CSN Login
Members Online: 8

You are here

CSN Outage 12/5/19

CSN will be down for maintenance on 12/5/19 from 10pm-12pm EST. We apologize for the inconvenience. 

Need some advice

jc7908
Posts: 5
Joined: Mar 2017

I am 53 yrs old, 5'9" and about 150lbs.  Have never had any serious health issues.  Here's my situation:

My PSA levels started going up last year, which coincidentally was when I started riding the stationary bike on regularly basis (3-4 times a week).  I have since stopped riding the stationary bike.

PSA (ng/mL)
Date Value 
01/31/2017 4.99
12/16/2016 5.77
10/24/2016 4.78
08/24/2016 4.13
03/14/2014 3.59 

My urologist recommeneded a biopsy but I requested an MRI first.  I recently underwent the multiplanar multi sequential pre and post contrast enhanced MRI.  The results showed no abnormalities or tumors but there was an area of restricted diffusion that looked suspicious.  The radiologist graded the area a PI-RADs 4.  My urologist recommends a MR-fusion biopsy.

I don't have any early signs or indications of PC so I'm still in the somewhat denial stage, although after reading the threads from this forum, I understand that the lack of indications doesn't mean much.   I'm wondering if I should get a second opinion on the MRI or just get the biopsy.  If I get the biopsy, should I have him take samples from only the suspicious area and not other areas of the prostate?  

I'd appreciate any advice/feedback.  TIA.

MEtoAZ
Posts: 37
Joined: Feb 2016

I had the standard 12 core biopsy back when in '15 when I was 52.  They did detect cancer and had an MRI following which did not really accomplish a lot but it was not using the latest generation "Tesla 3" MRI.  Your urologist seems to be up on latest trends which is good and with the MR-Fusion, he should be able to more likely get a core from the suspicious area.  This would seem to be a better way to determine if you have cancer or not wihtout the traditional 12 core, somewhat trial and error approach.  With your PSA elevated for this long, I would get the biopsy.  Even if they find cancer, this would likely be very early stage and you appear to be in in excellent condition and this is something you can absolutely beat. 

hopeful and opt...
Posts: 2226
Joined: Apr 2009

I am in an Active Surveillance program where, so far,  I have had five MR-fusion biopsies, so I am very knowledgeable about this procedure.

Since the prostate can change to some extent, it is better that you have the biopsy sooner than later.

At my biopsies, some of the cores that are taken are targeted, and others are random in the rest of the prostate. Not only can the targeted biopsy find cores of cancer, but also cancer can be found in  random ones, so have both done. Generally there are approximately 15 cores that are taken at my biopsies. 

A PI RAD score of 4 needs to be looked into to see if there is cancer or not.........the PI RAd goes from a low of 1 to a high of 5, so you definitely want to biopsy.

As you already figured out bike riding, sex, even a hard stool before a PSA can elevate the blood test.

jc7908
Posts: 5
Joined: Mar 2017

Thanks for your feedback guys.  I think I will schedule the biopsy.  Nevertheless, do you think it's necessary to get a second reading of my MRI from another radiologist?  Does anyone know if the PI RAD is an objective determination?   

H&O, did you have full anesthesia for the MR fusion biopsy?

hopeful and opt...
Posts: 2226
Joined: Apr 2009

I have confidence in the MRI that I have done and  radiologists that read my MRI since I am a patient at a high volume center of excellence in Los Angeles, however there is difference in  abillities of staff and radiologists, at various centers, some not being excellent . ...to be honest, I have not heard of a second opinion of the radiologist results. You may or may not wish to explore this, depending on where your MRI was done....was it a center of excellence?

PI RADs....Here is a discussion about Pi RAds

https://csn.cancer.org/node/304798

If you note in this discussion, I list the likelihood of cancers found by each of the five numbers in the Pi Rad scale.

I did not have a full anesthesia for the fusion biopsy, but the prostate is desensitized to liimit pain (in my case, there is variance of being uncomfortable, in the different biopsies that I have done , probably due to how the prostate was desensitized before the cores were taken; basically there is a snap when each core is taken, like a staple gun hitting the prostate)...it's very rare that a full anesthesia is recommended. The biopsy is uncomfortable, but bearable.....it takes about 15 to 20 minutes..... pretty much all of us have had a biopsy without anesthesia, others may wish to comment.

To add, the results of the MRI readings are locked into a three dimensional biopsy machine, in my case it was an Artemis machine, then the biopsy is done in a similar way to a standard twelve core biopsy done by a urologist in his office.

