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.

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stew80 | @stew80 | Dec 5 3:57pm

So sorry to hear this. Did you get antibiotics the day before the biopsy? I was told for my upcoming biopsy I'd be taking an anti-biotic the day before, the day of, and the day after.

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2 replies
packman7 | @packman7 | Dec 6 6:43am
In reply to @jc76 "I apologize. We on MCC get so used to using abbreviations that it has become a..." + (show)
@jc76

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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I’m at the crossroads of new results after 2019-2020 AS , now
PSA 16
Gleason 3+3 6
6/12 cores with cancer
PNI at 2 locations
Not sure what treatment to choose ?
They say these other issues require treatment even given Gleason of 6 .
Looking at RALP or Proton guided Radiation
Difficult to decide , any information to help away my decision??

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3 replies
packman7 | @packman7 | Dec 6 6:44am
In reply to @packman7 "I’m at the crossroads of new results after 2019-2020 AS , now PSA 16 Gleason 3+3..." + (show)
@packman7

I’m at the crossroads of new results after 2019-2020 AS , now
PSA 16
Gleason 3+3 6
6/12 cores with cancer
PNI at 2 locations
Not sure what treatment to choose ?
They say these other issues require treatment even given Gleason of 6 .
Looking at RALP or Proton guided Radiation
Difficult to decide , any information to help away my decision??

Jump to this post

Sway

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heavyphil | @heavyphil | Dec 6 7:22am
In reply to @stew80 "So sorry to hear this. Did you get antibiotics the day before the biopsy? I was..." + (show)
@stew80

So sorry to hear this. Did you get antibiotics the day before the biopsy? I was told for my upcoming biopsy I'd be taking an anti-biotic the day before, the day of, and the day after.

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Stew, what they give you is HARDLY enough to make up for puncturing your bacteria filled rectum 12 times and injecting….um…shit… into your body.
I’ve done simple dental cleanings on some patients with mitral valve issues, premedicated them with 2 grams of Amoxicillin and they’ve wound up hospitalized for a week with cardiac infections.
Get the TRANSPERINEAL BIOPSY!

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1 reply
jeffmarc | @jeffmarc | Dec 6 10:29am
In reply to @packman7 "I’m at the crossroads of new results after 2019-2020 AS , now PSA 16 Gleason 3+3..." + (show)
@packman7

I’m at the crossroads of new results after 2019-2020 AS , now
PSA 16
Gleason 3+3 6
6/12 cores with cancer
PNI at 2 locations
Not sure what treatment to choose ?
They say these other issues require treatment even given Gleason of 6 .
Looking at RALP or Proton guided Radiation
Difficult to decide , any information to help away my decision??

Jump to this post

I would normally say with a Gleason 6 you don’t do anything, but the PNI means that the cancer has spread outside the prostate. Even though Gleason six, isn’t really considered cancer by many doctors, yours has pretty much proven itself to be cancer.

It could be that your Gleason score is higher, but they’re just not getting biopsy samples from the right area. My Gleason score was 3+4 before surgery and 4+3 after. I know people that have gone from 3+4 to 9 after surgery, So it’s hard to rely on the Biopsy all the time.

Both choices you have outlined would probably work quite well, But I suspect that if you have surgery, they would want to do IMRT radiation, since it’s already spread outside the prostate.

Are you being treated at a center of excellence? Getting opinions From more than one Radiation oncologist And urologist, Asking about the need for radiation after surgery, could give you more information about what direction to choose.

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1 reply
stew80 | @stew80 | Dec 6 1:26pm
In reply to @heavyphil "Stew, what they give you is HARDLY enough to make up for puncturing your bacteria filled..." + (show)
@heavyphil

Stew, what they give you is HARDLY enough to make up for puncturing your bacteria filled rectum 12 times and injecting….um…shit… into your body.
I’ve done simple dental cleanings on some patients with mitral valve issues, premedicated them with 2 grams of Amoxicillin and they’ve wound up hospitalized for a week with cardiac infections.
Get the TRANSPERINEAL BIOPSY!

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Thanks for this concern you raise. I wonder if doing a 'cleanse' (i.e. like before a colonoscopy) would be beneficial.

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1 reply
northoftheborder | @northoftheborder | Dec 6 2:22pm
In reply to @stew80 "Thanks for this concern you raise. I wonder if doing a 'cleanse' (i.e. like before a..." + (show)
@stew80

Thanks for this concern you raise. I wonder if doing a 'cleanse' (i.e. like before a colonoscopy) would be beneficial.

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I don't know, but I'm guessing not. The fecal bacteria is still there; the cleanse is just to remove any bits of feces large enough to affect the accuracy of the colonoscopy.

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stew80 | @stew80 | Dec 6 2:42pm

Next question (can you tell I'm focused? Maybe more than I should be). Has anyone been diagnosed with a 'trabeculated' bladder wall? Apparently it's related to chronic outlet obstruction.

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1 reply
heavyphil | @heavyphil | Dec 7 6:17am
In reply to @stew80 "Next question (can you tell I'm focused? Maybe more than I should be). Has anyone been..." + (show)
@stew80

Next question (can you tell I'm focused? Maybe more than I should be). Has anyone been diagnosed with a 'trabeculated' bladder wall? Apparently it's related to chronic outlet obstruction.

Jump to this post

I agree with @northoftheborder in that a cleanse will not remove the bacteria. One study a few years ago (Hopkins?) showed that a simple povidone iodine suppository inserted one hour before the procedure cut the risk of infection by something like 98%. Please research this! Unfortunately no one does this simple step….
But it may be something for you to do on your own if you think you are going to go ahead with the trans rectal biopsy, in spite of all the posters who have suggested the trans perineal option. Have a feeling your urologist might scoff at the idea but maybe your primary care doc can get you an RX if one is necessary.
Also, I did have trabeculation in my bladder but it all went away after the obstruction (prostate!) was removed.

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