1. < Prostate Cancer

Received MRI Results Today

Posted by stew80 @stew80, Nov 30 10:30am

Hi Brothers,
My high PSA numbers (~ 12) led to me getting an MRI last week. Today I have the results and they are concerning. The highlights are:
One large lesion 2.7 x 1.7 x 2.5 cm in left peripheral zone.
One smaller lesion (0.8 cm) in right anterior mid-gland.
No lymphadenopathy.
No suspicious bone lesions.
PSA density is 0.45.
I'm not sure what this all means and I'm in a bit of a shock. I just wonder if anyone has had a similar diagnosis. I would appreciate any comments or opinions. I haven't had a medical consultation yet so the grading is not identified. I'm 84 and otherwise very healthy and active.

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

jc76 | @jc76 | Dec 4 8:04am
In reply to @heavyphil "Don’t mean to make you even more anxious but you REALLY should find someone out of..." + (show)
@heavyphil

Don’t mean to make you even more anxious but you REALLY should find someone out of your area who does transperineal biopsies.
Not only is the chance for blood infection greatly reduced, but access via the perineum affords greater access to the entire gland and they can get samples from areas very hard to reach with a transrectal approach.
Also, the very cavalier attitude of the nurse (who represents the Doctor!) tells me that these people either don’t care or are inept. OF COURSE you should have a biopsy with those results - are they nuts!!??
Anyway, make an investment in your future - since that’s where you’re at - and see if you can find a center of excellence or large university hospital that’s a few hours away by car or plane if necessary. Best of luck!

Jump to this post

@stew80 @heavyphil
When my urologist wanted to do my biosies trans rectal I did not agree. Then mentioned the increased risk for infection and said but if you get in you would only have to spend a couple of days in the hospital.

Done deal with me. Not only is there no anxiety and stress during the transperinal (anesthesia) it has extremely low risk on infection.

A personal decision but I dug my heels in and had it done transpernial and anesthesia.

REPLY
1 reply
spino | @spino | Dec 4 8:05am

@stew80 You mention in passing that you are 84 and that changes the treatment options because PC (prostate cancer) is typically a slow-growing cancer. The fact that you are dealing with lesions like many of us have 20 years earlier (on average) also might indicate that the cancer is slow-growing. You don't mention what other health problems you might be facing, but the single life expectancy table (for instance, here https://www.fidelity.com/retirement-ira/irs-single-life-expectancy-table) is 8.7 years at 84.
More recent studies including ProtecT mentioned here https://www.ox.ac.uk/news/2023-03-13-study-shows-delaying-treatment-localised-prostate-cancer-does-not-increase-mortality show that you may well have (statistically) the same likelihood of living 15 years with no treatment as with treatment given the results you did mention in your original post.
So what I'm saying is that the nurse who called you summed up a lot in a few words, but what she said is not on its face outside current medical opinion. It reminds me of my aunt, about your age, who as soon as she heard I had cancer said, "Well, you should take it out. You don't want that in you." My response, which I didn't say to her, was, "You may be right, you may be wrong." Since any medical treatment will have side effects, risks, and costs, opting for no treatment when that is likely to give you twice your all-cause life expectancy for this specific cause is a very good option to consider.
Here is a recent summary statement summarizing the status quo regarding biopsy technique: https://www.health.harvard.edu/blog/new-research-shows-little-risk-of-infection-from-prostate-biopsies-202402123013. Here are a few research articles listed under my google search of "risk of transrectal biopsy": https://pmc.ncbi.nlm.nih.gov/articles/PMC4548577/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10057203/ https://www.auajournals.org/doi/10.1097/JU.0000000000003788
and another consumer-level article: https://news.weill.cornell.edu/news/2024/09/new-prostate-biopsy-technique-lowers-infection-risk including the following quote:
"Prostate biopsies are an essential tool for detecting prostate cancer, and about 3 million people worldwide undergo the procedure each year. Dr. Hu noted that physicians collect about 90% of these biopsies in the United States via a transrectal procedure. Yet studies have found that 5% to 7% of patients develop infections after biopsy, and 1% to 3% require hospitalization for these complications, he said. To help prevent infections, physicians typically prescribe a prophylactic course of antibiotics before the procedure."
[For perspective, Johns Hopkins (a center of excellence) quotes overall survival rates with PC of 100% for 5 years, 98% for 10 years, and 95% for 15 years. https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-prognosis.%5D

REPLY
2 replies
heavyphil | @heavyphil | Dec 4 10:22am
In reply to @jc76 "@stew80 @heavyphil When my urologist wanted to do my biosies trans rectal I did not agree...." + (show)
@jc76

@stew80 @heavyphil
When my urologist wanted to do my biosies trans rectal I did not agree. Then mentioned the increased risk for infection and said but if you get in you would only have to spend a couple of days in the hospital.

