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Pressured by oncologist
Recently diagnosed: 3+4/7. Suspicious for intraductal, perineural invasion, cribriform decipher .52. Age 66 - healthy & active. Urologist referred me to local cancer treatment facility. MD told me I shouldn’t wait with treatment and should start hormones immediately. Followed by 24 radiation treatments. Actually walked me to his scheduler while telling me he disagrees with the 3+4 and should proceed as 4+3. He and scheduler were surprised when I walked out. Three weeks later and 3 hour drive to Fred Hutchinson (Seattle). 2 hour consultation with oncologist with totally different take. PSMA pet scan will be next. Today, I’m wondering what kind of kickback was lined up between my urologist & cancer clinic he sent me to. PS - OHSU in Portland, OR still continues to ignore referral & calls.
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HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
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FYI - still zero response from OHSU in PDX. I’m glad there are options - at this point Fred Hutchinson has exceeded my expectations immensely and further enforced through interviews with a couple of prostate cancer patients in waiting room.
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Hug
1 ReactionIf you have cribriform then your actual Gleason score is effectively much higher, as if they were a five in the two numbers. Especially high if the cribriform is more than a .25 mm.
Both surgery and radiation will have about the same effect. Advantage of surgery is that it allows you to do effective radiation after. If you do, radiation surgery is difficult.
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Hug
2 ReactionsThanks - scheduling a PMSA pet scan next.
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Hug
1 Reaction@ezpcic . First what was your PI-RADS Score on your MRI . And second : Have you ever purchased and studied Dr. Patrick Walsh's book " Guide to Surviving Prostate Cancer " or followed Dr Mark Scholz U Tube Videos on Prostate Cancer .
Finally . You can not determine if you have cancer from a PSE , DRE or MRI Test . They are signals only . A DRE Test cannot feel the area of the prostate where 90% of cancer starts .
A PSA & DRE are Amber lights - An MRI can be a RED light . The Biopsy confirms whether you have cancer or not . See below Re : 2nd and 3rd opinions .
CAUTION . Should you require a Biopsy : Go for a TRANSPERINEAL MRI Fusion Biopsy . NOT The outdated TRANSRECTAL where for obvious reasons the risk of infection is higher , plus with a Transperineal you can reach areas of thhe prostate much , much more easier .
And finallly and most important . After a Biopsy and you receive your Gleason Score . Get a 2nd even a 3rd opinion to confirm your Gleason score . Your treatment options rely on an accurate Gleason score .
Good luck.
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Hug
5 ReactionsThanks. Appreciate the feedback. My MRI was a Pirads 3. Here is the radiologists narrative.
MRI PROSTATE W WO CONTRAST
HISTORY: Prostate specific antigen above reference range R97.20: Elevated prostate specific antigen (PSA)
COMPARISON: None.
TECHNIQUE: Multiplanar multisequence MR imaging of the pelvis performed without and with intravenous contrast using the prostate protocol. Multiple B-value diffusion-weighted imaging in the axial plane was also performed through the prostate gland with
ADC mapping.
IV Gadavist 10 mL.
FINDINGS:
PROSTATE VOLUME: 6.8 x 4.29 x 6.1 cm with a prostate volume 95 mL.
PERIPHERAL ZONE: Diffuse abnormality of the peripheral zone noted characterized by low T2-weighted signal and mildly elevated diffusion-weighted signal and mildly decreased ADC signal without focal lesions. The capsule is well defined.
TRANSITION/CENTRAL ZONE: Diffuse nodular transition zone noted
OTHER PELVIS: No pelvic adenopathy identified. The seminal vesicles appear symmetric. The bladder appears normal.
Impression
IMPRESSION:
1. Diffuse abnormality the peripheral zone. This is a nonspecific finding and can be seen in both acute and chronic prostatitis or other inflammatory process and rarely in diffuse malignancy. Malignancy being considered less likely in the presence of
a well-defined capsule. Consider follow-up MRI in 6 months.
FINAL PI-RADS: 3, intermediate. The presence of clinically significant cancer is equivocal.
Although I've been researching Prostate Cancer for the last 3 months and my dad had it and surgery in the early 1990's but lived another 24 years, I have not read Walsh's book although many people reference it. I guess my approach is to try as many non invasive strategies, see what they say before I move to Biopsy.
Moving to Fred Hutch was wise. I was on AS for a few years there before proton therapy. No pressure on treatment options and a leading center. Pedigrees of the team there are solid , from John Hopkins , UCLA , etc.
@ezupcic . Thanks I appreciate your timely response . Active Surveillance seems in order at this juncture , with particular attention to your PSA ( DOUBLING TIME ) etc .
Are you immersing yourself in Prostate Cancer knowledge in order to be your own best advocate in future decision making ?
P.S. Are you aware that patients with a very low PSA can have prostate cancer , and those with a very high PSA may not ? A PSA can be in the thousands -- the highest recorded is over 20 ,000 . yes twenty thousand . Accordingly , PSA alone is a poor barometer .
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Hug
3 ReactionsBoy, there is a real iffy MRI. It may or may not be a problem, That isn’t what one wants to hear.
The PSE test was designed to filter out cancer versus non-cancer to decide whether or not you need a biopsy. That would be real helpful in this case but not all doctors will let you get one. There isn’t the only test, but it is very accurate 93%.
Sure, you can wait another six months, There are options.
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Hug
2 ReactionsI think I'll do another PSA asap and see where the numbers are at. Thanks for the response.