Newbie here and meeting Urologist tomorrow for next steps
Have had BPH issues for years and PSA fluctuating from 4-8. Had a few CT scans over the years and with PSA rising I talked Doc into MRI and have one lesion roughly 1cm x 1cm and PiRads 4. Meeting with my Urologist tomorrow to discuss next steps.
Prostate is 130cc.
Appreciate any advice or questions I should ask.
Comments
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He will likely recommend a biopsy. It should be a fusion biopsy targeting the lesion along with standard sampling on a grid. Ideal is retroperineal, as it has lower risk of infection. Ask about that. I was out for the biopsy, some aren’t. I’m glad I slept through it!
What is your PSA? Are you taking anything for the BPH?
I was similar, PIRADS 4 lesion, 140cc prostate.1 -
Yes, I am expecting a biopsy, and agree with your suggestion on type and perhaps being put out for it.
PSA is 4.17 this week, has fluctuated from 4-8 over past 5 months. I have focused heavily on diet, lifestyle and supplements over past 6 months, it may be helping overall but there is still the reality of a spot on the prostate and next steps.
What treatment did you do after biopsy?
Thank you
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Hi,
Your BPH is probably contributing to your higher PSA number. The biopsy will grade the aggressiveness of your lesion(Gleason score) and determine what you can do for treatment. If your score is 3+3 you could do active surveillance, if its higher(3+4,4+3,4+4,) you could be a candidate for surgery or radiation treatments. I have included a link for you to study.
Dave 3+4
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Thanks for the reply. I am expecting that will be his next step is a biopsy. I think I would prefer to be put out for it also. My research agrees retroperineal is the way to go, for lower chance of problems.
PSA has been checked monthly this year and has ranged from 3.8 to 7.9, with last two being 6.1 (April) and 4.2 (May).
I have been on Flomax for 12 years and was on Finasteride but was taken off last year due to low Testosterone, which returned to lower normal range in a few months.
What treatment plan did you follow?
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I am unsure about your reference to "retroperineal."
I had a transperineal fusion biopsy -
A transperineal prostate biopsy is a procedure that involves inserting a needle through the perineum, the skin behind the testicles, and into the prostate to look for cancer cells. The needle is guided by an ultrasound placed in the rectum. The doctor then takes multiple samples, which are sent to a lab where a specialist examines them under a microscope. The procedure is outpatient and takes 30–45 minutes
This was done at Cleveland Clinic with Nitrous Oxide first then local injections in the perinium and around the prostate. Great experience - done quickly, accurately and painlessly. Was back home in a couple of hours…
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You are correct, it is transperineal fusion.
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Update, Urologist is suggesting we wait. He had some concerns on the interpretation of the MRI which was not from hospital, it was independent. He said he will order an MRI from the hospital very quickly if he has any concerns.
Going to monitor PSA and keep an eye for six months. He feels the long term trend of my PSA is neutral and there is no concern. We looked at a 14 year chart and PSA levels today at 4.17 which is where we were 8 years ago. Also suggested that PSA would not have the drops it does if there was a cancer to be concerned about.
I am going to continue educating myself and perhaps get a second opinion.
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I have no idea where I came up with retroperineal 😀
@CanadianGuy, I was 3+3 on biopsy which was upgraded to 3+4 on second opinion by John Hopkins. I also needed to treat my BPH. I’d suffered a bout of urinary retention, did not want to do that again. I had HoLEP surgery to hollow out the prostate from the inside, removing 100cc of it. That also gave the urologist all that tissue to examine, which came back negative (yay). Now I remain on AS.0 -
Hi,
I think it a good advice in monitoring your situation during 6 months in a "clean" no drugs status. Finasteride surely has influenced your PSA levels during the period you took it.
Hopefully you are just confronting a BPH case.
Best,
VG
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Thank you, I agree that Finasteride may have reduced PSA some. I am heavily committed to a very clean lifestyle and diet and I can feel/see results. Will keep a close eye on PSA over next 6-12 months and react quickly if needed.
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Yes, size is a factor, maybe to my advantage here.
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I have considered HoLEP, and may keep it as an option. Very good news for you to have negative results on the tissue.
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My PSA went from 5+ before the procedure to 0.43 after. This is a common sort of result, as you get rid of lots of prostate and a lot of the associated inflammation that comes with BPH. My PSA has since risen to 0.87, but was that value on the last two tests, six months apart. I have another test in a month.
If the BPH is bad enough to treat, there are knock on positive impacts of a HoLEP on dealing with PCa, especially for someone with a humongous prostate. It’s real surgery, so I wouldn’t do it on a whim.
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Thanks @centralPA. @CanadianGuy, I was awake throughout my biopsy. While it wasn’t the most comfortable procedure I’ve ever had, I didn’t find it to be much more uncomfortable than a digital exam can be but I came away considering the prostate a”most inconvenient gland.” It took about 6 months from blood test to eventual biopsy. I don’t think I started understanding until after the biopsy and follow up PET/CT scan to determine any metastasizing.
There’s a LOT to consider with PCa so be patient with yourself. I have found that I needed to learn a bit just to begin to understand what questions were important to me and my situation.What part of Canada is home?
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Thanks for the feedback @RonB I agree it is a journey and I believe firmly in not being a passenger, I need to be educated and involved, I am learning more everyday.
The east Coast of Canada is home. New Brunswick more precisely.
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