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My MRI/Ultrasound Fusion Targeted Biopsy Experience

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

hello, good people. 
i would like to share with you my MRI/Ultrasound fusion targeted biopsy experience. as some of you may know, there were three lesions found on my prostate during my 3T mpMRI. one was a PI-RADS 4 and the other two were a PI-RADS 3. well, my uro recommended i have a MRI/Ultrasound fusion targeted biopsy.

my uro who performed the biopsy was dr. cara cimmino. she and i discussed my situation and she decided in order to prevent risk, she would only target the three legions and not take anymore samples. so she prescribed me bactrim for the antibiotic, magnesium citrate for a laxative and two pills of valium to reduce anxiety. 

i was scheduled to take the laxative the night before. i had water diarrhea. for most of the night, but luckily, it subsided 'round 2am eastern time. the bactrim i took at the next morning at 8am and i waited to get to the hosp. to start the procedure before i took the valium. right B4, dr. cimmino performed the biopsy, she performed a DRE and said that it felt normal. the nurse gave me an antibiotic shot, in my behind and numbed my rectal area. then she proceeded to perform the biopsy. she took like three samples from each lesion and told me that everything went well. she says the results should be back within a week. 

when i tell you i felt every nook and cranny, OMG. i thought the valium would knock me out. the valium didn't kick in until after the procedure was over. the biopsy took about 15 - 20 min. so, i'm guessing i'll know the results by this or next week.

VascodaGama's picture
VascodaGama
Posts: 3029
Joined: Nov 2010

Sw,

I laughed at your comments. What an experience. I hope the results confirm previous findings and that you can proceed with a more reliable clinical stage in hand.

It will be helpful in the decision making process.

Here is your previous thread and history;

https://csn.cancer.org/node/317774

Best wishes

VG

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

thank you, so much. i've been stressing prtty bad. one guy said he think i may have a gleason 6 or 7. i only pray that it's not cancer

prostatebiopsyblog
Posts: 2
Joined: Mar 2019

I can sympathize with the stress.  I had a single PIRADS 4 lesion found on an mpMRI recently and it was 3 long weeks for the results of the biopsy.  I had a 12 core sextant biopsy plus two additional UroNav fusion directed cores targeting the lesion from different angles.  Thankfully, no cancer was found, only some abnormal gland cells like I had in my first fusion biopsy 10 years ago.  Of course, there is always the risk of a false negative.  Wishing you the best for diagnosis and if treatment is necessary.

VascodaGama's picture
VascodaGama
Posts: 3029
Joined: Nov 2010

I do understand your stressful moment. We all go through the same feelings while waiting for the conclusions of the diagnosis. But being positive is not the end of life. It is not a death sentence. There are many means to deal with the facts. I think it will give peace of mind to every body if one knows exactly what one has. I say these for those following similar steps because you have been already diagnosed positive as commented in your other thread.

Let's be positive.

VG

jimbolow
Posts: 1
Joined: Apr 2019

I had a PSA of 14. Went to the uroligist, After a finger probe he said the right side was a little hard(not enlarged). Urine sample showed no blood or infection. I dont have any symptons for a failing prostate nor family history for this kind of cancer. Doctor wants to do a biopsy.He said that a PSA level at 14 and my age of 61 is probably 50/50 chance of being cancerous. Ive read that a biopsy could cause bleeding that may spread into the blood stream and make matters worse. Also read an article that a lot of men have some kind of form of cancer in the prostate but pretty much stays contained and usually not the culperate of death. The question I have. Has anyone been had treatment be done with out a biopsy? Has anyone have any other forms of testing done besides a biopsy?

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

Has anyone have any other forms of testing done besides a biopsy?

yes, but the tests i had was not as accurate as a biopsy. what you could do is find out who's doing the biopsy C how experienced they are. also,  research a procedure called in-bore MRI-guided targeted biopsyonly a interventional radiologist performs this type of procedure. so after you research information on that, research an interventional radiologist who performs this type of procedure in or near your area. for your benefit, PLEASE don't mention to your urologist that this idea was brought to your attention. that would be like asking a red sox fan to tell you about the yankees. you won't hear anything good about it, but trust me, it is a great procedure and very accurate. keep us updated. 