Done deal with me. Not only is there no anxiety and stress during the transperinal (anesthesia) it has extremely low risk on infection.

A personal decision but I dug my heels in and had it done transpernial and anesthesia.

Jump to this post

Don’t you just love it, jc?? ONLY a couple of days in the hospital - what an A**hole…

REPLY
1 reply
stew80 | @stew80 | Dec 4 11:10am
In reply to @danceguy "Had MRI early November. PI-RADS 5. 43 ml volume prostate. Tumor 1.25 inch by .75 inch..." + (show)
@danceguy

Had MRI early November. PI-RADS 5. 43 ml volume prostate. Tumor 1.25 inch by .75 inch in posterior peripheral zone. Tomorrow is biopsy day. Hoping for decent gleason but it is what it is.

Jump to this post

Please keep us posted once you learn more.

REPLY
packman7 | @packman7 | Dec 4 12:15pm
In reply to @jc76 "@michaelcharles When I chose to explore going to UFHPTI because the offered proton radiation treatments versus..." + (show)
@jc76

@michaelcharles
When I chose to explore going to UFHPTI because the offered proton radiation treatments versus photon I subscribe to receive their infomation packet.

In that packet they went into the differences between proton and photon, research, and informaiton on their treatments. Part of the package was two books. One of those two books was Walsh MD's bood on surviving prostate cancer.

I have suggested MCC posters to asked for UFHPTI free information packed as it includes those books mentioned on MCC as well as ton's of informatino and research. UFHPTI is a State of Florida Medical Facility and the doctors and techs are all salaried.

This (salaried employees) was make clear to me my first consultation there and that any additional test they wanted to do would be based on what they felt I needed specificially with no financial incentive to them by ordering additional tests or the type treatments they would recommend.

It is a ton of information made free to anyone and regardless of where you chose to go it can help as so much information is given to you. I had not a single incident of anyone at any time pushing me to go there only to let them know if I wanted to.

Jump to this post

What is UFHPTI ?

REPLY
2 replies
stew80 | @stew80 | Dec 4 12:19pm
In reply to @spino "@stew80 You mention in passing that you are 84 and that changes the treatment options because..." + (show)
@spino

@stew80 You mention in passing that you are 84 and that changes the treatment options because PC (prostate cancer) is typically a slow-growing cancer. The fact that you are dealing with lesions like many of us have 20 years earlier (on average) also might indicate that the cancer is slow-growing. You don't mention what other health problems you might be facing, but the single life expectancy table (for instance, here https://www.fidelity.com/retirement-ira/irs-single-life-expectancy-table) is 8.7 years at 84.
More recent studies including ProtecT mentioned here https://www.ox.ac.uk/news/2023-03-13-study-shows-delaying-treatment-localised-prostate-cancer-does-not-increase-mortality show that you may well have (statistically) the same likelihood of living 15 years with no treatment as with treatment given the results you did mention in your original post.
So what I'm saying is that the nurse who called you summed up a lot in a few words, but what she said is not on its face outside current medical opinion. It reminds me of my aunt, about your age, who as soon as she heard I had cancer said, "Well, you should take it out. You don't want that in you." My response, which I didn't say to her, was, "You may be right, you may be wrong." Since any medical treatment will have side effects, risks, and costs, opting for no treatment when that is likely to give you twice your all-cause life expectancy for this specific cause is a very good option to consider.
Here is a recent summary statement summarizing the status quo regarding biopsy technique: https://www.health.harvard.edu/blog/new-research-shows-little-risk-of-infection-from-prostate-biopsies-202402123013. Here are a few research articles listed under my google search of "risk of transrectal biopsy": https://pmc.ncbi.nlm.nih.gov/articles/PMC4548577/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10057203/ https://www.auajournals.org/doi/10.1097/JU.0000000000003788
and another consumer-level article: https://news.weill.cornell.edu/news/2024/09/new-prostate-biopsy-technique-lowers-infection-risk including the following quote:
"Prostate biopsies are an essential tool for detecting prostate cancer, and about 3 million people worldwide undergo the procedure each year. Dr. Hu noted that physicians collect about 90% of these biopsies in the United States via a transrectal procedure. Yet studies have found that 5% to 7% of patients develop infections after biopsy, and 1% to 3% require hospitalization for these complications, he said. To help prevent infections, physicians typically prescribe a prophylactic course of antibiotics before the procedure."
[For perspective, Johns Hopkins (a center of excellence) quotes overall survival rates with PC of 100% for 5 years, 98% for 10 years, and 95% for 15 years. https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-prognosis.%5D

Jump to this post

Thank you for this detailed response. Lots to review - the data and reality of my situation. I am 84 and fortunately a very healthy 84 (except for the prostate issues). 8.7 years more would be good. I'm greedy so I'd even like to exceed that. I began to read Dr. Walsh's book and one statement stands out. "The prostate gland does much more harm than good and is located in a terrible area that complicates treatment attempts." Anyway, I'll read on. Lots of good stuff to assess.
I'm going to search for the possibility of finding a transperineal biopsy option locally for all the reasons I've read here. With the identification of 2 lesions I assume they will want the grid 12 cores and then 6 or so more from the lesions.
My concern is a sense that I'm bypassing my assigned urologist who I haven't actually spoken to yet.

