update

Prior discussions 

the new guy - a candidate      26 Oct 2016

first contact                             30 Oct 2016

initial resistance                      9 Nov 2016 

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1.5T vs 3 T mp-MRI rationale   4 Dec 2016

I did get an insured 3T mpMRI in 2016. It came out PIRADS 3.  I could not get a fusion biopsy.  I waited for a brand new fusion biopsy option that did not arrive even in 2017 nor did the p2PSA marker availability resolve for a better lab series.  I did not start the chemistry series I anticipated bench marking with PSA, freePSA, and p2PSA in late 2016.   

I am prone to infections and hope to avoid dirty route biopsies vs an anterior US MRI fusion biopsy.

Insurance "lost" my second urologist that is the biggest techie in the area for 2017.   He hasn't pulled the trigger on an advanced   new fusion  US system either.

Infrequent PSA increased to 12.7 in Feb 2018. Some serious worries there, riding the hump on getting an unwanted 12 core biopsy anyway.  Began some of the chemistry series in Feb 2018, PSA 9.7 in May.

Reran the 3T mpMRI in May 2018, PIRADS 2, still no advanced fusion biopsy option at preferred hospital.  Fingerwave ok. New urologist in insurance network, has an old manual fusion US rig, the only one in region, but says biopsy not indicated at PIRADS 2.  

--- Latest mpMRI -----------------

PROSTATE GLAND: The prostate gland measures 3.8 x 6.1 x 6.0 (AP x T x CC), 72 grams (previously 45 grams). Again noted is the heterogenous prostate parenchyma with no signal changes.

Peripheral zone findings: Stable linear T2 hypointensities and mild T2 hypointensity with ill-defined margins; no evidence of restricted diffusion. (PIRADS 1)

Transition zone/central gland findings: The previously noted T2 heterogenous signal foci with obscured margins at the right (anterior and posterior) transition zone at the base and apex show no significant interval change in appearance. BPH nodules are again noted. (PIRADS 2)

There is no new nodule or suspicious focus noted in the peripheral zone and central gland.

OTHER FINDINGS: The seminal vesicles again show decreased T2 signal with foci of thickened septa, likely post-inflammatory changes. The vas deferens, neurovascular bundles and rectoprostatic angle are unremarkable. The urinary bladder is underfilled, without significant wall thickening or intravesical lesion. No enlarged pelvic lymph nodes. No abnormal bone marrow signal is observed.

IMPRESSION: Further increase in size of the enlarged prostate gland. Again noted is the heterogenous prostate parenchyma with no significant change in the peripheral zone and transition zone findings. No new nodule or suspicious focus is noted. (PIRADS 2)
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