Since you have 1 lesion visible on your MRI, it's important to make sure that the biopsy you're undergoing is and MRI fusion biopsy where the images from your MRI are "fused" with those of the ultrasound device and that the region of interest is "targeted" for core samples. You do not want the standardized systematic biopsy where 12 samples are taken (two each) from the 6 zones of the prostate. It's OK to that as addition just for mental satisfaction, but you want to make sure focus is on core samples from the region of interest. You need high assurance the biopsy procedure is focused on samples from the lesion.
Pi-Rads 4 indicates a high likelihood of prostate cancer. The lesion size is big enough to warrant a biopsy for sure. I wouldn't freak out about this, talk to your doctor first and he might want to follow up with a biopsy to see if it's worth addressing (if he does, ask for a Decipher as well).
Many prostate cancers don't need treated as they are very slow growing, just because you have it doesn't mean you are in for trouble. The saying that always goes around for many men: more likely to die WITH prostate cancer than FROM it.
Feb15
I just joined Mayo Connect. Great resource. I am new to Prostate problem world. Age 76. First MRI this coming Friday. urologist offered little as to how I should get ready for MRI.
ANY SUGGESTIONS TO PREP FOR MRI? Is enema helpful? I do 3 sets of kegels daily past 2 weeks.
Newcomer
Feb15
I just joined Mayo Connect. Great resource. I am new to Prostate problem world. Age 76. First MRI this coming Friday. urologist offered little as to how I should get ready for MRI.
ANY SUGGESTIONS TO PREP FOR MRI? Is enema helpful? I do 3 sets of kegels daily past 2 weeks.
Newcomer
An enema likely won't be required nor will be helpful, they are going to inject a dye into you so they can get prostate pictures with and without contrast so they can see if your prostate cancer has gone beyond the prostate bed.
MRI's a a cakewalk, don't worry about that. You lie down for 30 minutes while a machine runs over you.
3 sets of kegels every day is FANTASTIC! I'm glad to hear you started them early! Keep them up, but make sure you learn to force their release because that's more important. To make sure (and to learn the sensation of the release) take a deep slow big belly breath and that will force them to relax.
I was also Pi-Rads 4, Gleason 7, Decipher 0.68. Once removed I was upgraded from stage II to stage III.
I have no incontinence - not even a single drop, I have no erectile dysfunction and am basically as I was two weeks ago (prior to surgery).
This is to say that positive outcomes are possible. I worked for months hammering my pelvic floor through exercise and kegels, dropped 25lb and gained back 10 in muscle. I started working the problem the instant I found out and between that and an excellent surgeon I'm on the other side of it relatively intact.
I let myself get into a deep gloom over my diagnosis but still worked it hard. Part of the reason is that forums like this, inherently, don't have a lot of great news - most guys sticking around have issues or are like you and have questions - few of the success stories stick around but I'm trying to be the guy that does so that the next poor guy that has to go through all of this at least can see that it's not all bad.
Hey survivor
Any suggestions on a pelvic floor Physical Therapist. I am in the Phoenix area and so far no one has given me any help or suggestions and I want to get to the same post surgical position in terms of continence. I have read Life after Prostatectomy by Vanita Gaglani, RPT but I just don't seem to be making any progress. Thanks
Hey survivor
Any suggestions on a pelvic floor Physical Therapist. I am in the Phoenix area and so far no one has given me any help or suggestions and I want to get to the same post surgical position in terms of continence. I have read Life after Prostatectomy by Vanita Gaglani, RPT but I just don't seem to be making any progress. Thanks
Just Google pelvic floor therapist Phoenix, I just did and there's plenty out there. Just know they tend to be busy, between guys with incontinence/ED and women with post pregnancy issues.
What I did first was book with every one that could fit me in, then went back and canceled the ones that were the furthest out. In the end I canceled them all because I lucked into the one I have.
