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Is Treatment Delay Harmful?

rodgersmail
Posts: 2
Joined: Jun 2018

An MRI last month showed I have prostate cancer. A fusion biopsy requiring general anesthesia was scheduled, but I had a TIA (blood clot in vessel leading to eye) a week before. Due to anesthesia concerns--general anesthesia shortly after a stroke increases the risk of a recurrent stroke--the biopsy has been delayed 3 months. I wonder if the increased danger of a perioperative stroke due to anesthesia is greater than the increased danger of delaying treatment.  I have no idea how fast prostate cancers grow. If it's aggressive (assuming the worst), will the delay be harmful? Will I need another MRI? Thank you.

Old Salt
Posts: 720
Joined: Aug 2014

Sorry to read about that unexpected medical set back. I hope that you won't have another TIA anytime soon. 

Now, with respect to your question, it would be good to know more. You obviously don't have Gleason scores, but what did the MRI report show (ask for a copy)? VERY MUCH IN GENERAL, prostate cancer is slow growing and a reasonable delay for solid medical reasons is acceptable. Just my opinion, of course, and I didn't go to med school! 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3313
Joined: May 2012

Rodgers,

My mom had dozens (possibly even hundreds) of TIAs over the years, before stroke took her life. Some days she would have several in one day.  I know they are frightening.

I agree with Old Salt that almost always (probably 98% of the time, but this is a pure guess) there is no rush to have a PCa biopsy. Is there some reason they cannot do a conventional biopsy with only local pain medication ? What is your PSA ? Unless it is quite high or having rapid increase, waiting is very likely no issue. But of course your urologists is the best source for the answer to the question you asked us.

 

"Aggressive" is a relative thing among cancers. For PCa, nearly all are indolent, or slow-moving. But even the 'aggressive' ones are fast relative to the other PCas.  None are 'fast' relative to, say, colorectal or acute leukemia, or some others.  I suspect that your urologist will tell you that the wait is not an issue. But do ask him.

max

Clevelandguy
Posts: 462
Joined: Jun 2015

Hi Rogers,

I had my biopsy in the doctors office.  Was not bad at all, just felt a pinch when they took the sample.   I was completley awake.  Do they want to put you under with a general anesthesia for the Biopsy?  If they took the MRI for your Prostate I don't know why you would need another one.

 

Dave 3+4

ASAdvocate
Posts: 116
Joined: Apr 2017

Only a biopsy can diagnose prostate cancer. That is fact. Who told you otherwise?

They must have been guessing that a high PIRADS score could possibly indicate cancer. What was the PIRADS?

Prostate cancer is very slow growing. Mine was disgnosed nine years ago and is still indolent, so don’t worry about a few month’s delay.

rodgersmail
Posts: 2
Joined: Jun 2018

Thanks to the 4 people who replied so far. I look forward to further replies and even more info. I called my urologist practice after my TIA and left a message that was a much-simplified version of my post here.  A nurse called back and told me that prostate cancers grow slowly, so there was no problem. I had the feeling she knew no more than I, hence this post. My PSA in May, 2016, was 4.6 and my rectal exam then was negative for a lump. In March, 2018, my PSA, the last one I had, was 5.1. I had a pelvic MRI, which showed that I had a 5-mm tumor with a PIRADS score of 5, which I understand means a 90% probability that it's cancer. I want the new MRI fusion biopsy because it's far superior to the classic biopsy. It takes much longer--close to an hour--than the classic biopsy and the patient must lie perfectly still all the time, which is best accomplished under general anesthesia. My MRI will be over 4 months old by the time of my rescheduled biopsy, and I wonder if it will be out of date. The anesthesiologist dictated the 3-month wait. An allied question I didn't ask but am curious about is whether the anesthesiologist was being unduly cautious in setting the 3-month wait. My TIA wasn't a full-fledged stroke and did not involve the brain. But all she knows is that it was a "mini-stroke," as I described it simply to the receptionist. I expected a medical person to call back for a fuller description of the TIA, but no one did.

lighterwood67's picture
lighterwood67
Posts: 213
Joined: Feb 2018

My biopsy with the aid of 3T MRI imagery took 22 samples out of a normal size prostate.  I was wide awake.  I did feel some of the samples being taken.  Actual pain was negligible.  Imagery showed Pirads 4 and 5.  Biopsy showed Pirad 4 negative .  Pirad 5 positive.  Biopsy graded Gleason 4+3=7.  Seems to me the medical folks would address your possible stroke issues first and then  the possible prostate issue.  The medical folks will have to steer you on that one.  Good luck to you.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3313
Joined: May 2012

rodgers,

No one here can say whether or not your anesthesiologist is or is not being overly cautious. None of us is a doctor, and none of us writes as such.  To do so would be unethical and would also violate CSN protocols. (I actually have known two MDs who wrote at these Boards, but incognito, not as a doctor.)  The writers here share their own experiences and insights, and may give opinions, but not to the point of second-guessing a medical authority.

Few people have personal anesthesiologists; virtually everyone going for a surgery or other proceedure uses the doctor in rotation.  If the issue were really troubling me, I would ask another anesthesiologist his or her view of the matter.  You would have to pay a consultation fee, but it would yield peace of mind.

Your two PSA tests from 2016 'till 2018 show a very, very slow vector or doubling rate (these terms are synonomous and used interchangeably), which further confirms that you need not hurry anything.

max

VascodaGama's picture
VascodaGama
Posts: 3033
Joined: Nov 2010

We all freak out when told about cancer and the first though is to get rid of it the soonest thinking that cancer is in a speedy racing competition. Any one suggesting “wait” or "delaying" an intervention becomes suspicious to trust. Surely institutions work with schedules so that they tend to fit interventions according to their possibilities not the patient’s, unless urgency exists.

Your present cancer status, if any, would not be much different in three months (or even longer), apart from that any of the available treatments would provide the same result if done today or in three months time. I think you better follow the anesthesiologist advice and wait.

For the moment you still have no diagnosis of cancer. PIRADS predits it for the detected deformity (5mm) but this could be a tumor made of calculi (not cancer). The PSA is high and has slowly increased showing a pattern of being from cancer, however, BPH could exist too. I wonder if you had any urination issue or other symptom in the past that could identify hyperplasia.

A sample of the tissue is required (biopsy) and if positive, the choice of a treatment would be judged on the location of cancerous cells (biopsy, DRE and image exams). I do not know your age or other life issues but you would need to balance the risks from therapies against quality of life.

In my lay opinion you shouldn't rush. Get all the specific tests required for the diagnosis of the cancer and those specific to other illnesses or health issues that could interfere in a final decision. Do things coordinately and timely. Much work and study to be done before any decision.

Welcome to the board,

VG

 

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