Clevelandguy
Posts: 460
Joined: Jun 2015

Hi Jim,

Yes it does take a biopsy to confirm the presense of cancer and to grade it for aggressiveness.  I had absolutely no problems after my biopsy other than a little blood in my urine for a day or two.

Dave 3+4

VascodaGama's picture
VascodaGama
Posts: 3029
Joined: Nov 2010

SW,

You have created a newer thread but I drop my opinion in here as it contains more details of your story, therefore better to understand your situation.

You wrote;

"My PSA Is 18.67, Deciding Treatment ...  ...  is the cancer getting worse, because of no treatment just yet? i have no idea what to think. what R your thoughts? i'm scared U guys... "

We all have confronted similar situation when the need in making a decision approaches and we are afraid of choosing something that may not be the best we could have. This is a nerve breaking situation because we are dealing with the unknown and the doctors do not substitute us in the decision process. They always suggest and ask us to provide a final answer. This is scaring.

In my case I took two months of researches before deciding on a therapy. My wife and I worked as a team and we devoured the information that was available to us at the time (articles on treatments, test and exams' results, stories of identical cases, etc, etc), and did get second opinions from three specialists (another urologist, one radiotherapist and one HDR Brachy). I choose surgery and was quite comfortable with such option. Surely my wife and I knew then the possibility of fathering kids was over and sex would be on hold for many years. This occurred in 2000 (19 years ago) when imagenology for cancer was much limited than what is available today, and radiotherapy was linked to nasty outcomes. Surgery was at the time the gold standard in PCa treatment. Today much has changed. Equipments and modalities have improved significantly and radiotherapy reached similar status levels as that of surgery.

In fact, the principals in treating PCa seem to me to continuously being the same. Either, you look for a treatment to deal with a contained case or to deal with extraprostatic extensions case (localized but not contained). This is where radiation manages to be better as it can be focus for both cases at once; contained and spread. In contained cases, with surgery one knows that cancer is gone because it dissects the whole infected gland. With (all modalities of) radiation one knows that the gland is the target but the radiation doesn't fry the whole gland equally. There are regions where radiation is delivered with limits because it would affect close organs or facilities (for instance the sphincter area that stands at the base of the prostate) in the path of the rays. This limitation could jeopardy the outcome so that one should be assured that cancer is assumed to exist at other areas.

Accordingly, ide4ntifying and locating the cancer is essential to decide on a therapy and to assure the killing. In such respect, one needs to trust the facilities where the nuclear test was done, including the radiologist that provided the results. Our doctor depends much on such results to provide a reliable clinical stage from which one can gain more confidence when choosing a therapy. What is your clinical stage?

I assume that you have been attended by a radiotherapist. I wonder why you have to trust his opinion alone. Why is he consulting an urologist? Surely it is good to listen to added opinions but it should be you in doing such a step, visiting a doctor from a separate circle. You can then verify if his comments on " unfavorable intermediate risk category " is proper.
In any case, his proposed protocol involving ADT (Eligard) plus a combination of Radiation (external beam and brachy) is feasible for a patient with the status you have shared in your past threads. Gleason rate 4 is aggressive and many times linked to extraprostatic extensions. Have you done a DRE?

I recommend you to do more researches before deciding, getting additional consultations. You do not need to give a definite answer on your next visit (Wednesday). Just get notes on what he says, make some questions and request for more time to powder on the situation at home. Cancer doesn't spread that fast to become fatal. The increase on the PSA shows a similar curve since 2014. It tells you that you need to treat. Now you need to find that option that provides you comfort. There are always those things that we would not want to lose at such a young age.

Whatever you decide is good. Cancer is not going to kill you today but you will need to learn in living with the side effects caused by a therapy. Your wife and family are the best sources from where to get support in this difficult moment of a final decision.

