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Seminal Vesicle invasion

Fred1000
Posts: 10
Joined: Feb 2020

I am 54, in good shape and a year ago I had a routine blood test done. Six months later i went to my doc again and was told that my PSA was 4.8 and had to go see a urologist. Two blood test later my PSA went to 6.0 and 7.4. In one year my PSA went from 4.8 to 7.4. Three weeks ago i had a 3T MRI done and it doesnt look good. 

The prostate is enlarged in size measuring 4.7 x 3.4 x 4.1 cm (volume 34.2 mL). 


PSA Density: 0.21 ng/mL/cc. 

Lesion R1: 
Location: Right posteromedial to posterolateral peripheral zone at the base (series 5; image 23). This lesion does not cross the midline. 
Size: 9 x 9 mm 

T2: Ill-defined homogeneously, markedly T2 hypointense lesion with a relatively extended interface with the prostatic capsule. 
Extra-prostatic extension: There is definite extra-prostatic extension with infiltration of the right seminal vesicle. 
Neurovascular bundles: The neurovascular bundles are not involved. 
PI-RADS v2 T2: 4. 

R1: 9 x 9 mm lesion in the posterolateral to posteromedial peripheral zone of the base of the prostate is highly suspicious for prostate cancer with extra-prostatic extension into right seminal vesicle (PI-RADSv2 category 5). The lesion is marked and saved in PACS.

I dont see many people on here talking about SVI. From what i read it sound like a T3b or c hight risk Cancer.
Im getting an 18 core targeted biopsy done in a week So i dont know what my gleason score is yet. 

I am terrified!!! Can someone tell me if this is bad and what types of treatments there is and side effects cure rates etc.... i really need a life line...

 

 

 

VascodaGama's picture
VascodaGama
Posts: 3180
Joined: Nov 2010

Hi Fred,

Welcome to the board. We all go through the same experience and feeling when the results of a test doesn't fit the parameters. It is worrisome as the case could relate to prostate cancer, however, without the confirming biopsy you cannot tell if the MRI fgindings relate to cancer or calculi.
In any case you doing well in investigating the meaning presented in the radiologist's report. I believe that the urologist will aim those identified areas (base of prostate inclusive of Seminal vesicles) together with the typical template for the other regions of the gland, however, you can request him to direct extra needles to those areas.

I wonder if you had a DRE. The area indicated by the MRI (posterolateral to posteromedial peripheral zone of the base of the prostate) is at the reach of finger touch (DRE). A positive DRE is taken when they feel bumps or an harder surface (in comparison with hand's Thenar). You can request the urologist to do the digital exam before proceeding with the biopsy.
Accordingly, only after these tests you can verify if the clinical stage T3 is compatible with your judgment. Surely, the presence of extraprostatic extensions would limit the options for a treatment but it all depends how far those extensions are judged to exist. Localized cases do well with radiation therapies.

So far you have not been yet diagnosed with cancer. Let's hope that your high PSA relates to a benign issue in a 34 cc gland. Sharp increases of the PSA typically refer to a case of hyperplasia. The negative aspect in the T2 findings is the involvement of the Seminal vesicle as it leads to a worse prognosis but treatable.

Best of lucks in this journey.

VGama

Fred1000
Posts: 10
Joined: Feb 2020

Vascoda, 4 needle biopsies was taken in the area that the MIR shows cancer present and 14 others were taken to check the rest of the prostate. I Received pathological report and 7 out of the 18 cores was positive for cancer(all on the base on the right side). 6 had a gleason score of 3+4=7 and one was 4+3=7. 

An extra prosthetic extension was identified and two of the needle biopsies shows PNI. 
The urologist I'm seeing dr Alan E Thong at Stanford says I'm Stage T1C And he thinks he can get all the cancer out in one shot. I asked for a second opinion because Exta prostatic extention and SVI tells me it's T3B.

I saw a radiologist oncologist,  dr Patrick Swift from Stanford on Monday and he diagnosed me as stage T3B and showed me the MIR image. The areas were it infiltrate the seminal vesicles doesn't look as dark and he thinks it might be in the beginning stage.

I am starting on 18 months of hormonal therapy this weekend after a bone scan. I will then get one or two treatments of high dose rate brachytherapy and 6 weeks later start with 40 sessions of External beam radiation. I'm having second thoughs and are very afraid to start the hormonal treatment. 
am I making the right desicion? I am so confused and terrified.

I bought a book from a dr Mark Scholz and watched his videos on YouTube about the Azure ( high risk) stage of prostate cancer and it seems like the dr I'm seeing worked with him and knows him well. https://youtu.be/vtd3RzjE_aI

Steve1961
Posts: 301
Joined: Dec 2017

If I were you .i would try to get an app with both the radiologist and surgeon together and Hear both sides as to why one treatment would be better than the other and come to an agreement between the 3 of you ..if there is a good chance u can take it out and have it be gone ..THAN DO IT ..hormone treatment and radiation take forever and are no joke ..that's for sure ...side effects are 10 fold compared to surgery 

 

Fred1000
Posts: 10
Joined: Feb 2020

Hi Steve, 
With all the horror stories I've read about RP, makes me extremely afraid. If I take the chance and have RP and there are positive margins, I will have to get EMRT and hormone treatment anyway and have the side effects of RP too.  The first urologist said I'm a T1C and totally ignoring the ECE and SVI. Do I trust him to do the surgery? It feels like I'm running out of time. I want it gone so I can go on with my life. Should I start the Cosadex pills this weekend to temporary stop the cancer growth to give me more time to see another oncologist?