A good therapist will do a very physical exam on you - how you stand, how you sit, how you walk - and then may do a digital exam to actually feel your pelvic floor muscles as you engage and release them. They will also give you exercises to do and show you the proper way to Kegel - there IS an improper way that will hinder your progress.
I started out with an elevated PSA of 10.9 ( my first PSA test ever ) I was 67 , a month later I had a second test which showed 11.0 - I started getting nervous and did all the reading - I was worried about getting a biopsy though - my health care provider was really pushing me towards it but the more reading I did I became convinced that the first thing I should do would be to get an MRI . My provider kept saying no to an MRI they would only approve a biopsy ..... I said no ..... only an MRI at this point . After 6 weeks they finally agreed to getting an MRI - the MRI came back with a 5mm lesion contained in the prostate not threatening to breech and no spread could be found beyond the prostate walls . The results did come back as a Pi-Rad 4 . I went for a follow up visit to the doctor after taking another PSA test ( 6 months after the last one ) it came back as 8.7 . Soon I will be making a follow up appointment to get another PSA test - it's been 6 months , my plan is to do nothing ( basically active surveillance ) until I get either a spike in my PSA results or the lesion grows quickly or threatens to breech the prostate - after which time I'll throw the kitchen sink at the problem .
I would get the biopsy. I know there are horror stories but the vast majority are no big deal. The most uncomfortable part of my biopsy was the antibiotic shot in each hip before hand. I would not wait until PSA rises, it gets bigger, or has breached the prostate as that makes treatment much more invasive. If you have a mild or intermediate cancer after the biopsy, there are some relatively easy non-invasive ways to treat it. My post earlier in this thread talks about me doing Tulsa Pro, but there are other good options to get ahead of this.
At first I was going to get a biopsy upon the doctors recommendation but after extensive research on getting a biopsy I came across some seldom mentioned problems with getting a biopsy - things never mentioned in these threads or by urologists , possibly serious problems beyond the chances of infection , bleeding , pain etc. There are MANY cases of people with prostate cancer being spread that were thought to be low risk situations - and surprised the patients and doctors involved . The blame was put on " sub-microscopic " prostate cancer cells that were undetectable ..... These patients all had at least one biopsy . My worry was that , and others speculate the same possibility - that maybe the process of perforating the prostate with a needle over a dozen times could possibly be creating a " leak " of these submicroscopic prostate cancer cells and introducing them into other parts of the body ( bones , lymph nodes etc. ) .
This is what changed my mind on the biopsy , maybe punching holes in the prostate wall membrane ( if not absolutely necessary ) could be problematic .... maybe nature constructed the prostate wall in a way that prevents submicroscopic cancer cells from escaping ..... anyway , this was my logic in choosing to go with the MRI instead - I will be keeping a close eye on the situation and if things get more threatening as time progresses I will be quick to act .
I started out with an elevated PSA of 10.9 ( my first PSA test ever ) I was 67 , a month later I had a second test which showed 11.0 - I started getting nervous and did all the reading - I was worried about getting a biopsy though - my health care provider was really pushing me towards it but the more reading I did I became convinced that the first thing I should do would be to get an MRI . My provider kept saying no to an MRI they would only approve a biopsy ..... I said no ..... only an MRI at this point . After 6 weeks they finally agreed to getting an MRI - the MRI came back with a 5mm lesion contained in the prostate not threatening to breech and no spread could be found beyond the prostate walls . The results did come back as a Pi-Rad 4 . I went for a follow up visit to the doctor after taking another PSA test ( 6 months after the last one ) it came back as 8.7 . Soon I will be making a follow up appointment to get another PSA test - it's been 6 months , my plan is to do nothing ( basically active surveillance ) until I get either a spike in my PSA results or the lesion grows quickly or threatens to breech the prostate - after which time I'll throw the kitchen sink at the problem .
PiRad4 indicates a high likelihood of cancer. If you wait for it to get worse you may be depriving yourself of much less invasive treatments like TulsaPro or HIFU…
THE KITCHEN SINK IS NOT FUN!!