 

 

Clevelandguy
Posts: 469
Joined: Jun 2015

Hi,

I think the urologist that takes the biopsy would sample the whole Prostate(several cores), and let's hope a sample or two around(in) the suspicious area(make sure he does hit that area).  No use doing the biopsy IMO if he did not hit the suspicious area.  Good luck...................

 

Dave 3+4

jc7908
Posts: 5
Joined: Mar 2017

H&O, my urologist did not mention Artemis or desensitizing the prostate.  Is Artemis a robotic biopsy machine?  I asked my urologist for a second opinion on my MRI and he referred me to Geoffrey Sonn, at Stanford Univ. Medical Center.  It probably makes sense to have the biopsy done there.

Thanks again everyone for all the feedback and info so far.  I'm really grateful that I found this forum with so many poeple who are willing to share their knowledge and experiences. 

Josephg
Posts: 165
Joined: Jan 2013

I had no general anesthesia for my biopsy.  As 'hopeful' indicated, I also had a local anesthetic injected into each side of my prostate, prior to the biopsy.  These two injections pinched a bit momentarily, uncomfortable, but not really painful.  Then, for the biopsy, one side of my prostate was totally numb, and I just felt a minor 'push' after the snap sound, as the needle entered the prostate and took its core sample.  The other side of my prostate was not quite as numb, and I felt a minor twinge that could be interpreted as uncomfortable, for most of the snaps.  So, overall, the biopsy procedure itself was no big deal.

Grinder
Posts: 442
Joined: Mar 2017

I had local anesthetic, and only part was anesthetized. The rest felt like a bee sting in my you know where. But it wasn't anything you can't survive, and its over quickly. I didn't run screaming out of the room or anything, I just wanted to get it over with.

hopeful and opt...
Posts: 2226
Joined: Apr 2009

 

MRI/TRUS fusion biopsies, why MRI/TRUS prostate biopsy. |

http://sperlingprostatecenter.com/mritrus-fusion-biopsies/

http://yalemedicine.org/urology/conditions/prostate-cancer/prostate-cancer-yales-assertive-approach-to-watchful-waiting.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581822/

Stanford has the Artemis machine........see below

http://abc7news.com/health/new-imaging-system-at-stanford-monitors-prostate-cancer/186665/

Please keep us in the loop

H

 

DianeC926's picture
DianeC926
Posts: 2
Joined: Mar 2017

My 88 year old dad decided to do this surgery without confiding in me. Of course the device failed and he is beside himself, what's worse is that he has put a call into the doctor twice now to find out what had happened and what can be done but low and behold, no answer back. My heart breaks first of all that any doctor would do this surgery on an 88 year old man with this kind of risk failure just so he can hold his penis when going to the bathroom a few more years is beyond me, really doc? Needless to say my dad wants it removed as he says its uncomfortable when sitting down but would have lived with this device inside had it worked, I am obviously trying to convince him into leaving it in rather risk going under again, is this wrong of me?

Does anyone know the success rate on this, especially in an 88 year old man? The doctor not calling back has me suspicious as well, would this be considered malpractice? 

I can't say I am happy about this and I am trying to help my dad now in any way I can. I would so appreciate the help if someone has any suggestions on how to further help my dad.

Thanks so much

Diane

 

 

hopeful and opt...
Posts: 2226
Joined: Apr 2009

You can click on the cover page, upper left hand corner, under discussion topics to do this...best

jc7908
Posts: 5
Joined: Mar 2017

Hi Everyone,

I had my biopsy at Stanford last week and got the results this week.  Here goes:  20 cores taken, 5 cores Gleason 6 (3+3) and 2 cores Gleason 7 (3+4).  I have a follow up appointment with the urologoist in a few weeks to go over options.  My urologist specializes in RK so I'm sure that's what he will recommend.  Can you guys suggest some questions I should ask during my appointment?  

I've read quite a bit on this board about RP vs CK vs other radiation treatments vs AS so I understand that there isn't a perfect solution/treatment but it sounds like CK offers the least amount of side effects and seems to lead to the same long term results as RK.  Can those who have undergone CK comment on the following:

What happens to the prosate after CK treatment?  Is it basically a "dead" organ that just exists in your body?

where can I find a list of the top CK surgeons?

What other factors should I consider WRT CK?

Is CK more effective on early stage PC?