 

eonore
Posts: 86
Joined: Jun 2017

Fred,

I think you have a great plan in place.  With evidence that the cancer is outside the prostate capsule, there is no reason to select RP.  Radiation covers the prostate and the field you are concerned about.  If I was in your shoes, I would do exactly what you are doing.  Make sure to discuss with your RO covering the entire pelvic field.

As far as side effects go, I had less from radiation than I did from surgery.

Eric

Fred1000
Posts: 10
Joined: Feb 2020

Thank you Eric! i Started the Casodex 5 days ago and worst SE so far is a headache every day and some brain fog. I'm Getting my first 3 month Lupron shot on Tuesday, I hope the SE's are not going to become worse. It worries me when people tell me " it's your decision". I am desperately looking for someone to tell me that I'm making the right decision so thank you!

Steve1961
Posts: 301
Joined: Dec 2017

YES BY ALL MEANS take the chance ..horror stories happen most men after surgery are great ...like yelp u only hear bad reviews ...surgery 2 side effects only ......radaiation HA theres about 10 to 15 side effects ...trust me I know I git them all ...radiation should be used as a last resort in my book ...look at lighter wood he did surgery and is great ..

eonore
Posts: 86
Joined: Jun 2017

Steve,

What you fail to grasp is that if the cancer is outside the prostate, then he will wind up doing radiation anyway, with two potential sets of side effects.  Surgery will not work for him.  He needs a treatment that has a chance of getting all the cancer!

lighterwood67's picture
lighterwood67
Posts: 252
Joined: Feb 2018

Go get that 3T MRI guided biopsy.  The definitive tool in diagnosing Prostate Cancer is a biopsy.  MRI's are tools and lead to other tests.  I can tell you right now my 3T MRI was inaccurate on some of its conclusions.  This really came out in the pathology report once I had my prostate removed.  Good luck on your journey.  You are on an excellent site with many life lines that have years of experience with prostate cancer.  Just remember we are not doctors.  Any choice you make is yours based on the information provided.  So as of right now, you do not know.  Go get the biopsy.

Fred1000
Posts: 10
Joined: Feb 2020

I had two DRE's and ultrasound done by my local urologist. He could not feel anything and according to the ultrasound, my prostate was not enlarged and perfectly symmetrical. The ultrasound was done about 8 months ago. I didn't want to get a blind biopsy so I opted to go to Stanford with more advanced equipment. I had another DRE recently and he couldnt feel anything either. According to the MRI my prostate is enlarged now. Ive been waiting for the MIR for almost a month and are very anxious about the procedure and prognosis. It took my general practitioner 6 months to read my lab result. It feels like the cancer or something is spreading fast and doctor’s are too slow to act. I’m not sure if it is psychological but i feel all kinds of pains in my pelvic area, below my belly button. A full bladder also now feels like its masked with a slight pain. This adds to my anxiety. It feels like the wind is knocked out of me.

VascodaGama's picture
VascodaGama
Posts: 3180
Joined: Nov 2010

Fred,

It is common to read from newly diagnosed folks about those psychological feelings occurring allover the body. We try connecting any little feel with the cancer because the day before diagnosis we were healthy and now we think we are rotten. In fact we are now listening to our body more attentive to the extent that even the work of heart's valves is noticed or thought to be felt. Our brain is tricking us and at such a status we become vulnerable to medical vultures. Pain may exist in very advanced cases of prostate cancer (PCa) when metastases have deteriorate bone or have interfere with the functioning of an organ but these are rare cases in young newely diagnosed patients with low PSA (<50).

Some doctors may be tempted to urge patients to decide quickly for avoiding spread, which is an erroneous way of thinking. PCa does not spread that fast and your status of today would not be much different if it were 4 to 6 months later. Apart from that the treatment process would be the same with the same expected outcomes. It is no surprise that the medical world take its time when the issue relates to PCa. You can request your doctor for a faster answer and intervention but it doesn't lead you to a better outcome.

If you become positive for PCa, I recommend you to be prepared and educate yourself on the issue, investigating on options and on the risks involving treatments, before deciding. Quality of life is at jeopardy and those with longer Life Expectancy are the ones that will surffer more from the consequences. Ironically, young patients are the ones recommended for aggressive therapies in NCCN oncological guidelines which turns these at higher risk for cumulative side effects.

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,

VGama  

Hellostone
Posts: 22
Joined: Jan 2020

Fred, I recently went through a similar period of anxious uncertainty following a mpMRI. The waiting without knowing was, for me, the hardest part. In my case, the targeted biopsy confirmed the PCa diagnosis--but it could have come up negative, as yours could do. So don't diagnose yourself yet!!

