My Latest MRI and Back Story

centralPA
centralPA Member Posts: 341 Member
in Prostate Cancer #1

Figured I'd share the journey…

Just had my first MRI while on Active Surveillance. My history is had rising PSA in Fall 2021 (from 4 in 2020 to over 5 in 2021), had an MRI then which identified a PIRADS 4 lesion, had a biopsy with 12 samples on a grid and 3 in the lesion. The 12 on a grid were normal, the lesion samples indicated 3+3=6. I had the biopsy reviewed by John Hopkins, they upgraded to 3+4=7 with just a wee bit of 4. Polaris said lower risk.

My prostate was 140cc (huge) and I had urinary problems. Enjoyed a bout of urinary retention following my biopsy, about a week later, with catheterization in the ER at 2:00 AM. Yay!

Consult with uro folks, they recommended AS, I chose to have a HoLEP procedure to resolve my BPH problems and debulk the prostate so I'd be suitable for radiation (or surgery) down the road. Had the HoLEP, they removed 95cc of material from the prostate. Pathology found no cancer in it, which of course means the cancer is still there in what's left of my prostate.

PSA post-HoLEP dropped all the way to 0.45, and has now slid back up to around 0.95 and steadied. That's a low value.

So here's the results from my MRI, 3 years after the first one in 2021. I've been curious as to what is left following the surgery, which resolved ALL uro problems. My bold font.

FINDINGS

Prostate: The prostate measures 4.3 x 3.3 x 4.7 cm (DynaCAD prostate boundary segmentation volume 34 mL). Moderate changes of benign prostatic hyperplasia. The majority of the prostate is surgically absent from prior debulking/biopsy procedure. Precontrast T1 weighted imaging demonstrates no evidence of intrinsic T1 hyperintensity to suggest hemorrhage.

Lesion (DynaCAD ROI) 1:

Location: Left posterolateral peripheral zone at the mid gland to apex. The lesion does not extend across the midline.

Size: 1.2 x 0.7 x 0.9 cm (as measured on ADC for PZ lesion and T2WI for TZ lesion)

T2W: 4. Circumscribed, homogeneous moderately hypointense lesion. The lesion has an extended interface with the overlying capsule, which increases the risk of microinvasion. No definite extraprostatic extension, seminal vesicles invasion, or neurovascular bundle involvement.

DWI: 4. Focal markedly hypointense on ADC and markedly hyperintense on high b-value DWI.

DCE: Positive. Focal enhancement corresponding to a suspicious finding, earlier or contemporaneous with adjacent normal tissue.

PI-RADS: 4. Clinically significant cancer is likely to be present.

Seminal vesicles normal.

Bladder: Bladder wall thickening likely indicating chronic outlet obstruction.

Bowel: Visualized portion of the rectum normal.

Peritoneum: No free fluid in the pelvis.

Lymph nodes: No lymphadenopathy in the visualized portion of the pelvis.

Vasculature: Iliac vessels patent.

Abdominal wall: Normal.

Osseous structures: Circumscribed 2.5 cm ovoid T2 hyperintense lesions in the right acetabulum on image 31 series 2.

IMPRESSION:

1. 1.2 cm lesion in the left peripheral zone at the mid gland to apex. PI-RADS: 4. Clinically significant cancer is likely to be present. This lesion has been segmented for targeted biopsy.

2. Indeterminate 2.5 cm lesion of the right acetabulum, favored to be benign. Precautionary follow-up bone scan recommended.

************************************

Just had a PSA test today, get the results in a day or two. Curious to see what the Uro says about the bone scan suggestion. Based on power-googling, the acetabulum (cup in the hip where the femur plugs in) lesions are likely osteoarthritis.

The PIRADS 4 lesion has grown since the MRI in 2021, length increased from 1 cm to 1.2 cm.

I have a consult with the Uro on 8 January.

Comments

  • Clevelandguy
    Clevelandguy Member Posts: 1,205 Member
    edited December 17 #2

    Hi,

    Since you still have Prostate tissue intact you will have a PSA reading. That reading needs to be monitored and hopefully stays stable over several months/years. Is it time for another biopsy using the MRI data to hit the Pirads 4 lesion area? PMSA PET scan in your future?

    Dave 3+4

  • Rob.Ski
    Rob.Ski Member Posts: 174 Member
    #3

    Have you had additional biopsies since the original? I thought they were part of AS.

  • centralPA
    centralPA Member Posts: 341 Member
    #4
    https://csn.cancer.org/discussion/comment/1719566#Comment_1719566

    Yeah, I was surprised it dropped all the way to 0.4 or so post-HoLEP, my most recent value is 1.07, so it has reached mostly a steady state now. I have about a quarter f my original prostate, and my PSA is about a quarter of its original value, or so.