I'm thinking that I should treat this while I'm relatively young and healthy, rather than going on AS.  On the other hand if I choose AS, would I need to have regular biopsies, or only if PSA level started to elevate?  I guess AS is almost like russian roulette.  Sorry, I'm just rambling now.

Anyway, appreciate any feedback.  Thanks.

MK1965
Posts: 179
Joined: Jun 2016

As old adage says: "Measure twice before you cut!", I would say think 100x before deciding on surgery.

I was 51 at time of dx and surgery and I did not have good experience with my 7 1/2 months post op. If you plan to radiate stick with that. I wanted to radiate but changed my mind and went surgery route which did not turn well for me. Being young and in good health, I was told I am perfect candidate for robotic surgery which failed to produce expected results.

At biopsy I was 4+3 which was downgraded post op to 3+4.

Just my bad outcome. Now, no use to complan. Damage is done. I can not go back. If I could, I would do nothing but monitoring and when treatment becomes necessary than I would pursue it. For me QOL  always weighs more than quantity. Everybody has different priorities. You will find men who are praising there outcome and is up to you to buy it or leave it to them.

Good luck with whatever you choose.

MK

Clevelandguy
Posts: 469
Joined: Jun 2015

Hi,

Both RP or CK are good choices for PCa.  All treatment options have side efects so study them all before you make your choice.  From what I know about CK the prostate tissue slowly dies over months/years but I don't know if all the tissue dies.  You should be able to get some good suggestions from your doctors on who has the best latest equipment for the treatment plan you choose.  Don't be afraid to ask for a second opinion on treatment modes or hospitals.  Do a lot of homework so you will know what to expect.  Good luck and keep in touch with us if you have any questions.

Dave 3+4

Grinder
Posts: 442
Joined: Mar 2017

Just as an addendum... I have to point out that RP was the right decision based on my OTHER prostate issues as well. In cases like mine, RP was necessary, it wasn't about choosing the most reliable or the fewest side effects. It had to be done because it fit my profile exactly. Judging from other posts in this forum, CK is a better option if there are no other prostate issues presently, or in the future hereditarily. So it's about what fits your profile best, between you and your doctor. I would suggest not only asking current opinions, but reading back into the archives of this forum, looking for pertinent headings that will give you a wide variety of others' experiences.

GeorgeG
Posts: 127
Joined: May 2017

The whole point of AS is to avoiding treating a PC which is not life threatening. Some PC is slow growing and in fact if a man lives to 85 he has a 50-85% chance of dying with but only a 3% chance of dying of PC. The trick of course is figuring out where to apply AS because some PC's are more aggressive and only have a shot at cure if treated early. From the literature it appears that AS is getting more refined and the data is getting better about outcomes and better institutions are leaning into this choice where appropriate. Make sure that you get all of your advice on this from a high end institution that is associated with the latest research like a teaching hospital. I also prefer to get at least some of my advise from a doctor that is not paid on one choice, IOW they are treatment agnostic and get paid a salary regardless like at Hopkins and Mayo. One of the most frequently cited sources for expected outcomes is the MSK nomogram which use thousands of cases to compute your likely outcomes. Treatment and AS are both gambles of sorts, that's why it is so important for you to be honest with yourself about your priorities. As has been stated here and in many other threads, some guys lament their side effects, some lament not acting sooner. Many of course are thankful for their excellent choices. Play the movie forward in your head. How would you feel if treatment is successful/fails. How would you feel if AS is successful/fails. Only you know your priorities And your baseline status. Some guys for instance don't seems to care about ED at all. For others it's a real issue.

As far as radiation vs surgery, the outcomes are similar but the side effects and there progression are different. ED for instance starts of immediate for surgery and is delayed for radiation if it occurs. Your health status (competing mortality risks) and age also play into the decision. There are individual stories here about good and bad outcomes for both but let high volume, quality data be your guide. Lastly, the skill of the doctor is very important. Make sure that whoever treats you has done hundreds if not thousands, is up to date on the latest data and helps you through your choices. That's at least half the battle. I had surgery at Hopkins (4,000 open RP's) and now SRT with HT at Mayo (30 years and over 100 papers). I also went to MSK. RP results were 95% continence, partial ED, PC not cured. I have no regrets. SRT and ADT have less than a 50% chance at cure for me but it's the right choice for me and I am 2 months in. I have no regrets. 

Good luck and remember that while there are stories here about poor outcomes, there also thousands of stories of excellent success In cure or at least significant delay. 

 

George

 

Subscribe to Comments for "Need some advice"