Talk to your urologist about a transperineal biopsy; aside from other advantages, it affords better access to all parts of the prostate; the transrectal does not.
You really want to know if this lesion is the only culprit; other areas may also have cancerous cells that are not coalesced enough to form a discernible image on MRI.
If everything else is normal, a single lesion is easily treatable with focal therapy and any side effects will be minimal.
Phil
At first I was going to get a biopsy upon the doctors recommendation but after extensive research on getting a biopsy I came across some seldom mentioned problems with getting a biopsy - things never mentioned in these threads or by urologists , possibly serious problems beyond the chances of infection , bleeding , pain etc. There are MANY cases of people with prostate cancer being spread that were thought to be low risk situations - and surprised the patients and doctors involved . The blame was put on " sub-microscopic " prostate cancer cells that were undetectable ..... These patients all had at least one biopsy . My worry was that , and others speculate the same possibility - that maybe the process of perforating the prostate with a needle over a dozen times could possibly be creating a " leak " of these submicroscopic prostate cancer cells and introducing them into other parts of the body ( bones , lymph nodes etc. ) .
This is what changed my mind on the biopsy , maybe punching holes in the prostate wall membrane ( if not absolutely necessary ) could be problematic .... maybe nature constructed the prostate wall in a way that prevents submicroscopic cancer cells from escaping ..... anyway , this was my logic in choosing to go with the MRI instead - I will be keeping a close eye on the situation and if things get more threatening as time progresses I will be quick to act .
Phil’s response is good. My MRI was Pi-rads 4 & showed a single lesion. I wanted to know what was there. My fusion biopsy identified all six cores in that lesion as cancerous. The other 12 random cores in my prostate were negative. I then had a PSMA scan to ensure it had not spread. That gave me the confidence to go forward with Tulsa Pro and I could not be happier at this point.
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Since you have 1 lesion visible on your MRI, it's important to make sure that the biopsy you're undergoing is and MRI fusion biopsy where the images from your MRI are "fused" with those of the ultrasound device and that the region of interest is "targeted" for core samples. You do not want the standardized systematic biopsy where 12 samples are taken (two each) from the 6 zones of the prostate. It's OK to that as addition just for mental satisfaction, but you want to make sure focus is on core samples from the region of interest. You need high assurance the biopsy procedure is focused on samples from the lesion.
-
Like -
Helpful -
Hug
2 ReactionsFeb15
I just joined Mayo Connect. Great resource. I am new to Prostate problem world. Age 76. First MRI this coming Friday. urologist offered little as to how I should get ready for MRI.
ANY SUGGESTIONS TO PREP FOR MRI? Is enema helpful? I do 3 sets of kegels daily past 2 weeks.
Newcomer
An enema likely won't be required nor will be helpful, they are going to inject a dye into you so they can get prostate pictures with and without contrast so they can see if your prostate cancer has gone beyond the prostate bed.
MRI's a a cakewalk, don't worry about that. You lie down for 30 minutes while a machine runs over you.
3 sets of kegels every day is FANTASTIC! I'm glad to hear you started them early! Keep them up, but make sure you learn to force their release because that's more important. To make sure (and to learn the sensation of the release) take a deep slow big belly breath and that will force them to relax.
-
Like -
Helpful -
Hug
1 ReactionHey survivor
Any suggestions on a pelvic floor Physical Therapist. I am in the Phoenix area and so far no one has given me any help or suggestions and I want to get to the same post surgical position in terms of continence. I have read Life after Prostatectomy by Vanita Gaglani, RPT but I just don't seem to be making any progress. Thanks
Just Google pelvic floor therapist Phoenix, I just did and there's plenty out there. Just know they tend to be busy, between guys with incontinence/ED and women with post pregnancy issues.
What I did first was book with every one that could fit me in, then went back and canceled the ones that were the furthest out. In the end I canceled them all because I lucked into the one I have.
