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PSA/MRI not too bad, Biopsy not too good. What??
61 years old, both brothers have had Pca, one died from it, other RARP and no issues since
PSA over last 4 years, from 1.8 to 5.7
Last PSA two weeks ago 2.4 (Mayo Rochester)
Transrectal Biopsy 2021, 1 out of 12 positive, Right Base Lateral: 3+3, 2% of sample positive, Oncotype DX (biomarker) very unlikely to spread
AS for 4 years
MRI 2024 no tumors, nothing at all, clean MRI totally
June 2025 - first visit to Mayo (Jax)
MRI 2025 (Mayo Jax) - one tumor 1cm/0.21cc Right Posterior Lateral, PIRADS 3, no spreading at all
Tranperineal Biopsy one week ago (Mayo Rochester), 9 are negative, 6 are positive:
Right Posterior Lateral Apex: 3+3, tumor is 30% of specimen
Right Posterior Lateral Base: 3+3, tumor is 20% of specimen
Left Anterior Horn: 3+3, tumor is 60% of specimen
Left Anterior Apex: 3+3, tumor is 5% of specimen
Left Anterior Medial: 3+4, % of pattern 4 is less than 10%, "tumor involves 30% of overall specimen (1 of 2 cores). Most affected core is involved by tumor over 60% of its length"
Right Posterior Lateral: 3+4, % of pattern 4 is less than 10%, "tumor involves 20% of overall specimen (3 of 3 cores). Most affected core involved by tumor over 40% of its length"
For the 3+4s they did multiple samples, for rest one core sample only
Pathology report does not mention anything like criboform or IDC (not sure if this is because they found none or because that level of detail is not included in my report)
Have not had Decipher, have not had PSMA PET, no treatment at all up to this point.
Meet with Mayo Rochester NP next week to review results.
Not sure what to make of this. Seems like MRI missed some tumor(s)? Maybe was MRI also wrong when it found no spreading?
Not sure of next steps. Any advice? Thanks in advance!
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@jeff1963
An MRI is not the best way to find cancer spread.
The PSMA pet scan is the industry standard for finding prostate cancer in the body. As long as your PSA is above .5 you should have that test and not another MRI.
@jeffmarc I didn't ask my question correctly.
Sometimes the cancer is so advanced that surgery is not an option.
All of my diagnostic tests (MRI, biopsy) said surgery is an option. What happens on operating table if surgeon finds that the diagnostic tests were wrong and the cancer is so advanced that surgery is not an option?
@jeff1963 I’m not a doctor, this is just my opinion. I don’t think a surgeon can tell while doing a prostatectomy how advanced the cancer is. The pathology afterwards is where lots more information is revealed (e.g. spread into vesicles, bladder neck, margins, pathological Gleason scores, etc.) If lymph nodes are removed they can check those too. My husband’s pre-surgery MRI scan showed it was contained in the gland but a follow-up PSMA showed spread in lymph nodes. This was also found when lymph nodes were examined after the surgery. A follow-up PSMA showed the extent of the lymph node involvement and treatment plan was changed. I believe the best we can do is gather as much information as we can (like you are doing), find the right doctors, and move forward. I wish you well.
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If it has not spread outside the prostate to other organs, they will normally just do the surgery and if it is more extensive they will tell you that margins are not clear, If it has spread wider than they thought it was then they will recommend radiation sooner rather than later. Once they start surgery, they will remove the prostate and any lymph nodes they suspect.
If they are sure it has spread to the lymph nodes they may not want to do surgery and prefer to do radiation because they can treat everything that way. If the Affected lymph nodes are near the prostate they might still go with surgery, But then you may find the margins are not clear as mentioned above.
I’ve never heard of them, not completing the prostatectomy because the cancer had spread more than expected.
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