REPLY
1 reply
jeffmarc | @jeffmarc | Dec 4 2:22pm
In reply to @spino "@stew80 You mention in passing that you are 84 and that changes the treatment options because..." + (show)
@spino

@stew80 You mention in passing that you are 84 and that changes the treatment options because PC (prostate cancer) is typically a slow-growing cancer. The fact that you are dealing with lesions like many of us have 20 years earlier (on average) also might indicate that the cancer is slow-growing. You don't mention what other health problems you might be facing, but the single life expectancy table (for instance, here https://www.fidelity.com/retirement-ira/irs-single-life-expectancy-table) is 8.7 years at 84.
More recent studies including ProtecT mentioned here https://www.ox.ac.uk/news/2023-03-13-study-shows-delaying-treatment-localised-prostate-cancer-does-not-increase-mortality show that you may well have (statistically) the same likelihood of living 15 years with no treatment as with treatment given the results you did mention in your original post.
So what I'm saying is that the nurse who called you summed up a lot in a few words, but what she said is not on its face outside current medical opinion. It reminds me of my aunt, about your age, who as soon as she heard I had cancer said, "Well, you should take it out. You don't want that in you." My response, which I didn't say to her, was, "You may be right, you may be wrong." Since any medical treatment will have side effects, risks, and costs, opting for no treatment when that is likely to give you twice your all-cause life expectancy for this specific cause is a very good option to consider.
Here is a recent summary statement summarizing the status quo regarding biopsy technique: https://www.health.harvard.edu/blog/new-research-shows-little-risk-of-infection-from-prostate-biopsies-202402123013. Here are a few research articles listed under my google search of "risk of transrectal biopsy": https://pmc.ncbi.nlm.nih.gov/articles/PMC4548577/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10057203/ https://www.auajournals.org/doi/10.1097/JU.0000000000003788
and another consumer-level article: https://news.weill.cornell.edu/news/2024/09/new-prostate-biopsy-technique-lowers-infection-risk including the following quote:
"Prostate biopsies are an essential tool for detecting prostate cancer, and about 3 million people worldwide undergo the procedure each year. Dr. Hu noted that physicians collect about 90% of these biopsies in the United States via a transrectal procedure. Yet studies have found that 5% to 7% of patients develop infections after biopsy, and 1% to 3% require hospitalization for these complications, he said. To help prevent infections, physicians typically prescribe a prophylactic course of antibiotics before the procedure."
[For perspective, Johns Hopkins (a center of excellence) quotes overall survival rates with PC of 100% for 5 years, 98% for 10 years, and 95% for 15 years. https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-prognosis.%5D

Jump to this post

I’m not sure whether you are saying he doesn’t need a biopsy because at his age he still will live long enough if he does nothing. That may be true if he has a Gleason seven or less, but with a Gleason eight or above, it could become aggressive quite quickly and it could cause pain, Usually bone pain to start. @

After the biopsy, you can figure out whether or not you want to do treatment

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stew80 | @stew80 | Dec 4 2:37pm

I agree. It makes sense that a biopsy has to be done for the reason you stated here.

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jc76 | @jc76 | Dec 4 4:43pm
In reply to @packman7 "What is UFHPTI ?" + (show)
@packman7

What is UFHPTI ?

Jump to this post

I apologize. We on MCC get so used to using abbreviations that it has become a habit.

UFHPTI. University of Florida Hospital Proton Therapy Insitute. It is a State Facility built in 2006. Salaried doctors, like Mayo doctors are. It is located in Jacksonville Florida on same land that Shands Hospital but it is a separate facility but doctors have referral privlages at Shands Hospital and testing facilities.

The cost to build UFHPTI all the way back in 2006 was 125 million. It recently went through millions of dollars to update of all 5 gantries to the latest technology for proton radiation.

I am familiar with another proton radiation facility built around the same time in California. At first only a few proton facilities were built and available for patients. Why, because they are extremely expensive to build and until recently insurance (Medicare does cover it now) not covering.

There are many facilities now including Mayo phoenix and Mayo Rochester that have proton radiation as well as photon radiation. Mayo Jacksonville is building a new cancer facility which will offer proton radiation treatment. Right now Mayo Jacksonville only offers photon radiation and was reason I went to UFHPTI although all my original testing, biopsies, etc. were done at Mayo.

I had a second opinin done at UFHPTI were all my medical records were electronically sent to UFHPTI. UFHPTI concurred with all test results and wanted to order a PSMA for further dertemination of if cancer has spread and I had the PSMA done at Shands.

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