Need some advice

I am in an Active Surveillance program where, so far,  I have had five MR-fusion biopsies, so I am very knowledgeable about this procedure.

Since the prostate can change to some extent, it is better that you have the biopsy sooner than later.

At my biopsies, some of the cores that are taken are targeted, and others are random in the rest of the prostate. Not only can the targeted biopsy find cores of cancer, but also cancer can be found in  random ones, so have both done. Generally there are approximately 15 cores that are taken at my biopsies. 

A PI RAD score of 4 needs to be looked into to see if there is cancer or not.........the PI RAd goes from a low of 1 to a high of 5, so you definitely want to biopsy.

As you already figured out bike riding, sex, even a hard stool before a PSA can elevate the blood test.

I have confidence in the MRI that I have done and  radiologists that read my MRI since I am a patient at a high volume center of excellence in Los Angeles, however there is difference in  abillities of staff and radiologists, at various centers, some not being excellent . ...to be honest, I have not heard of a second opinion of the radiologist results. You may or may not wish to explore this, depending on where your MRI was done....was it a center of excellence?

PI RADs....Here is a discussion about Pi RAds

https://csn.cancer.org/node/304798

If you note in this discussion, I list the likelihood of cancers found by each of the five numbers in the Pi Rad scale.

I did not have a full anesthesia for the fusion biopsy, but the prostate is desensitized to liimit pain (in my case, there is variance of being uncomfortable, in the different biopsies that I have done , probably due to how the prostate was desensitized before the cores were taken; basically there is a snap when each core is taken, like a staple gun hitting the prostate)...it's very rare that a full anesthesia is recommended. The biopsy is uncomfortable, but bearable.....it takes about 15 to 20 minutes..... pretty much all of us have had a biopsy without anesthesia, others may wish to comment.

To add, the results of the MRI readings are locked into a three dimensional biopsy machine, in my case it was an Artemis machine, then the biopsy is done in a similar way to a standard twelve core biopsy done by a urologist in his office.

I had local anesthetic, and only part was anesthetized. The rest felt like a bee sting in my you know where. But it wasn't anything you can't survive, and its over quickly. I didn't run screaming out of the room or anything, I just wanted to get it over with.

My 88 year old dad decided to do this surgery without confiding in me. Of course the device failed and he is beside himself, what's worse is that he has put a call into the doctor twice now to find out what had happened and what can be done but low and behold, no answer back. My heart breaks first of all that any doctor would do this surgery on an 88 year old man with this kind of risk failure just so he can hold his penis when going to the bathroom a few more years is beyond me, really doc? Needless to say my dad wants it removed as he says its uncomfortable when sitting down but would have lived with this device inside had it worked, I am obviously trying to convince him into leaving it in rather risk going under again, is this wrong of me?

Does anyone know the success rate on this, especially in an 88 year old man? The doctor not calling back has me suspicious as well, would this be considered malpractice? 

I can't say I am happy about this and I am trying to help my dad now in any way I can. I would so appreciate the help if someone has any suggestions on how to further help my dad.

Thanks so much

Diane

Hi,

Both RP or CK are good choices for PCa.  All treatment options have side efects so study them all before you make your choice.  From what I know about CK the prostate tissue slowly dies over months/years but I don't know if all the tissue dies.  You should be able to get some good suggestions from your doctors on who has the best latest equipment for the treatment plan you choose.  Don't be afraid to ask for a second opinion on treatment modes or hospitals.  Do a lot of homework so you will know what to expect.  Good luck and keep in touch with us if you have any questions.

Dave 3+4

The whole point of AS is to avoiding treating a PC which is not life threatening. Some PC is slow growing and in fact if a man lives to 85 he has a 50-85% chance of dying with but only a 3% chance of dying of PC. The trick of course is figuring out where to apply AS because some PC's are more aggressive and only have a shot at cure if treated early. From the literature it appears that AS is getting more refined and the data is getting better about outcomes and better institutions are leaning into this choice where appropriate. Make sure that you get all of your advice on this from a high end institution that is associated with the latest research like a teaching hospital. I also prefer to get at least some of my advise from a doctor that is not paid on one choice, IOW they are treatment agnostic and get paid a salary regardless like at Hopkins and Mayo. One of the most frequently cited sources for expected outcomes is the MSK nomogram which use thousands of cases to compute your likely outcomes. Treatment and AS are both gambles of sorts, that's why it is so important for you to be honest with yourself about your priorities. As has been stated here and in many other threads, some guys lament their side effects, some lament not acting sooner. Many of course are thankful for their excellent choices. Play the movie forward in your head. How would you feel if treatment is successful/fails. How would you feel if AS is successful/fails. Only you know your priorities And your baseline status. Some guys for instance don't seems to care about ED at all. For others it's a real issue.

As far as radiation vs surgery, the outcomes are similar but the side effects and there progression are different. ED for instance starts of immediate for surgery and is delayed for radiation if it occurs. Your health status (competing mortality risks) and age also play into the decision. There are individual stories here about good and bad outcomes for both but let high volume, quality data be your guide. Lastly, the skill of the doctor is very important. Make sure that whoever treats you has done hundreds if not thousands, is up to date on the latest data and helps you through your choices. That's at least half the battle. I had surgery at Hopkins (4,000 open RP's) and now SRT with HT at Mayo (30 years and over 100 papers). I also went to MSK. RP results were 95% continence, partial ED, PC not cured. I have no regrets. SRT and ADT have less than a 50% chance at cure for me but it's the right choice for me and I am 2 months in. I have no regrets. 

Good luck and remember that while there are stories here about poor outcomes, there also thousands of stories of excellent success In cure or at least significant delay. 

George