Diagnosed with PIRADS 4 - Need Help Finding the Best Care

Hi Swags,

You have at least one thing in your favor, you are 3+3 which gives you plenty of time to research and decide.  The path you choose only you can make based on doing your homework.  Hopefully you will be confident when you make that decision based on your research on what is best for you and your family.  I think everyone goal is to get rid of the cancer with minimal side effects and minimal organ and tissue damage. Both methods have side effects, sometimes minor, sometimes severe.  People have done surgery with good results and bad results.  Same way with Radiation but some people will swear there is only one way to go, but there is not.  Some people in my opinion let their bias cloud their decisions.  You can also choose Active Surveilance which you just monitor the cancer for months or years. I know too many choices.........

With all that being said I had my surgery at University Hospitals in Cleveland, my Urologist/Surgeon was Dr. Ponsky and he is very good with Robotic Surgery, came highly recommended by my Internest.  I had a very easy recovery with no infections, ED went away totally in about 1.5 years, I still drip a drop or two of urine with heavy exercise so I wear a light pad every day. Just got my latest PSA test results today, over 6 yrs. with undetectable readings.  Cleveland Clinic also does excellent  work with either Robotic Surgery or external beam radiation via Cyberknife.  Don't know where you are at in Michigan or how far you are willing to travel.  I don't think you can beat the two punch combo of the Cleveland Clinic and University Hospital.  I am from the Akron area and if you have anything seriously wrong with you most people choose one of these two.  Sound like you are doing the right thing with your research, I am sure other will chime in with their experience.

Dave 3+4

Hi, John.  Welcome to the board. 

I would like you to share more details of the diagnosis because it doesn’t make sense what you write above. The biopsy results do not imply the statement in the MRI report. Something is not matching up. Is there other data, exams or tests?

What took you to do the biopsy? Did you have symptoms along the years that took you to exams or needed interventions?

What is your PSA's histology?

Please note that MRI do not diagnose cancer.  A biopsy does it. Either, the biopsy missed an aggressive tumor or the MRI report is erroneous. 

Low risk cases are usually directed to active surveillance (AS) which in my opinion is the preferable option for a case with 1 out of 12 cores positive of Gleason score 6 (3+3). You may want to get a second opinion from another urologist or consult a medical oncologist specialist in prostate câncer. 

Best wishes, 

VG 

As folks above have stated, at the end of the day, this decision regarding treatment options, or not, is yours, and yours alone, to make.  Continue to do your research as you are now doing, but be wary of entering the realm of 'analysis paralysis'.  You will not find one person, that after talking to him/her, will make that decision look obvious, easy, and definitively concrete to you.  I can personally assure you that it does not work that way.  You will eventually have to make this decision yourself, and once made, you cannot look back and/or question it.  PCa survivors look at the present and the future only, as it is the only constructive means to achieving and maintaining an acceptable quality of life as a PCa survivor.

That being said, I, as a lay person, and not a medical professional, do strongly encourage you to find and engage a Medical Oncologist, one you can trust and have a great doctor/patient relationship with for your entire PCa journey.  A Medical Oncologist is not predisposed to, or have any special interest/relationship/preference with any specific treatment.  A Medical Oncologist will review your situation, they will discuss the options and anticipated results and pros and cons of each, and they will make specific treatment recommendations to you that are in both your short-term and long-term best interests.  They may recommend Active Surveillance for you, based upon the information that you have provided us so far.  If they recommend surgery, and you agree, they will refer you to a surgeon who they know and trust will perform a great surgery on you.  Likewise, if they recommend radiation and/or hormone treatments, and you agree, they will personally manage the hormone therapy, and they will refer you to a Radiation Oncologist who they know and trust will perform great radiation therapy on you.

I have been a PCa survivor, who has been under the guidance of a Medical Oncologist for my entire 10 year PCa journey.  Under the guidance of this Medical Oncologist I have gone through surgery, hormone treatments, and radiation therapies.  Recommended surgeons and Radiation Oncologists have come and performed their specialties on me, and then they went away, after their jobs were complete.  My Medical Oncologist has remained with me throughout my entire PCa journey, and this is the one person that I meet with every 4 months to review my PSA results, and to discuss my current state and future plans/strategies for my PCa journey.  Most recently, my Medical Oncologist helped me obtain access to a drug for only $300 per month (which retails for $7000 per month, or $2000 per month, after insurance) for part of my current treatment plan.

I wish you the best of outcomes on your PCa journey.

I can understand that your are concerned about the (somewhat ambiguous) MRI report. Reading prostate MRIs is not easy at all. Could you get a second opinion from someone who interprets prostate MRIs 'for a living'?