prostrate cancer

12tugod
12tugod Member Posts: 23 Member
edited August 2023 in Prostate Cancer #1

2021 I was diagnosed with a rising PSA 5.0. The DR right of the bat recommended a MRI which revealed suspicious legions then onward to biopsy. The biopsy noted an agressive legion Gleason 8 along with 2 other gleason 6 on left side. In addition, 3 other gleasons 6 on right side. . I chose the HIFU option on the left side. fast forward, after a 6 month follow up biopsy, the left side was clear but the right revealed 4 gleason 6s and 1 gleason 7 (3/4). The DR is recommending (1) prostrate removal, (2) radiation. I am choosing active surveillance. My research says the gleason 3/4

is a group 2 VS 4/3 is a group 3. I appreciate any responses or advice on this issue.

PS: HIFU is expensive as Heck. (So is my life and well being)

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Comments

  • lighterwood67
    lighterwood67 Member Posts: 374 Member
    #2

    Just curious. Did you have any side effects from the HIFU treatment? And currently what is your PSA? I had a RP in March of 2018. Currently, my PSA is < .04ng/ml. I am continent. I am intimate with my wife. Best of luck on your journey.

  • centralPA
    centralPA Member Posts: 238 Member
    #3

    Hi @12tugod sorry you find yourself here.

    Youre playing a risky game for sure. Some questions to help understand what’s going on.

    After your HIFU did you have another MRI? Doesn’t sound like it.

    On the right side, was the 3/4 found where the MRI had previously identified lesions? Was this biopsy a different sampling approach? More samples?

    What percentage of the 3/4 was graded 4?

    How did the HIFU go? Catheter in for a week?

  • Josephg
    Josephg Member Posts: 381 Member
    #4

    I had 3+4 results from my biopsy. I had a prostatectomy and thought that I was finished with PCa. However, I had a 4+3 after my prostate was removed and analyzed, and a still detectable PSA. I had six months of hormone therapy and IMRT radiation to the prostate bed, and again thought that I was finished with PCa.

    Since then, I had one recurrence a decade later and SRBT radiation therapy, in my left inferior pubis ramus (local metastasis), and I've just come off a two year hormone therapy cocktail. I'm hoping to remain cancer undetectable for as long as possible.

    No two prostate cancer cases are exactly alike, but I strongly recommend that you get at least one additional opinion from a "Medical Oncologist", before you make your final decision regarding next steps (or no next steps).

    Yes, long life and well being are important, for sure, but I suggest that you not ignore the presence of 3+4 PCa.

  • 12tugod
    12tugod Member Posts: 23 Member
    #5
    https://csn.cancer.org/discussion/comment/1705186#Comment_1705186

    No side effects from HIFU. Only the left side revealed gleason 8. Left side is clear of cancer. I should have had full Prostrate HIFU. Dang 1 week with cath was the worse for me. First time in my life with cath.

  • 12tugod
    12tugod Member Posts: 23 Member
    #6
    https://csn.cancer.org/discussion/comment/1705187#Comment_1705187

    The DR says 6 months after HIFU, it is protocal to get a MRI and a biopsy. The MRI did not reveal any warnings (strange), but the biopsy did. By the way, today I had another PSA. the result went up from 1.970 (11/2022) to 3.570 (04/2023) Got me thinking again. The 4 was 10%. Cath was terrible, never experienced that before.

  • centralPA
    centralPA Member Posts: 238 Member
    #7

    That last PSA jump is a fairly quick doubling rate, unfortunately.

    Im assuming your G8 was 4+4 and not 5+3, correct?

    I would at a minimum want another PSA in 3 months.

    My gut feeling is you will have to come off AS in the not too far future. Maybe immediately.

  • lighterwood67
    lighterwood67 Member Posts: 374 Member
    #8
    https://csn.cancer.org/discussion/comment/1705199#Comment_1705199

    Still curious. What is your current PSA? And by the way, if you think the catheter was bad, you better hope you do not get a cystoscopy. For me, that was one of the most memorable moments in my life.

  • 12tugod
    12tugod Member Posts: 23 Member
    #9
    https://csn.cancer.org/discussion/comment/1705204#Comment_1705204

    HIFU ablated GS 8 (5+3) Target left 40%

    GS 8 (3+5) LLM 50%

    GS 6 LLA 15%, Target right 5%.

    Left side all clear.


    I am dealing with the right side now. Tough.

    My next follow-up with DR is in August 2023.


    What I am seeing from others is the side affects after what other methods they choose. Now I feel so normal other than mental worrying.

  • Clevelandguy
    Clevelandguy Member Posts: 999 Member
    #10

    Hi,

    I’m curious, why not HIFU on the right side. Seems like it worked for you on the left side.

    Dave 3+4

  • 12tugod
    12tugod Member Posts: 23 Member
    #11
    https://csn.cancer.org/discussion/comment/1705218#Comment_1705218

    According to the DR at the time the legions on the right side was deemed safe zone meaning gleason 3/3 not sirous. But you have a good point that I need to address with him on next visit.

