Received MRI Results Today

@danceguy
For those reading your post and seeing many of us that insisted our biopsies be done transperinal and not transrectal shows what can happen if transrectal.

I did not agree with my urologist who wanted to do my transrectal. I wanted it done transpernial with MRI/Fusion (which my urologist also could do. I got my other Mayo medical team members involved and he changed his mind and said okay transperinal.

Were you told that the transrectal carried around a 2% increase in getting an infection? That the transpernial rate of infection was almost negigilble? Where you told if you did get infection would have to be in hospital for treatment?

I was told this and refused to have it done transrectal and if my urologist would not do it transperninal I would have gone elsewhere.

I feel for you @danceguy and I hope your posts shows we can do many things to lesson further complications when going through prostate testing and treatments.

When you get your biopsies asked for Decipher test.

@packman7
We all were at some point in our journey of what to do.

Asked your urologist about getting a Decipher test. The Gleason 6 is low and usually I see others who are at 6 getting active surveillance. I was 3+4=7.

Do some research on proton and photo radiation if your urologist and R/O are recommending treatments. You say other issues are present justifying treatment versus Gleason score of 6.

This is why your medical professional know you and your case and your specific medical profile.

Mayo Clinic, John Hopkins, Cleveland Clinic are great sources of treatments along with the proton radiation you mentioned.

Also if you have the time you can request a information package from UFHPTI. They are proton radiation providers since 2006. The packet they send has the two books on prostate cancer you see mentioned here on MCC. The include information and research on prostate cancer, the treatments, the outcomes, the side affects, and also what UFHPTI offerrs. It a free package (FED EX to you) with a ton of information and abosultely no pressure to go to UFHPTI for treatments.

What did I have. Rising PSA numbers but still normal. Referral to urologist for DME, normal. MRI done as MRI/Fusion showing suspicious areas. Biospies scheduled. Came back 3+4=7. Referred to R/O. R/O recommended photon radiation with hormone but ordered Dechipher. Decipher came back low risk not intermediate the biopsies were at. Treatment changed from photon (20 rounds) with hormone to radiation only.

Got second opinin at UFHPTI who also did PSMA and agreed with diagnosis and treatment but they do proton radiation not photon. Had 30 rounds on proton radiation.
Hope I was able to help but not familiar with RALP so can helped on that one.

Thanks for info ! Going to Rochester Mayo urologist Dec 13 and will go over options from him , hopefully I have some time to decide what treatment I choose . The PNI confuses me given the Gleason 6 !

Hey Jeff, I consider you “the man” on this thread as you have much personal experience with this disease and sit on other boards/blogs, etc.
However, please take a look at Dr Andrew Barsky’s paper on PNI. It can be accessed on the Memorial Sloan Kettering website under his credentials. He is my current doctor at Sloan and we discussed this paper at length. I do not think PNI always means that the cancer is outside the prostate, nor does it point to more dire prognosis as it once did. It IS a sign of the extent of disease inside the gland but doesn’t mean necessarily that the cancer cells used the neural sheath as a conduit OUT of the gland.
Anyway, just wanted to point that out to @packman7 so he doesn’t freak out any more than ‘normal’😊

I was told about a 1% infection rate with their protocol. I ended up being the 1%. If i ever need another one, it WILL be done transperineally.

Today it seems that I am getting the upper hand on the infection. Have not taken even an acetaminophen since 3AM, and nothing else other than the amoxicillin, and fever has been around 98 all day. My normal baseline is 97.5. Ate a good lunch and will prob go for a walk as I have been mostly bedridden since Wed pm.

And thanks for the counsel on the Decipher test

You are correct. PNI Does not mean it has spread outside the prostate. It does, however, seem to mean the cancer is aggressive. I see multiple statements about PNI, from NIH and others, that are similar to this.

“Prostate cancer has a propensity to invade and grow along nerves, a phenomenon called perineural invasion (PNI). Recent studies suggest that presence of PNI in prostate cancer has been associated with cancer aggressiveness.

Jeff, I wish I wasn’t so bad at copying and pasting! The gist of Dr Barsky’s article is that PNI is NOT associated with post surgical Gleason upgrading. And that PNI offers - in a perverse way - a clearer look into the actual “Gleason-ness” of the original presurgical biopsy.
In my own case I had PNI in perhaps six cores out of twelve. I was diagnosed with Gleason 4+3 unfavorable. My surgical pathology report remained the same - no 5’s detected.
Of course, here I am 5 yrs later having salvage radiation so my cancer was obviously more aggressive. My doctors at Sloan however, ascribe this more to the surgeon’s laxness at doing complete lymph dissection than pure aggressiveness.
So the spread of the cells toward the neural sheath -PNI- does, in fact, point to a more aggressive type of cell but not one that has necessarily escaped into the surrounding tissues.
Best

Yes you receive these antibotics . I assume you are going for the Transperineal Biopsy NOT the more risky for infection , possibly sepsis , TRANSRECTAL BIOPSY , for obvious rreasons . Several countries , for example Norway have banned the TRANSRECTAL BIOPSY for this reason . Many Urologists in the USA now refuse performing the transrectal .
Many fear a biopsy . In Canada they almost never give you an anesthestic , just a local numbing in the perineal area . IT IS A WALK IN THE PARK .

The important reference on your MRI which you do not mention is the PI-RADS Score . RADS 5 HAS THE HIGHEST PROBABILITY THAT YOU HAVE CANCER , A 98 % CHANCE . Mine was a PI-RADS 5 the worst .
Your Oncologist or GP will send you for a Biopsy , this is the only way they will confirm you have cancer .
AN MRI CANNOT CONFIRM YOU HAVE CANCER .
My Recommendation : Have a TRANSPERINEAL MRI Fusionn Biopsy . NOT , I repeat NOT a TRANSRECTAL BIOPSY ,where their is a higher risk of infection , possibly sepsis , FOR OBVIOUS REASONS .
Finally : Get a 2nd or 3rd opinion of your Gleason Score which is determined by your pathology results from the biopsy -- INSIST ON A 2nd OR 3rd OPINION -- I DID . And they were different .
Treatment priorities and opions are determined by your Gleason score .
Go out and buy Dr. Patrick Walsh's bookk : " Guide to Surviving Prostate Cancer " . Educate yourself from this book on tests , what they mean and all your treatment options . The pros and side effects are all explained . It will be the best money you ever spent -- It could save your life .
I was digonosed at age 84 . My 1st Biopsy was negative . My MRI PI-RADS 5 was in conflict with the biopsy results . I had a 2nd MRI and Transperineal biopsy . My results Gleason 3 +3 = 6 . I questioned this result and had a 2nd and 3rd opinion to determine my most likely and true Gleason Score . They were different .
I am currently , for the past year on ACTIVE SURVEILLANCE , I.E PSA tests every 3 months and just had an MRI one year after the 1st one - It showed no change . You will learn all about active surveilllance , Focal Therapies etc when you read Dr. Walsh's book.
Good Luck .