What does "This abuts the prostate margin over 6mm" mean?

Posted by rogerc525 @rogerc525, Feb 3 10:36am

Hello everyone –
61 years of age. PSA 9.7, 15%fPSA, Velocity 1.05 (1.5 jump from June to December 2023), PSA density .12, two lesions PIRADS 3 and 4.

Back in 2017 I signed up for testosterone replacement therapy (from one of those men’s health clinics in Florida). They send you to LabCorp for initial blood work then after their MD reviews the results you’re FedExed a box every other month with a vial of testosterone, HCG and an estrogen blocker. I’ve been injecting 200mg of testosterone since signing up for the program. Testosterone levels have ranged from 750 to 1450 depending on the day of the week.

In December of 2019 PSA came back at 6.8 then January 2020 PSA went up to 7.4 with a PHI of 37.1, February 2020 PSA went down to 5.8. In March of 2020 I had a perineal biopsy that came back negative. PHI test August of 2021 was 53.5. Then March 2022 PSA was 7.6 and PHI was 42.1.

In March 2023 I changed jobs, insurance, and moved. My new primary care doc ordered PSA test June 2023 that came back at 8.2 with 29% free. November 2023 CDC came back indicating a value of 1 for myelocytes in the free blood. Then in December 2023 PSA came back at 9.7 with 15% free, CDC reports no myelocytes present and off to the Urologist I went.

January 2024 Urologist ordered a prostate MRI on a 3 Tesla Magnet with and without contrast.
Prostate size: 5.4 x 5.2 x 5.8 cm. Prostate volume: 81ml. Calculated PSA density .12
Peripheral zone: Slightly heterogeneous high signal. Focal findings absent.
Transition zone: Moderate heterogeneity consistent with prostatic hyperplasia. Focal findings are present.
Impression:
1. .7cm PIRADS 4 lesion anterior transition zone, midline, at the prostate apex just anterior to the urethra. This abuts the prostate margin over 6mm.
2. 1 cm PIRADS 3 lesion left anterior transition zone mid gland.

So here’s my question: What does “This abuts the prostate margin over 6mm” mean? Does it mean the lesion abuts the edge of the prostate and into the margin 6mm? And since the subject lesion is .7cm or 7mm does it mean there’s 1mm on the inside of the prostate and 6mm outside? And if so, is it likely to have entered the free blood, migrated to the bone marrow, and spit out a myelocyte?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

imbimbo | @imbimbo | Feb 4 8:54am

Did you consult with your urologist ?

rogerc525 | @rogerc525 | Feb 4 9:25am

Yes - He said “I don’t really get into the radiology” and that he’s “just looking for the score” and that “it’s the pathology that’s going to tell us what to do”. And that myelocytes in the free blood “have nothing to do with prostate cancer”.

However, that doesn’t answer my question so that’s why I posted the inquiry here.

retiredboomer71 | @retiredboomer71 | Feb 4 12:02pm

My interpretation:
1. “This abuts the prostate margin...” means the 7mm lesion is next to the prostate outer edge (google 'capsule').
Of course, you want to know how much of the 7mm lesion is next to the edge...
2. "...over 6mm."

If the lesion had extended outside the prostate, I'd expect the MRI report to identify it as extraprostatic extension.

Hopefully an expert will chime in and confirm my interpretation.

lag | @lag | Feb 4 2:36pm

In reply to @rogerc525 "Yes - He said “I don’t really get into the radiology” and that he’s “just looking..." + (show)

The answer from your urologist is shockingly flippant and makes him sound either uninformed or unconcerned. Try to get a radiation oncologist to look at the scan results and answer your questions about them.

spino | @spino | Feb 4 5:59pm

In reply to @retiredboomer71 "My interpretation: 1. “This abuts the prostate margin...” means the 7mm lesion is next to the..." + (show)

Sounds like that to me too

retiredboomer71 | @retiredboomer71 | Feb 4 7:18pm

I'm guessing the next step your Urologist will suggest is a biopsy.
Since your MRI already identified lesions, ask for an MRI/Ultrasound fusion biopsy. This uses your MRI as a kind of road map overlay to target regions of interest in your prostate.
These biopsies are analyzed to determine how aggressive your cancer is (Gleason score), which helps you decide on appropriate treatment.
Biopsies are tolerable but not fun. That is, get the best procedure the first time... your treatment will be guided by high-confidence info, and it's unlikely you'd need a repeat biopsy anytime soon.
Best wishes.

retiredboomer71 | @retiredboomer71 | Feb 4 7:26pm

Also, consider a PSMA PET Scan. This helps determine if your prostate cancer involves lymph nodes or other metastatic spread outside the prostate.

bens1 | @bens1 | Feb 5 7:08am

In reply to @rogerc525 "Yes - He said “I don’t really get into the radiology” and that he’s “just looking..." + (show)

I had a skilled but flippant Urologist who did not answer all my questions. It does not seem uncommon in the Urology field. I got alternate opinions (test types and doctors) throughout the prostate cancer process. You might want to consider the Decipher test. It uses your biopsy material to evaluate the modes of treatment and the aggressiveness level. Doctors DO use it to adjust recommendations. I also got a MyRisk genetic test, again from the biopsy or as a spit test to see if the material indicates an active type of gene that might indicate a possible issue for your sons or daughters (i.e. brcca1) in the future.

trusam1 | @trusam1 | Feb 5 8:59am

"Abuts" is the word of interest here. It means coming up to the edge of, maybe even touching. Example: a building which "abuts" another may be very close to or almost share a wall with a building next to it. But it will not extend into the building next door.

Thus, IMO the radiologist interprets the MRI to show a .7 cm lesion (probably, but not yet proven cancer) coming to the edge of the prostate but not extending beyond it. The length of that abutment, where it touches the edge, is 6 mm. It does not mean it extends 6 mm outside the prostate.

rogerc525 | @rogerc525 | Feb 14 6:35pm

It took awhile but I finally found it...here's what it means:

Radiologist used the term "Abuts the prostate margin" as one of the parameters of a suspect lesion. Another way to say it is, "Tumor Contact Length" or TCL. Below are edited excerpts and a link to the study Published online 2016 Aug 24.
TCL, defined as length of PCa in contact with capsule, has been shown to correlate with microscopic EPE . TCL has a good interreader reproducibility making it a promising mpMRI parameter for predicting T staging.

In our study, TCL emerged as an independent predictor of +pEPE with a 4% increase in risk of +pEPE per 1 mm increase in TCL.

Similarly, Rosenkrantz et al. showed in a cohort of 98 patients who underwent mpMRI before radical prostatectomy that TCL was a stronger predictor of EPE than did subjective reader interpretations of qualitative mpMRI parameters.

With continuous advancement in the imaging technology and radiologist experience, increasing TCL should be viewed with increased risk/suspicion for adverse whole-mount pathology.

TCL was an independent predictor of +pLN in our cohort and, as a single parameter, had moderate ability in predicting +pLN preoperatively.

A specific TCL threshold number (mm) is reported that may have broad predictive value. TCL is an independent predictor of EPE, LN status, and BCR in patients undergoing radical prostatectomy. This objective mpMRI parameter can be easily measured and has previously been shown to have minimal interreader variability.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900897/
Here's something more recent:
When using the cut-off value for TCL 6.9 mm, and for ADC 0.63 × 10–3 mm2/s to predict EPE, each value showed high sensitivity for predicting EPE of prostate cancer with CA. In addition, the combined cut-off value yielded a better AUC of 0.82, showing high specificity and accuracy.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9316129/