Here are ideas for your List of Question to the doctor for your next meeting;

http://csn.cancer.org/node/224280

http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

 

Best wishes and luck in this journey.

VGama

 

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

What is your clinical stage?

stage 1 grade 3. it was this second opinion and elevated PSA that i believe threw everything off.

Have you done a DRE?

yes. my most recent was in january=normal. just before that in sept/oct with another uro=normal. then last summer with my old uro=normal. i've been wonderng is it prostatitis that gave my PSA this extra boost, because i've been urinating more than usual over these last few weeks, worse than january.

i just woke up, so i'll read more of your post and respond in a bit. thank you for your thoughts.

VascodaGama's picture
VascodaGama
Posts: 3029
Joined: Nov 2010

SW,

I would suggest you to share with us the details and results of the biopsy. How many cores were driven and what were the contents (%) in each one. In your shoes I wouldn't draw any conclusion if the biopsy has not investigated all traditional zones of the prostate. Analyzing the lesions identified in your previous MRI (Aug 2018) alone is not enough for a good judgment. I wonder what your meaning of "stage 1 grade 3" is. The only comment from you on grading was " ... john epstein downgraded my PSA to low grade G6 ... " which has no meaning. Does "G6" refer to Gleason score 6?
Please read this link and provide details for us to specify opinions;

https://www.cancer.net/cancer-types/prostate-cancer/stages-and-grades

 

Best,

VG

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

my signature

================

D.O.B. 1973

07/14 PSA 5.5

08/14 TRUS Bx Prostatitis & BPH

07/15 PSA 5.9

01/16 PSA 7.6

03/16 PSA 6.2

07/16 PSA 6.9

10/16 PSA 6.9

03/17 PSA 7.2

05/17 3T MRI Good

11/17 PSA 7.7

11/18 PSA 10.8 Cipro for 2 wks

07/18 PSA 11.9

08/18 3T MRI: 3 per ZN focal ABN, 1 with a PI-RADS 4 lesion & 2 with PI-RADS 3 lesions. No extra PCa disease, pelvic LAD, or pelvic lesions

02/19 MRI fusion biopsy

Bx Findings

A. PROSTATE, LESION 1, LEFT APEX, 3D MRI FUSION BIOPSIES: * BENIGN

B. LESION 2, RIGHT MID GLAND *PCa, GS 4+3=7 (GRADE GRP 3) 3 OF 3 CORES

(95% DISCONTINUOUS, <5%, <5%) * GS GRADE 4 60% OF THE TUMOR

0 PERINEURAL INVASION IS PRESENT

INFLAMMATION.

C. LESION 3, DIFFUSE LEFT MID GLAND, 3D MRI FUSION NEEDLE CORE BX's

PCa, GS 3+4=7 (GRADE GRP. 2) LESS THAN 5% OF THE FRAGMENTED CORES

GS GRADE 4 INVOLVES 5% OF THE TUMOR

2nd Bx OPINION

A. Benign

B. PCa, GS 3+3=6 (Grade Grp. 1) 80% of 1 core

C. PCa, GS 3+3=6 (Grade Grp. 1) 20% of 1 core

Considering options

VascodaGama's picture
VascodaGama
Posts: 3029
Joined: Nov 2010

Hi,

The info you share above is for 5 cores taken from:

1) one core from left Apex

2) three cores from right mid

3) one core from left mid

It seems that the base area of the prostate was not included in the biopsy. I wonder why they didn't check the whole gland.

JH second opinion may be more reliable than the one from the pathologist at your radiologist office. However did they checked all 5 cores?

The procedure doesn't follow the traditional biopsy investigation. You may accept this way of investigation but in your shoes I would not choose radiation without checking the base of the prostate.

Best

VG

 

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

do you have an email address? maybe i can email you the actual pathology reports so you can see for yourself. maybe i missed somethng and didn't paste it on here.