  • centralPA
    centralPA Member Posts: 341 Member
    edited December 18 #5
    https://csn.cancer.org/discussion/comment/1719575#Comment_1719575

    Not yet. Since they did pathology following the HoLEP, I got to delay the next one. I talked with the Uro at my July check, she was kind of leaning to a biopsy then maybe? We agreed to see what the PSA did in January, and to get an MRI.

    With the low PSA, I’m confident the lesion on the hip is not PCA, and is most likely arthritis. Could be something else. The Uro signed off on a bone scan, so we’ll have more info shortly. I expect a biopsy is in my near future too. It is time. If that comes back 3+3=6 just in the lesion, I will stay on AS.

  • Josephg
    Josephg Member Posts: 460 Member
    #6
    https://csn.cancer.org/discussion/comment/1719586#Comment_1719586

    "With the low PSA, I’m confident the lesion on the hip is not PCA"

    I recognize that you still have part of your prostate intact, so your PSA will naturally be higher than a person without a prostate, like me. However, my PSA rose from undetectable to 0.98, when my Medical Oncologist ordered a PET scan. The scan found a PCa lesion in my left pubic bone, which was subsequently treated with SRBT and 2 years of ADT.

    My point here is that your PSA does not need to be high for a local metastasis to occur.

  • centralPA
    centralPA Member Posts: 341 Member
    #7
    https://csn.cancer.org/discussion/comment/1719595#Comment_1719595

    Everyone agrees a bone scan is smart business, so I'm booking the bone scan now. Stay tuned.

    I'm imagining having a conversation with my wife, "Good news, I don't have to worry about the PCa any more…because there's something worse going on."

  • swl1956
    swl1956 Member Posts: 129 Member
    #8

    Would not a PSMA PET scan be a better choice than a Bone scan? It's my understanding that they're far more sensitive in finding the bandit. I've had both. Osteoarthritis did light up some areas in my bone scan and there was some activity in the larynx with the PSMA PET which turned out to be nothing. Was stressful to see that though! The radio tracers can accumulate in some organs and can give false positives.

    Hoping your PSA and scan results are both in your favor.

  • centralPA
    centralPA Member Posts: 341 Member
    #9
    https://csn.cancer.org/discussion/comment/1719615#Comment_1719615

    Interesting question on the PSMA. The suggestion for a bone scan came from the radiologist who reviewed the MRI.

    Since I am 100% disabled under the VA, I will just keep getting scans until I am out of scans to get. 🙂

  • swl1956
    swl1956 Member Posts: 129 Member
    #10
    https://csn.cancer.org/discussion/comment/1719617#Comment_1719617

    I'm just a dumb ****, but I have read where the "bone scan" is becoming passe and may be gradually replaced by the more telling PSMA. Seems to me like some institutions and perhaps insurance providers are dragging their heels on recommending and or paying for the newer sensitive scan. My local urologist thought it unnecessary. I had to insist on my first PSMA through him. He was surprised that my insurance (United Healthcare) covered it. The first (7 months ago) PSMA PET scan I had clearly qualified the MRI images that Pca was still in the gland. I'll be getting another PSMA PET in a couple weeks at Fox Chase. I'm praying that this upcoming one will show the same??? Might they be available to you through the VA?

  • centralPA
    centralPA Member Posts: 341 Member
    #11
    https://csn.cancer.org/discussion/comment/1719662#Comment_1719662

    I am going to ask the Uro about the PSMA scan. What am really going to ask is, what are we looking for with this scan?

    Getting the scan scheduled was a minor goat rope. Hershey told me I could schedule it locally. I called around, each would just say have them send the order. I said, no, I am checking on availability in the schedule. They’d ask what kind of bone scan. I am like, oh there are different kinds? I don’t know, the “regular” I guess. That’s not enough information it turns out. 🙂

    So I go back to Hershey and ask via the portal to upload a copy of the order. They say they will fax it directly to the provider, and what is their phone number? I remind them that I am looking for a provider and need to know what the hell bone scan I am exactly supposed to get. Frustration enters at this point. I leave two portal messages and leave three voice mails and finally someone calls me back and tells me they’ll email me a copy of the scan order. Yay.

    After shopping around, I am getting my scan on Christmas Eve. I have a back up appointment for second January with a different provider in case that falls through. Of course the VA shows up late to the party and tells me I should get it done at their hospital. 😕

    The scan is a whole body bone scan with SPECT. More to follow when it is done.

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