Can someone please help us understand our results

Prostate cancer can only be diagnosed by a biopsy....an MRI does not diagnose.

PIrad scores range from 1 to 5; and indicate how likely the tumor that is found is cancerous. Pirad of one is least likely, while a five is most likely. Your husband's Pirad is a four, so having a biopsy is indicated. A urologist is the one who does this.

There is no extracapsular extension, that is, if there is a cancer, it is not outside the capsule.....a good thing.

I do not know what an "ADC value" rmeans.

There are various types of biopsies that are available. Most urologists do a random 12 core biopsy. Now there are new three dimension biopsy machines that are available in that can target the results found in the MRI, that one can place greater confidence in. Major centers of excellence have such three dimensional biopsy machines. My biopsies are done with an Artemis machine.

I wonder, your husbands race; African American males are more likely to be diagnosed and is reoommemded to be monitored at a younger age, 40 yo

Hi,

Yes he will need a biopsy hopefully guided by the MRI study to determine if he has cancer.  They will rate it as 3+3 or 3+4, ect. where the first number is the majority of the cells in the sample and the second number is the minority of the cells.  A 3 is less agressive than a 4 or a 5, a 4 is less agressive than a 5.  Of course you want the first number to be a 3. 3+3 is usually the mildest form of cancer where a 4+5 would be an agressive form of cancer.   Let us know what the results are.

Dave 3+4

Love of,

With all of the other guys above, the main takeaway from what you write is that the only fact highly suggestive of PCa is the Pirad.  As all have mentioned, neither this nor the T3 MRI confirms the disease.  With all, I say that a biopsy is very much necessary at this point.  Virtually all biopsies today are ultrasound guided, but the Artemis system is probably best. Ask the urologust specifically about Artemis.

His case does warrant investigation.  As Vasco noted, many of his symptoms are factors not ordinarily caused by per se PCa.  Most are also associated with BPH/BEP, but his gland is relatively normal in size, not enlarged in the range that commonly causes BPH.  ADC is not regarded as very accurate regarding PCa.  Its importance is usually limited to brain cancers a a few others.

His Jewish ancestry is likely not of significance.  If Ashkenazi (Central European strain; Poland, Hungary, and adjacent nations), it will increase the likelihood of positive BRCA 1 or BRCA 2 genes, but that is more relevant of BCa (Breast cancer) than prostate.  Ethnically, the rates for PCa fall highest on (1) blacks, (2) whites, and (3) Asians.  Sephardic Jews (Spain, Morocco, Northern Africa, most of the Middle East) are no more likely to have BRCA than any other population.

One thing in the list of symptoms that caught my attention was night sweats. As a Lymphoma survivor I know that night sweats have few causes. The two causes that are related to over 95% of cases are lymphoma and menopause.  'Menopause' is broadened to include most hormonal and histimine abnormalities generally (in both men and women).  As his doctor reviews his blood panels, ask him about what might be causing the night sweats; it is not ordinarily associated with PCa, except in cases of men who are on or who have received hormonal therapy (HT) or therapeudic castration.

And finally with everyone, I would say that a two week wait is meaningless. You are probably lucky to get in even that quickly, but PCa is virtually never a cause to rush anything.  Go on a minivacation during the wait and have some fun. Sitting and worrying is counterproductive in every way.  I would say finally that in the unlikely case that his urologiost does not see fit to order a biopsy, I would ask him to order it anyway, or go to another doctor. Biopsy of the prostate is overwhelmingly safe, and by medical testing standards, easy and inexpensive.

max

Has he had a urine culture yet?

on what was said above...

The symptoms are typical of an infection, although, as was pointed out, there should have been a corresponding rise in the PSA if the prostate was infected.

Does he have pain when urinating in his urethra? I was surprised that was not listed in the symptoms involving urination. It does not have to be intense pain, just a sharp pain as urine flows through the urethra. If there were, then like tth guys are saying, the symptoms are typical of a Urinary Tract Infection, or cystitis, a bladder infection.

Infection can be various pathogens but usually bacterial. E coli, Staphyllococcus, etc. can infect the bladder... In my case, I battled a Staph infection in my prostate off and on for 10 years, and my symptoms were very similar to your husband's but for my higher PSA levels every time the Staph infection flared up again. I did sweat as my immune system battled the infection, but not just at night.

Has anyone done a urine culture yet? Your husband could be dealing with both prostate cancer and an infection. I was dealing with all three... recurring staph infection, benign hyperplasia, and prostate cancer.

The infection would respond to antibiotics, but not eradicated totally. At first I figured I had just "caught it" again, but after the fifth prostatitis attack, it was apparent the antibios could not eradicate the infection... possibly because the prostate is much harder to treat with antibios than a UTI or bladder. 

I was experimenting with many antibios... I was so desperate to get my prostate size down. Ciprofloxacin was the least effective p, but most prescribed. Bactrium, Levaquin, et al. finally got it down to 250cc at the time of my biopsy.

I finally gave up and had a prostatectomy to kill three birds with one stone. So like the guys said above... the symptoms are not typical of pristate cancer, but it sounds like both an infection somewhere plus prostate cancer. The PC is not an immediate danger if caught early, though the  symptoms of the infection may seem scary and related.

