing lesser amounts of PSA serum.
One note for discussion with your doctor is the incorporation of ADT (hormonal treatment) in the RT procedure of your choice. ADT helps the job of the RT in the killing process. Typically it starts 2 months in advance of the RT, and continues for a period that can last more than one year.
ADT will add more side effects so you should be prepared regarding other health issues. Total panel blood tests is recommended in advance (liver, kidneys, heart, etc). In my case I also checked the testosterone which proved to be helpful when on ADT.
Some guys with high risk cases do dexa scans to check bone health. At 60 I was found with osteopenia.
I recommend you to research the matter and prepare a long list of questions to the doctor, for your next meeting.
We all experience that freaking out period. However, has you advance in your research the fear attenuates. Do not rush. Do things coordinatly.
Best wishes and luck in this journey.
VGama
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Can't thank you enough for your input I truly appreciate it!!!
I will dive into the research and prepare my list of questions. My appointment is on the 27th and I will post the recommendations for input. I know ultimately it is my decision but input from others who have been through this is always greatly appreciated.
Vandarant
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Hi,
If it was me I would ask the doctor(s) about doing a Pet scan to better define the location of the cancer which could help you decide on which radiation treatment to choose. I have included a link which can help you understand the various treatments plus their side effects.
Dave 3+4
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I am new as well. I am an Ortho Surgeon. healthy and fit my whole life. PSA jumped 2.7 to 4 over 2 yrs and no symptoms of any kind (urinary nor ED) MRI PIRAD -4 Fusion biopsy 9/16 cores + 4 were GS6, 3 were GS 7 (3+4) and 1 was GS7 (4+3). The higher ones in the target while GS 6 and 5% GS 7 (3+4) on other side. Needless to say being a surgeon I know too much. Went to USC - after discussion chose RRP over other because diffuse disease AND the experience at USC (over 15000+ among their docs) is that after radiation, HIFU etc IF there is recurrence and surgery needed, it can be a mess- from fistulas to secondary cancer of bladder, colon etc. Frankly the decision is the most difficult of my life and I make complicated medical decisions regularly. My docs always to PSMA PET ahead of time to help them decide how far up the lymph node chain they need to dissect. Surgery in DEC and anxiety is palpable. Very glad I found this forum and the wise words by so many. God Bless
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I had my biopsy sent to John Hopkins for a second open which resulted in a much more aggressive cancer. Hopkins has me at GL 9 and Group 5. I also had a PSMA PET scan which showed the lymph node lit up. I met with my urologist/surgeon last Thursday and she recommended hormone and radiation treatment. She recommended this because she was concerned that she could not cut wide enough to get all the cancer without major risk of hurting the surrounding tissue including rectum.
I am meeting with radiation oncologist at the Mayo Clinic next Monday and then a local radiation oncologist in Green Bay, WI next Tuesday.
Everyone's cancer is different so do your research, listen to your docs and make the most educated decision you can. I am finally beyond the freaked out stage and now dealing with everything as the next steps come along.
I hope to have an actual treatment plan decision after talking to the oncologists next week.
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Given my experience in healthcare, I suggest finding the absolute BEST to treat if you can do that. I live out of town but traveling to USC because they are a high level tertiary facility and handle many complications seen by the less skilled surgeons AND complications from Radiation etc. I would STRONGLY suggest meeting with UROLOGY at MAYO if in WI or take a trip to MD Anderson in Houston or USC KECK Medical Center in LA. They have tons of data and while there are always successful outcomes with every time of treatment, GS9 is nothing to play around with. A skilled surgeon can debulk the tumor and avoid or handle injury to surrounding structures and perhaps then, with less tumor burden, adjuvant treatment can be more successful. No question it can get confusing. Pick an expert and then TRUST that expert. Hindsight is always 20/20 and this disease will play with your mind. stay focused!! I look forward to hearing the good news from you soon!
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Hi again,
Thanks for the update.
These added information classifies your case as T3c N1 M0 for the PET being positive to lymph nodes and negative to far metastasis.
The up grade of the Gleason score to a higher risky Gs9 is significant because of the involvement of the lymph nodes. These are the routes used by the bandit to travel to far places.
A combination treatment may be advisable. You can debulk the whole gland with some lymph nodes adding three months later radiotherapy. Or you can avoid the typical side effects of surgeries choosing among the radiation modalities. Some Gs9 survivors have chosen the combination RP+RT+ADT with success. Surely the number of side effects increases at each step.
You doing well in getting the opinions from various specialists.
Hope for the best.
VG
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