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 8 12:52pm
In reply to @clandeboye1 "The important reference on your MRI which you do not mention is the PI-RADS Score ...." + (show)
@clandeboye1

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 .

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I appreciate all that you have written here. It does help and yes, I will ask Santa for the Dr. Walsh book. Nice to read comments from someone who is my age. I believe that is a big factor on how clinicians view their patients even though 84 yr old should have the same urgency and treatment options as a 64 yr old person.
My MRI does say PI-RADS 5 for one lesion and PI-RADS 4 for the other one. It also said there was motion so the assessment couldn't be as complete as it should be. I kept very still (I thought) for 30 minutes or so during the scan so I was disappointed to read "very limited examination due to motion"

REPLY
jeffmarc | @jeffmarc | Dec 8 5:12pm
In reply to @heavyphil "Jeff, I wish I wasn’t so bad at copying and pasting! The gist of Dr Barsky’s..." + (show)
@heavyphil

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

Jump to this post

Yes, he did say it was not more aggressive with “clinically localized prostate cancer.” If it has spread outside of prostate, then PNI wasn’t studied.

Another ASCO Study Found much higher rates of reoccurrence with PNI. The people that had PNI Had an 19% chance of reoccurrence and 3.1% for other people in the study that did not have PNI.

As I mentioned, I did find multiple places on the web where they said it was more aggressive.

REPLY
jc76 | @jc76 | Dec 9 5:44am
In reply to @clandeboye1 "The important reference on your MRI which you do not mention is the PI-RADS Score ...." + (show)
@clandeboye1

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 .

Jump to this post

@clandeboye1
Good information.
The doing of self research is important.

I keep recommending UFHPTI information packet. It is free and comes FED EX at no pressure to go with them. The information packet includes the book you mentioned written by DR. Walsh and another one that has been mentioned. It contains a ton of information and research. It is just one of the things I did to help me decide. I donated my books to local library.

Getting second opinions is paramount to being informed about your specific condition. We are all different and all cases of prostate cancer should be specific to yours. Becoming your own advocate in the treatment of any physical or mental condition by research, second opinions, asking questions, getting additional tests is really fundamental to making the right decision for your health.

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clandeboye1 | @clandeboye1 | Dec 9 3:18pm

@stew80
Have you met with your GP or your Urologist yet ? He / She will send you for a Biopsy or perhaps a clearer MRI before the Biopsy . You will require a clearer MRI for your biopsy . Also read my post to insist on a TRANSPERINEAL MRI Fusion Biopsy NOT a TRANSRECTAL . KEEP US POSTED .
Merry Xmas & Happy New Year .

REPLY
stew80 | @stew80 | Dec 9 3:45pm

Thanks for your message. I called my GP today and updated her. She said that the main info they need is on the current MRI. Two lesions (PIRADS 5 AND 4). There is also an indication that one lesion may have encroached the edge of the prostate and the worry is it may have spread locally. I am pushing to get the biopsy sooner than what is booked (20 Feb 2025) by getting on a short list. I don't think there is a 'pay' option to get it sooner. On the transrectal versus perineal biopsy issue, the Cancer Center here doesn't do perineal. My GP said that despite the infection potential, there are fewer layers to punch through rectally and the results are more accurate. I also asked about a povidone iodine suppository and she said she hadn't heard about using it for a biopsy, but it made sense. Apparently it's available over the counter. Finally, my GP said that, sad but true, they look at 84 and have the tendency to be less in tune to the urgency.
Merry Christmas and Happy New Year to you as well.

REPLY
2 replies
heavyphil | @heavyphil | 6 days ago
In reply to @stew80 "Thanks for your message. I called my GP today and updated her. She said that the..." + (show)
@stew80

Thanks for your message. I called my GP today and updated her. She said that the main info they need is on the current MRI. Two lesions (PIRADS 5 AND 4). There is also an indication that one lesion may have encroached the edge of the prostate and the worry is it may have spread locally. I am pushing to get the biopsy sooner than what is booked (20 Feb 2025) by getting on a short list. I don't think there is a 'pay' option to get it sooner. On the transrectal versus perineal biopsy issue, the Cancer Center here doesn't do perineal. My GP said that despite the infection potential, there are fewer layers to punch through rectally and the results are more accurate. I also asked about a povidone iodine suppository and she said she hadn't heard about using it for a biopsy, but it made sense. Apparently it's available over the counter. Finally, my GP said that, sad but true, they look at 84 and have the tendency to be less in tune to the urgency.
Merry Christmas and Happy New Year to you as well.

Jump to this post

Stew, rectal is definitely NOT more accurate but get the suppository - it will protect you immensely! Best regards for the Holidays!

REPLY
callibaetis | @callibaetis | 5 days ago

Antibiotic prophylaxis for my transrectal biopsy consisted of levofloxacin and a shot of ceftriaxone (Rocephin).

REPLY
stew80 | @stew80 | 5 days ago

Mine will be auro-ciprofloxacin and jamp-fosfomycin.

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