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,812 Member
    edited April 2023 #12

    12tugod,

    I am stunned that any oncologist would put you on A/S, with your clinical history. None of our resident lay experts on A/S have chimed in yet (whom I noticed), but I doubt you meet Best Practices A/S qualifications. I am the first to admit that I am not well versed in A/S, but I believe that JUST a Gleason of 8 would disqualify in most protocols. The fact that your more recent biopsy showed only a Gleason of 6 does not by any means prove that no Gleason 8 remains.

  • Rob.Ski
    Rob.Ski Member Posts: 141 Member
    #13

    If HIFU is very expensive, would it have cost the same to do the entire prostate vs. half? If you need a second round for the other side, are you paying again? Haven't seen too many that have had this treatment.

    Biopsies tell you that you do have cancer, not 100% that you don't. The needle can miss the cancer, it's only a small sampling of the gland. After a surgery, the entire prostate can be evaluated. Not uncommon for the pathology to change.

    What did you PSA do after HIFU?

  • ASAdvocate
    ASAdvocate Member Posts: 193 Member
    #14

    Yes, technically, you may be within the AUA guidelines to do AS with only one core having ten percent of Gleason 4 pattern. But, the number of positive cores would sway me to agree with the others that you are taking some risk, and may not be on AS for long.

  • 12tugod
    12tugod Member Posts: 23 Member
    #15
    https://csn.cancer.org/discussion/comment/1705325#Comment_1705325

    HIFU Feb 1 2022/ PSA's:

    05/06/2022 - 2.100 08/09/2022 - 1.580 11/08/2022 - 1.970 4/23/2023 3.570

  • 12tugod
    12tugod Member Posts: 23 Member
    #16


  • Old Salt
    Old Salt Member Posts: 1,308 Member
    #17

    Advice from the American Urological Association:

    1. Clinicians should inform patients with intermediate-risk prostate cancer considering whole gland or focal ablation that there are a lack of high-quality data comparing ablation outcomes to radiation therapy, surgery, and active surveillance. (Expert Opinion)

    Clinically Localized Prostate Cancer: AUA/ASTRO Guideline (2022) - American Urological Association (auanet.org)

  • 12tugod
    12tugod Member Posts: 23 Member
    #18
    https://csn.cancer.org/discussion/comment/1705335#Comment_1705335

    Thanks for additional info. Focal ablation (HIFU) worked for me on the left side without all to completions that others are dealing with.

  • 12tugod
    12tugod Member Posts: 23 Member
    #19


  • 12tugod
    12tugod Member Posts: 23 Member
    #20
    https://csn.cancer.org/discussion/comment/1705187#Comment_1705187

    I had that following MRI results on Dec 9 2022:

    1. No lesions are seen suspicious for clinically significant prostate cancer

    2. Post ablation changes in the left prostate gland with left shift of the prostatic urethra.


    PI-RADS CLASSIFICATION (Probability of a clinically significant cancer)

    1 - Very low (highly unlikely)

    2 - Low (unlikely)

    3 - Indeterminate (equivocal)

    4 - High (likely)

    5 - Very high (highly likely)

    Narrative

    PROCEDURE: Enhanced , Unenhanced MRI Pelvis


    CLINICAL INDICATION: prostate cancer


    TECHNIQUE: Using a body phased array coil small field-of-view imaging of the prostate was performed using the following sequences; [axial T1-weighted, axial T2-weighted, sagittal T2-weighted, coronal T2-weighted, diffusion-weighted]. Axial T1-weighted

    images [with fat suppression] through the prostate were obtained before and [dynamically] after the intravenous administration of IV contrast.

    Using a large field-of-view, the entire pelvis to the level of the aortic bifurcation was imaged with the following sequences fat suppressed T2-weighted, Axial T1-weighted images ]

    Postprocessing images with DynaCAD software were obtained and submitted for analysis.


    COMPARISON: Prostate MRI from 11/12/2021.


    PSA level: 1.4 ng/ mL in 8/2022.


    FINDINGS:

    Prostate Size: 3.5 x 2.4 x 4.1 cm.

    Volume: 17.9

    PSA density 0.07 ng/mL/cm3



    TRANSITION ZONE:

    * T2 images demonstrate heterogeneous multinodular appearance, without evidence of suspicious nodules.

    Post ablation changes in the transition zone with left shift of the prostatic urethra.




    PERIPHERAL ZONE :

    No focal lesion of low signal intensity in T2 weighted images, restricted diffusion or focal enhancement in the peripheral zone


    Post ablation changes in the left peripheral zone.


    Extraprostatic extension N/A


    Seminal vesicles: Normal serpiginous appearance without thickening of the walls, abnormal restriction or enhancement


    Bladder: underdistended bladder, limiting the evaluation of its walls.


    Lymphadenopathy: No significant lymphadenopathy by size criteria.


    Bones: No suspicious osseous lesions.


    Other: None

    TRUSS BIOPSY on FEB 13, 2023 finding multiple 3/3's and one 3/4.


    I am confused. help me with advice. How can this be?

  • 12tugod
    12tugod Member Posts: 23 Member
    #21


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