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What does "This abuts the prostate margin over 6mm" mean?
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?
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STAGING TERMS
Abuts “capsule” of prostate means Tumor touches the “capsule”
Bulges “capsule” of prostate means
Convex contour of the “capsule”
Bulging prostatic contour over a suspicious lesion: Focal, spiculated
(extraprostatic tumor)
Broad‐base of contact (at least 25% of tumor contact with the capsule)
Tumor‐capsule abutment of greater than 1 cm
Lenticular tumor at prostate apex extending along the urethra below
the apex
American College of Radiology
PIRADS V2 Lexicon (PIRADS-V2-Lexicon.pdf)
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Hug
1 ReactionUpdate:
Went to Mayo in Rochester for a second opinion/read of the radiology. The local radiologist (RAYUS Radiology-Portland) was completely wrong, and I suspect, was in cahoots with the urologist fishing for the billing of unnecessary biopsies. Mayo rated lesion 1 a PIRADS 2. The second lesion (claimed to be abutting the prostate margin) does not exist.
When RAYUS Radiology sent the bill, in lieu of payment, I forwarded the matter to my legal team consisting of three (3) firms and five (5) attorneys. Interestingly, I no longer have a balance due.
Headed back to Mayo for prostate enucleation next month.
Measure twice. Cut once.
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Hug
2 ReactionsI'm in Portland, too. Are there any local prostate cancer radiation oncologists or medical oncologists you can recommend?
Based on my experience described above...I dont trust any of them.
For me, it's Mayo or nothing.
If your doctor cant answer these questions, find another doctor.