Thats only a guess, however.

hopeful and optimistic said:

Jew

Just noticed that you wrote that your husband is Jewish...... I am an Ashkenazi Jew.

About 9 or 10 years ago, there was a study done at Albert Einstein in NYC among Ashkenazi Jews....a correlation was shown between breast and prostate cancers. 

 

 

h & o,

My father's ancesteral line comes from Prague, where many still live today. My surname is one of the most common in the Czech Republic.  There is a significant Jewish element in my ancestry, but for the last 200 years or so most have been R.C. in religion.  Because of the Jewish element, my female cousins have been testing for the BRCA 1 and BRCA2 gene mutations, linked to BCa; this is the so-called "Angelina Jolie gene."  To my knowledge, all have tested positive.  This gives an astonishing 87% liklihood of developing highly aggressive BCa, and removal of both breasts is recommended, which some have done as a precautionalry, like Angelina.

I have not yet studied any possible links to PCa, but it is an interesting topic.

max

Most biopsies are no problem, but two of mine were awful. Pain and tripled PSA for six months afterwards. These were by a professor of urology at Johns Hopkins. Nothing helped except time and sitz baths. Three of every 100 biopsies results in hospitalization for sepsis, and one of every 1400 is fatal. Also, an endorectal coil is extremely painful, and there is no need for them with 3T machines. Also, I have had a PIRADS 4 lesion hit with multiple biopsies and nothing found. It was downgraded to PIRADS 3 when version 2 came out.

So, be careful what you ask for. Has he had a PHI, 4K Score, or PCA3 test?  I would recommend them as a next step.

I was thinking the same thing as Old Salt... dont be afraid to find another urologist... preferably one that is not associated with your present urologist's clinic/organization. 

I went through 5 different guys at different times... any time I felt I was being manipulated or talked down to, I bailed by cancelling the next appointment and not rescheduling. The last guy gave me a complete picture of my particular situation, and a complete overview of treatment options, and the side effects possible as well.

But this is a big city, where the university has clinics, and they compete with Urology clinics, so I had the luxury of finding the urologist I was most comfortable with. This is another reason I am dead set against socialized medicine... not that free enterprise doesn't have flaws, but I have freedom to explore the marketplace. I would check the competing organizations and if at ALL possible, get a referral from a friend or family or even your GP, somebody so it doesnt have to be a crap shoot when choosing a urologist. 

And I would still have a culture done just to rule out infection as a cause of his symptoms. After all its easy and there are no side effects... you just pee in a cup. That's all. Then the lab tests it for pathogens. It will probably be negative, but at  least you will have ruled that out. But that's just me.

There is a difference among radiologists in the ability to read the T3 MRI report, so I believe that your urologist sending the MRI results to an expert was a good call.

I wonder where you live?; I'm guessing that you are in the nyC area?...if so, NYU would be a great place to go since they have sophisticated three dimensional biopsy equipment......at this point it is not necessary to go to Texas..

In my lay opinion, no one knows if cancer exists without analyzing a sample of it under the microscope.

Guessing a diagnosis of prostate cancer via a MRI or PSA and follow it with again another guess on a clinical stage (quite common) is like playing Russian roulette. The lucky ones survive.

Your doctor is simply giving his opinion based on the experience he has had along his professional life. You may think his behavior ambiguous but that is what urologists do. They rarely contest the report/opinion of another physician from a different specialty so that the tendency is to stick with answers following their guide lines. I believe that your doctor doesn’t trust the Pi-rads system but he cannot deny it, however he is giving you his opinion based on the low PSA, the age of your husband and his family history (NCCN guidelines), in which cases the probability of having PCa is rather low. The same guidelines also don’t recommend MRI exams in cases of low PSA.

Pi-rads classification in a MRI exam is a recent tool used in the PCa screening process.  In the 1990^th PCa screening via a PSA test was not credible by many doctors too.  My GP used to screen PCa via the Prostate Acid Phosphate (PAP) which he did in my case annually since I become 45 yo. It was by chance that in 2000 a different doctor substituting him in my annual checkup conducted a PSA that started my history with the bandit. I see your husband’s case similar to mine as he started the screening via means not yet recognized worldwide.

Your suggestion on the probability of a cancer being aggressive if diagnosed in a case of low PSA histology is correct. The doctor confirmed your opinion but a Pi-rads 4 doesn’t diagnose cancer. It all becomes true if in a biopsy a pathologist identifies the existing bandit. Another MRI (no matter how sophisticated it could be) wouldn’t give you peace of mind if done today or in six months time.

In any case, I do understand your worries in regards to your wishes in having a child and the influence cancer could have in the process, in particular if a radical treatment is to be performed. Surgery would eliminate a natural conceiving process. Radiation would also limit possibilities or even prohibit it to happen during a long time. Even a biopsy could be prejudicial if that would include cores at the seminal vesicles. Probably your doctor is thinking on this too and trying to delay any action that directly or indirectly could harm your dreams. In your shoes I would follow the case only with periodical PSA tests (every 3 to 4 months) and take action if the PSA increases to levels above the normal to his age (PSA=2.6). Meanwhile try enjoying life fully or look for artificial insemination...

Hope your dreams become real.

Best wishes,

VG