A good therapist will do a very physical exam on you - how you stand, how you sit, how you walk - and then may do a digital exam to actually feel your pelvic floor muscles as you engage and release them. They will also give you exercises to do and show you the proper way to Kegel - there IS an improper way that will hinder your progress.
-
Like -
Helpful -
Hug
2 ReactionsI started out with an elevated PSA of 10.9 ( my first PSA test ever ) I was 67 , a month later I had a second test which showed 11.0 - I started getting nervous and did all the reading - I was worried about getting a biopsy though - my health care provider was really pushing me towards it but the more reading I did I became convinced that the first thing I should do would be to get an MRI . My provider kept saying no to an MRI they would only approve a biopsy ..... I said no ..... only an MRI at this point . After 6 weeks they finally agreed to getting an MRI - the MRI came back with a 5mm lesion contained in the prostate not threatening to breech and no spread could be found beyond the prostate walls . The results did come back as a Pi-Rad 4 . I went for a follow up visit to the doctor after taking another PSA test ( 6 months after the last one ) it came back as 8.7 . Soon I will be making a follow up appointment to get another PSA test - it's been 6 months , my plan is to do nothing ( basically active surveillance ) until I get either a spike in my PSA results or the lesion grows quickly or threatens to breech the prostate - after which time I'll throw the kitchen sink at the problem .
-
Like -
Helpful -
Hug
1 ReactionI would get the biopsy. I know there are horror stories but the vast majority are no big deal. The most uncomfortable part of my biopsy was the antibiotic shot in each hip before hand. I would not wait until PSA rises, it gets bigger, or has breached the prostate as that makes treatment much more invasive. If you have a mild or intermediate cancer after the biopsy, there are some relatively easy non-invasive ways to treat it. My post earlier in this thread talks about me doing Tulsa Pro, but there are other good options to get ahead of this.
-
Like -
Helpful -
Hug
4 ReactionsAt first I was going to get a biopsy upon the doctors recommendation but after extensive research on getting a biopsy I came across some seldom mentioned problems with getting a biopsy - things never mentioned in these threads or by urologists , possibly serious problems beyond the chances of infection , bleeding , pain etc. There are MANY cases of people with prostate cancer being spread that were thought to be low risk situations - and surprised the patients and doctors involved . The blame was put on " sub-microscopic " prostate cancer cells that were undetectable ..... These patients all had at least one biopsy . My worry was that , and others speculate the same possibility - that maybe the process of perforating the prostate with a needle over a dozen times could possibly be creating a " leak " of these submicroscopic prostate cancer cells and introducing them into other parts of the body ( bones , lymph nodes etc. ) .
This is what changed my mind on the biopsy , maybe punching holes in the prostate wall membrane ( if not absolutely necessary ) could be problematic .... maybe nature constructed the prostate wall in a way that prevents submicroscopic cancer cells from escaping ..... anyway , this was my logic in choosing to go with the MRI instead - I will be keeping a close eye on the situation and if things get more threatening as time progresses I will be quick to act .
PiRad4 indicates a high likelihood of cancer. If you wait for it to get worse you may be depriving yourself of much less invasive treatments like TulsaPro or HIFU…
THE KITCHEN SINK IS NOT FUN!!
Talk to your urologist about a transperineal biopsy; aside from other advantages, it affords better access to all parts of the prostate; the transrectal does not.
You really want to know if this lesion is the only culprit; other areas may also have cancerous cells that are not coalesced enough to form a discernible image on MRI.
If everything else is normal, a single lesion is easily treatable with focal therapy and any side effects will be minimal.
Phil
-
Like -
Helpful -
Hug
2 ReactionsPhil’s response is good. My MRI was Pi-rads 4 & showed a single lesion. I wanted to know what was there. My fusion biopsy identified all six cores in that lesion as cancerous. The other 12 random cores in my prostate were negative. I then had a PSMA scan to ensure it had not spread. That gave me the confidence to go forward with Tulsa Pro and I could not be happier at this point.
-
Like -
Helpful -
Hug
4 Reactions