VascodaGama's picture
VascodaGama
Posts: 3029
Joined: Nov 2010

SW

I am not a doctor to give you advice on the pathologist's report. You can check yourself the details or if in doubt you can call your doctor and inquire on the details of the biopsy. Ask him if the whole areas of the prostate were exam and on the total number of needles/cores taken, and what was found.

The typical and recommended biopsy by the NCCN and urological associations is a template of 12 needles covering the two lobes (right and left) at the apex, mid and lateral zone and the base (the area just below the bladder). If lumps are detected then urologists take two extra needles directional to those places, completing a 14 needle biopsy. Some still go further and direct extra needles to the seminal vesicles and nerve bundle.

In rereading your past posts it seems that you or your doctors are following a different standard regarding the way to evaluate your case status. It is true that since the introduction of the Pi-rads several doctors use today the simple results of a multiparametric MRI to decipher a clinical stage. This is a newer practice but is not yet in full swing around the world. I have my doubts on the matter but as I said, I am a simple PCa patient, not a doctor, and you are not me.
The end goal would be to get to a conclusion in choosing the best therapy, which surely would follow the NCCN guidelines. I wonder if such newer ways of judgment with basis on MRI images alone got any newer interpretation when deciding on a treatment. At blindfold, radiotherapy is the only one to fit all stages. It could cover the all localized areas zipping out any bandit hidden around. In such a case not even a clinical stage would be required. One may take just one core to detect cancer and follow straight with a combination treatment of radiation that covers the prostate plus the surrounding areas and lymph nodes. Why bodder with more and more analysis.

Well, my opinion is that this way would just lead to unnecessary risks and side effects. In the end it may as well work beautifully. The patient will have to learn to accept the fate alone. Before starting a therapy, the patient will be requested to sign an agreement relieving the doctor and the clinic from any responsibility on the chosen treatment and its outcome.
I would not like to be put in such situation unless I am full confident that the matter works in my favor. I wuld need to be full confident on the doctors caring my case. But, we know too that other established ways also fail even if these are based on years of experience all over the world.

In regards to Epstein's second opinion on the cores I wonder if your clinic has sent all samples for examination. Typically they send one from each zone just to certify the classification of the cells (Gleason pattern). Again, if Gleason 6 is in fact the true classification and one can trust the radiologist report (negative extraprostatic extensions) then surgery could fit well as a choice. Another blindfold interpretation.

One note on the MRI/Ultrasound fusion targeted biopsy looks at the basic reason for its practice. This sort of biopsy is usually done when one sees his PSA increasing constantly after a negative 12/14 needle plate biopsy. The main intent is to get a reason for the PSA behavior so that the urologist tries finding cancer in between the areas of the template with the help of an image. In your case, it seems that it was done to substitute the tradition biopsy. Those areas away from the boring have not been analyzed but they could have cancer of sizes under the limits of a MRI detection (4 to 7 mm).

Please note that I have no medical enrolment. I have a keen interest and enthusiasm in anything related to prostate cancer, which took me into researching and studying the matter since 2000 when I become a survivor and continuing patient.

Best wishes,

VGama

 

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

i had the fusion biopsy that took eight cores. my uro only targeted the areas that were seen on the mri. 6 of those 8 cores had cancer in them. now that my PSA has reached an 18, my RO wants me to do lupron, but even his nurse said yesterday that would be hell on my body. so, i was looking into maybe doing proton therapy, but i read another guy was on hormone therapy already and considering proton therapy vs. i think external beam. i guess my main goal should be to find out how aggressive is this tumor or have another but more specific bioopsy

VascodaGama's picture
VascodaGama
Posts: 3029
Joined: Nov 2010

SW,

I do not want to confuse you or displace you from your believes but in your shoes I would get second opinions from doctors away from the circle of your present doctor. Get copies of all exams and tests and consult another specialist before proceeding with something. You need to create confidence in the option you are choosing.

Please read this link on second opinions;

https://csn.cancer.org/comment/1290680#comment-1290680

Best

VG

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