Seminal Vesicle invasion

Hi Fred,

Welcome to the board. We all go through the same experience and feeling when the results of a test doesn't fit the parameters. It is worrisome as the case could relate to prostate cancer, however, without the confirming biopsy you cannot tell if the MRI fgindings relate to cancer or calculi.
In any case you doing well in investigating the meaning presented in the radiologist's report. I believe that the urologist will aim those identified areas (base of prostate inclusive of Seminal vesicles) together with the typical template for the other regions of the gland, however, you can request him to direct extra needles to those areas.

I wonder if you had a DRE. The area indicated by the MRI (posterolateral to posteromedial peripheral zone of the base of the prostate) is at the reach of finger touch (DRE). A positive DRE is taken when they feel bumps or an harder surface (in comparison with hand's Thenar). You can request the urologist to do the digital exam before proceeding with the biopsy.
Accordingly, only after these tests you can verify if the clinical stage T3 is compatible with your judgment. Surely, the presence of extraprostatic extensions would limit the options for a treatment but it all depends how far those extensions are judged to exist. Localized cases do well with radiation therapies.

So far you have not been yet diagnosed with cancer. Let's hope that your high PSA relates to a benign issue in a 34 cc gland. Sharp increases of the PSA typically refer to a case of hyperplasia. The negative aspect in the T2 findings is the involvement of the Seminal vesicle as it leads to a worse prognosis but treatable.

Best of lucks in this journey.

VGama

Fred, I recently went through a similar period of anxious uncertainty following a mpMRI. The waiting without knowing was, for me, the hardest part. In my case, the targeted biopsy confirmed the PCa diagnosis--but it could have come up negative, as yours could do. So don't diagnose yourself yet!!

If you'd like to learn more offline, I would recommend you consider picking up a book or two. I've gotten a lot out of Patrick Walsh's Surviving Prostate Cancer (often recommended as the go to resource) and Mark Scholz's Key to Prostate Cancer.

Good luck, and try to breathe calmly for now. easier said than done, I truly know!

cheers,

bill

Fred1000 said:

Your comments helps a lot, thank you!!

Thank you VGama and everyone that commented. It makes me feel a little better knowing that i'm not alone and getting help and advise from you guys really helps. 
The biopsy is in 6 days and i'm very afraid. Does it hurt? Any chance of my prostate swelling and having to get a gatheter after the 18 core biopsy? Any advise on what to do or not to do before and after.

Thank you

Fred

It can be painful but not as bad a a dentist drill or anything like that generally.

There is a risk of bleeding after the biopsy so make sure you get someone to take you to and from the session.

Take a spare pare of pants and trousers (underpants and pants in US speak? ) in case you do leak.

Wait a while after the session before you go home to let things settle down.

You will find your semen goes rusty red for a few weeks after the biopsy. I never had bloody urine but that may be a possibility. Talk to your specialists about these side effects and what to do about them beforehand.

Mainly it is undignified

H

Hi Fred,

I would not worry too much on the ride home.  I don't  remember much pain after, I thought they numbed me with a local so that should take some time to wear off.  I do remember some discomfort the next few days after my biopsy but nothing really bad & no infections.  Just a little embarrassing to us all but you realize that your doctor does many of these so they should have their routine down so they go fairly quickly.  Good luck......

Dave 3+4

Fred1000 said:

Surgery or HDR brachytherapy combined with ADT & EBRT

Vascoda, 4 needle biopsies was taken in the area that the MIR shows cancer present and 14 others were taken to check the rest of the prostate. I Received pathological report and 7 out of the 18 cores was positive for cancer(all on the base on the right side). 6 had a gleason score of 3+4=7 and one was 4+3=7. 

An extra prosthetic extension was identified and two of the needle biopsies shows PNI. 
The urologist I'm seeing dr Alan E Thong at Stanford says I'm Stage T1C And he thinks he can get all the cancer out in one shot. I asked for a second opinion because Exta prostatic extention and SVI tells me it's T3B.

I saw a radiologist oncologist,  dr Patrick Swift from Stanford on Monday and he diagnosed me as stage T3B and showed me the MIR image. The areas were it infiltrate the seminal vesicles doesn't look as dark and he thinks it might be in the beginning stage.

I am starting on 18 months of hormonal therapy this weekend after a bone scan. I will then get one or two treatments of high dose rate brachytherapy and 6 weeks later start with 40 sessions of External beam radiation. I'm having second thoughs and are very afraid to start the hormonal treatment. 
am I making the right desicion? I am so confused and terrified.

I bought a book from a dr Mark Scholz and watched his videos on YouTube about the Azure ( high risk) stage of prostate cancer and it seems like the dr I'm seeing worked with him and knows him well. https://youtu.be/vtd3RzjE_aI

If I were you .i would try to get an app with both the radiologist and surgeon together and Hear both sides as to why one treatment would be better than the other and come to an agreement between the 3 of you ..if there is a good chance u can take it out and have it be gone ..THAN DO IT ..hormone treatment and radiation take forever and are no joke ..that's for sure ...side effects are 10 fold compared to surgery 

Hi Fred,

I will never forget the day in my Internal Medical doctors office before I had my biopsy he said "I think you have cancer".  What a blow but after I did learn it was cancer via the biopsy the immediate question in my mind was what do I have to do to either kill or arrest the cancer.  I felt the sooner I delt with it the better so I listened to the Urologist and Oncologist and went on from there.  Nobody wants to hear the cancer word but the guy behind my house is dealing with Pancreatic cancer which in my non medical opinion is worse than my cancer.  Take it one step at a time if it is cancer. It was easier for me to deal in smaller steps than think about the rest of my life all at once.  Your doctors should provide you with a treatment map if needed on your first future steps. All of us here either have had cancer at one point and are here years later to talk about it.

Dave 3+4