If you'd like to learn more offline, I would recommend you consider picking up a book or two. I've gotten a lot out of Patrick Walsh's Surviving Prostate Cancer (often recommended as the go to resource) and Mark Scholz's Key to Prostate Cancer.

Good luck, and try to breathe calmly for now. easier said than done, I truly know!

cheers,

bill

Fred1000
Posts: 10
Joined: Feb 2020

Thank you VGama and everyone that commented. It makes me feel a little better knowing that i'm not alone and getting help and advise from you guys really helps. 
The biopsy is in 6 days and i'm very afraid. Does it hurt? Any chance of my prostate swelling and having to get a gatheter after the 18 core biopsy? Any advise on what to do or not to do before and after.

Thank you

Fred

hewhositsoncushions
Posts: 344
Joined: Mar 2017

It can be painful but not as bad a a dentist drill or anything like that generally.

There is a risk of bleeding after the biopsy so make sure you get someone to take you to and from the session.

Take a spare pare of pants and trousers (underpants and pants in US speak? :)) in case you do leak.

Wait a while after the session before you go home to let things settle down.

You will find your semen goes rusty red for a few weeks after the biopsy. I never had bloody urine but that may be a possibility. Talk to your specialists about these side effects and what to do about them beforehand.

Mainly it is undignified :)

H

Fred1000
Posts: 10
Joined: Feb 2020

The undignified part bothers me but i guess we have to do what's needed to stay alive. Luckily i'll be laying with my back towards them. i dont even know how many people will be in the room with the MRI targeted biopsy. I have a 3 to 4 hour drive after the procedure, depending on traffic. The wife will be driving and I hope the long sit in the car is not going to cause any problems. Thanks Cushions!

Clevelandguy
Posts: 546
Joined: Jun 2015

Hi Fred,

I would not worry too much on the ride home.  I don't  remember much pain after, I thought they numbed me with a local so that should take some time to wear off.  I do remember some discomfort the next few days after my biopsy but nothing really bad & no infections.  Just a little embarrassing to us all but you realize that your doctor does many of these so they should have their routine down so they go fairly quickly.  Good luck......

Dave 3+4

Gforce
Posts: 21
Joined: Jan 2020

The Biopsy is a piece of cake. You will be more scared than anything, not much in the way of pain, and when done, your ride home will be fine. I was diagnossed at 53. All of my 12 cores positive: 10-6 and 2 were 3+4. All is contained as far as they know and no SVI. You can start doing your research now. I chose 6 months Lupron and 8 weeks Proton. I am now at my 20th Proton treatment. I got put on Flomax to relieve burning/pressure at 2 weeks in and all is great. I had the spaceoar gel put in to protect my rectum. So far so good. If this treatment cures my cancer, it will be the best choice I have every made. 

Fred1000
Posts: 10
Joined: Feb 2020

I had the 18 Core biopsy yesterday. Everything went well.  I felt a dull pain with every shot that lasted about a second. The only part that really hurt was when he turned the probe that was connected to a robotic arm clocks and counter clockwize to line the needle up for the next shot. It felt like the probe wasnt round and had a sharp edge. 4  needles into the area that shows possible cancer on the MIR and 14 into the rest of my prostate. I watched the placement of the needle on a 42" color monitor while doing it. The 4 hour ride back home was a little uncomfortable. I had no pain the next day and no blood in my urine. I will be getting the pathology report on Monday. I know I have to deal with this but are terrified to get bad news. I might have to leave my job and go home for the day before reading the report.....I am so affraid!!!

VascodaGama's picture
VascodaGama
Posts: 3180
Joined: Nov 2010

Fred,

I am with you. Waiting for the results is scaring. I was very scared too back in 2000 after biopsy but later, the statement by my doctor saying "... you have cancer!!" was worse. I blanked out and still cannot recall how did I get home, a mere 4 subway stops from the hospital. It changed the way I appreciate life. Today, I feel grateful for the experience. You will get there too. Be positive whatever the result shows to be. You will manage it well. Get a family member together the next time you visit the doctor.

Wishes for peace of mind.

VG

 

Fred1000
Posts: 10
Joined: Feb 2020

Thank you VascodaGama! I dont think 3T MIR's are wrong but maybe there is hope for me!.....It feels like my entire life is falling apart at this moment but im trying to stay positive.

Clevelandguy
Posts: 546
Joined: Jun 2015

Hi Fred,

I will never forget the day in my Internal Medical doctors office before I had my biopsy he said "I think you have cancer".  What a blow but after I did learn it was cancer via the biopsy the immediate question in my mind was what do I have to do to either kill or arrest the cancer.  I felt the sooner I delt with it the better so I listened to the Urologist and Oncologist and went on from there.  Nobody wants to hear the cancer word but the guy behind my house is dealing with Pancreatic cancer which in my non medical opinion is worse than my cancer.  Take it one step at a time if it is cancer. It was easier for me to deal in smaller steps than think about the rest of my life all at once.  Your doctors should provide you with a treatment map if needed on your first future steps. All of us here either have had cancer at one point and are here years later to talk about it.

Dave 3+4

Fred1000
Posts: 10
Joined: Feb 2020

Thank you Dave!

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