69 years old recent MRI DCE positive PR4

Hello - I have an update - Since previous prodding my urologist has been going quickly. I have now completed the scan and the biopsy was last week. Received the results today of 14 cores. The2 lesion cores came back 3+4,
6 Cores 3+3, 5 cores 3+4, and one 4+3. A decipher test was requested but have not seen that yet. So I now have a PET scan scheduled to check out lymph nodes etc. Very apprehensive about this result. Those that have responded are greatly appreciated.

An additional question - I have previously been a patient at Mayo Rochester for other issues and wonder if that will help me get seen for the PCa?

Thanks

PET as in PSMA PET scan? That is important. From you description, only the PSMA PET has the sensitivity to pick up the 7mm lesion. It is not hard to deal with. But it can become a problem later. The low Gleason score can be misleading.
Dont mind me. I am only a layman trying to make some sense of the whole thing.

So an update - I did hear from my Urologist and they are setting up a biopsy next week (1st week of may).
His response was that he viewed the actual images and currently not overly concerned and felt I was 50/50 for cancer. He also indicated that I have a very enlarged prostate (4x) that accounts for the raised PSA levels. So he said that level PSA 7.8 aligns with a gland of that size. So if it is cancer it may be early IDK. I'm being hopeful but
vigilant. The biopsy is guided via the MRI data and an ultrasound device.
Many thanks to those who responded to reduce my anxiety 🙂

My urologist also believed that my 7.8 PSA aligned with the volume of my enlarged prostate My follow up MRI was clear. However my biopsy showed 2 cores of cancer, one at 3+4. I elected to have an RP. The post RP pathology report showed my cancer was actually at 4+5 and close to the capsule. So far my two follow up PSA blood tests show < 0.01. Praying for more of the same in the future. Bottom line, do everything possible to ensure your results are accurate and give you the information needed to make the best decision and give you some peace of mind. Best wishes!🙏🏻🤞

kjacko,

well it was obvious that my hopefulness was going overboard. The numbers I posted of my biopsy results were based a a very fast paced phone call with my urologist giving me numbers and saying he was ordering PSMA pet scan to check those 5 suspicious lymph nodes . I was able to actually get the report and realized I had stated things incorrectly. As it was in the reports out of 14 cores 8 were benign. 1-3+3, 4-3+4, and, 1-4+3. The 4+3 was on the line of 50% pattern 4 which is one point above max for a 3+4.,So overall i'm rated 4+3. My stage is T1c for now until I get the scan. I am waiting on the decipher test. Interesting that where the MRI found a PR 4 lesion, the two cores there came out benign and 3+4

My father had prostate cancer at in 1999 at 75 and lived to 91, but succumbed to it later on. Im not sure he was doing any thing watchful. He had bracytherapy LDR with it and not aware if he took anything else other than flomax. I'm hopeful that since his was slow growing so will be mine.

Unfortunatly I wish it was the only thing going on. My Cardiologist is recommending a Stent be placed because scans and other test have been inconclusive about a blockage, But that requires blood thinners for a year and that would preclude any prostate surgery or radiation. So im kinda going to have to gamble on the balance here on cancer treatment vs the unknown Cardiac risk.

Trying to keep my Spirits up.

kjacko,

well it was obvious that my hopefulness was going overboard. The numbers I posted of my biopsy results were based a a very fast paced phone call with my urologist giving me numbers and saying he was ordering PSMA pet scan to check those 5 suspicious lymph nodes . I was able to actually get the report and realized I had stated things incorrectly. As it was in the reports out of 14 cores 8 were benign. 1-3+3, 4-3+4, and, 1-4+3. The 4+3 was on the line of 50% pattern 4 which is one point above max for a 3+4.,So overall i'm rated 4+3. My stage is T1c for now until I get the scan. I am waiting on the decipher test. Interesting that where the MRI found a PR 4 lesion, the two cores there came out benign and 3+4

My father had prostate cancer at in 1999 at 75 and lived to 91, but succumbed to it later on. Im not sure he was doing any thing watchful. He had bracytherapy LDR with it and not aware if he took anything else other than flomax. I'm hopeful that since his was slow growing so will be mine.

Unfortunatly I wish it was the only thing going on. My Cardiologist is recommending a Stent be placed because scans and other test have been inconclusive about a blockage, But that requires blood thinners for a year and that would preclude any prostate surgery or radiation. So im kinda going to have to gamble on the balance here on cancer treatment vs the unknown Cardiac risk.

Trying to keep my Spirits up.

Hello All, its been about a month since I posted and many things have occurred since then. So a bit of a recap-
I "skipped" seeing my Dr for 3 years - a mistake for sure. I went in on another issue and he wanted to run a blood profile which among other things said my cholesterol was too high and my PSA was 8.75 This was up from 4.25 3 years previously. So off to the urologist I went 3 weeks later and my PSA was 7.75 but DRE was indicating a very large prostate.

Had an MRI which showed pRADs 4 lesion plus some suspicious lymph nodes. To top that off I found out that I had something called a pelvic Kidney from birth which means my left kidney sits to the left and above my bladder. I have Chronic Kidney disease stage 2 as well from blood clots during a near death Covid encounter in 2020.

Since then the MRI prompted the Guided Biopsy with 6 of 14 cores positive with one core 4+3=7 at 50% GS 4 which pushed me into unfavorable intermediate risk.
Decipher Score took 2 weeks to arrive and said I was low risk at .41.

Back to my GP to discuss my cholesterol again and ran another PSA, this time 6.95
This was all followed up with a PSMA PET scan with Pylarify. That came back totally clean, I mean nothing even in the prostate!

Had a consult with my urologist then to discuss all this. His concern was due to the size of the prostate (106cc) and the pelvic kidney surgery could be problematic, He did say he would be willing to give it a shot which did not instill confidence in me what so ever. I asked about the PET scan being negative and he said he did understand that either. I said I wanted to talk to an RO and so I got a a referral.

Talked to the RO and he said that because the PET scan was questionable, the questionable lymph nodes remain suspicious. He had no answer for that either but was going back to the radiologists of the MRI and the PET Scan for further definition. The PET scan however showed no change in their size from the MRI 8 weeks previously. My RO feels they may be a non issue but wants to rule them out somehow. So then we had the what if talk, in other words if the lymph nodes were ok. He recommend EBRT with ADT for six months noting that the gland needs to be shrunk, He also mentioned a new procedure to shrink the prostate used mainly for BPH which I have a lot of called PAE or prostate artery embolism that they do. In this procedure they go in with an arterial catheter and place plastic balls in the specific arteries that feed the prostate which causes it to partially die. A 2 hour outpatient procedure. My RO is going to present my case to a group of other oncologists to get their response and recommendations.

So my questions to this community:
Has anyone else had a fully negative PET scan like this in spite of a positive biopsy?
Anyone with experience with the PAE?
Do you think my RO is correct about the treatment plan given the data?
Thanks for wading through all this - lots of great experience here!

I plan on getting a second opinion from Mayo or even move my treatment there.