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prostrate cancer
2021 I was diagnosed with a rising PSA 5.0. The DR right of the bat recommended a MRI which revealed suspicious legions then onward to biopsy. The biopsy noted an agressive legion Gleason 8 along with 2 other gleason 6 on left side. In addition, 3 other gleasons 6 on right side. . I chose the HIFU option on the left side. fast forward, after a 6 month follow up biopsy, the left side was clear but the right revealed 4 gleason 6s and 1 gleason 7 (3/4). The DR is recommending (1) prostrate removal, (2) radiation. I am choosing active surveillance. My research says the gleason 3/4
is a group 2 VS 4/3 is a group 3. I appreciate any responses or advice on this issue.
PS: HIFU is expensive as Heck. (So is my life and well being)
Comments
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Hi @12tugod sorry you find yourself here.
Youre playing a risky game for sure. Some questions to help understand what’s going on.
After your HIFU did you have another MRI? Doesn’t sound like it.
On the right side, was the 3/4 found where the MRI had previously identified lesions? Was this biopsy a different sampling approach? More samples?
What percentage of the 3/4 was graded 4?
How did the HIFU go? Catheter in for a week?
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I had 3+4 results from my biopsy. I had a prostatectomy and thought that I was finished with PCa. However, I had a 4+3 after my prostate was removed and analyzed, and a still detectable PSA. I had six months of hormone therapy and IMRT radiation to the prostate bed, and again thought that I was finished with PCa.
Since then, I had one recurrence a decade later and SRBT radiation therapy, in my left inferior pubis ramus (local metastasis), and I've just come off a two year hormone therapy cocktail. I'm hoping to remain cancer undetectable for as long as possible.
No two prostate cancer cases are exactly alike, but I strongly recommend that you get at least one additional opinion from a "Medical Oncologist", before you make your final decision regarding next steps (or no next steps).
Yes, long life and well being are important, for sure, but I suggest that you not ignore the presence of 3+4 PCa.
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The DR says 6 months after HIFU, it is protocal to get a MRI and a biopsy. The MRI did not reveal any warnings (strange), but the biopsy did. By the way, today I had another PSA. the result went up from 1.970 (11/2022) to 3.570 (04/2023) Got me thinking again. The 4 was 10%. Cath was terrible, never experienced that before.
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HIFU ablated GS 8 (5+3) Target left 40%
GS 8 (3+5) LLM 50%
GS 6 LLA 15%, Target right 5%.
Left side all clear.
I am dealing with the right side now. Tough.
My next follow-up with DR is in August 2023.
What I am seeing from others is the side affects after what other methods they choose. Now I feel so normal other than mental worrying.
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12tugod,
I am stunned that any oncologist would put you on A/S, with your clinical history. None of our resident lay experts on A/S have chimed in yet (whom I noticed), but I doubt you meet Best Practices A/S qualifications. I am the first to admit that I am not well versed in A/S, but I believe that JUST a Gleason of 8 would disqualify in most protocols. The fact that your more recent biopsy showed only a Gleason of 6 does not by any means prove that no Gleason 8 remains.
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If HIFU is very expensive, would it have cost the same to do the entire prostate vs. half? If you need a second round for the other side, are you paying again? Haven't seen too many that have had this treatment.
Biopsies tell you that you do have cancer, not 100% that you don't. The needle can miss the cancer, it's only a small sampling of the gland. After a surgery, the entire prostate can be evaluated. Not uncommon for the pathology to change.
What did you PSA do after HIFU?
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Advice from the American Urological Association:
- Clinicians should inform patients with intermediate-risk prostate cancer considering whole gland or focal ablation that there are a lack of high-quality data comparing ablation outcomes to radiation therapy, surgery, and active surveillance. (Expert Opinion)
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I had that following MRI results on Dec 9 2022:
1. No lesions are seen suspicious for clinically significant prostate cancer
2. Post ablation changes in the left prostate gland with left shift of the prostatic urethra.
PI-RADS CLASSIFICATION (Probability of a clinically significant cancer)
1 - Very low (highly unlikely)
2 - Low (unlikely)
3 - Indeterminate (equivocal)
4 - High (likely)
5 - Very high (highly likely)
Narrative
PROCEDURE: Enhanced , Unenhanced MRI Pelvis
CLINICAL INDICATION: prostate cancer
TECHNIQUE: Using a body phased array coil small field-of-view imaging of the prostate was performed using the following sequences; [axial T1-weighted, axial T2-weighted, sagittal T2-weighted, coronal T2-weighted, diffusion-weighted]. Axial T1-weighted
images [with fat suppression] through the prostate were obtained before and [dynamically] after the intravenous administration of IV contrast.
Using a large field-of-view, the entire pelvis to the level of the aortic bifurcation was imaged with the following sequences fat suppressed T2-weighted, Axial T1-weighted images ]
Postprocessing images with DynaCAD software were obtained and submitted for analysis.
COMPARISON: Prostate MRI from 11/12/2021.
PSA level: 1.4 ng/ mL in 8/2022.
FINDINGS:
Prostate Size: 3.5 x 2.4 x 4.1 cm.
Volume: 17.9
PSA density 0.07 ng/mL/cm3
TRANSITION ZONE:
* T2 images demonstrate heterogeneous multinodular appearance, without evidence of suspicious nodules.
Post ablation changes in the transition zone with left shift of the prostatic urethra.
PERIPHERAL ZONE :
No focal lesion of low signal intensity in T2 weighted images, restricted diffusion or focal enhancement in the peripheral zone
Post ablation changes in the left peripheral zone.
Extraprostatic extension N/A
Seminal vesicles: Normal serpiginous appearance without thickening of the walls, abnormal restriction or enhancement
Bladder: underdistended bladder, limiting the evaluation of its walls.
Lymphadenopathy: No significant lymphadenopathy by size criteria.
Bones: No suspicious osseous lesions.
Other: None
TRUSS BIOPSY on FEB 13, 2023 finding multiple 3/3's and one 3/4.
I am confused. help me with advice. How can this be?
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