prostate MRI results one year after SBRT

I had bad news today, seems to be the more issues with prostate. In another thread you could read how they screwed up an Aquablation in 2/2024). Ended up resident did surgery and messed up. My surgeon claims he was available?? After another scoping they said I need a revision Aquablation surgery. I said no for now and went on Flomax. Anyway, they did lots of tests and found no cancer. Actually Medicare wouldn't pay for a big chunk of surgery and said they were not to bill me either. I didn't really understand all the technical reasons why they wouldn't pay.
Last month I had PSA of 5.23 when a few months earlier it was 3.2. Then they scheduled me for MRI of prostate. Did another PSA and it was down to 4.16, but still wanted the MRI. Report is below, doesn't look good PI-RADS 5. Can't seem to get a hold of doctor to see what we are going to do, really stressed. Seems like doctors are too few and too busy to give good service. I bet if I was someone important big name, I would get some attention. At one point they say in report Lesions (PI-RADS 3 or higher), like more than 1, but in body only mention 1, but it is not good. If I understand it, it hasn't spread. Wish I could get a plan with doctor!

FINDINGS:
Prostate measurement: 5.7 x 5.0 x 4.9 cm Prostate volume: 68.75 cc PSA: 4.16 ng/mL PSA density: 0.06 ng/mL/cc
Peripheral zone: See below.
Transition zone: No index lesion. Stromal and glandular BPH nodules.
Lesions (PI-RADS 3 or higher):
Lesion # 1: Location: Left posterior peripheral zone extending from the base to the apex Size: 2.4 x 1.3 x 2.6 cm (5.83 cc). T2: T2
hypointense DWI: Marked restricted diffusion DCE: Focal early enhancement, positive Prostate margin: Abuts the capsule without
definite invasion Overall PI-RADS Score: 5/5
Prostatic capsule: Intact.
Neurovascular bundles: Not involved.
Seminal vesicles: Not involved.
Lymph nodes: No lymphadenopathy.
Bones: No acute osseous abnormality.
Other findings: Small fat-containing right inguinal hernia.
IMPRESSION:
1. The prostate gland measures 5.7 x 5.0 x 4.9 cm with volume of 68.75 cc. PSA density is 0.06 NG/mL/CC. 2. Lesion # 1: PI-
RADS 5 lesion in the left posterior peripheral zone extending from the base to the apex measures 5.83 cc. No frank extracapsular
extension. 3. No pelvic lymphadenopathy.
PI-RADS Category 5: Very high (clinically significant prostate cancer is highly likely to be present)

@diverjer
Finding your old message is going to be extremely difficult, but maybe not necessary.

Enough of your prostate seems to be still there that maybe SBRT radiation might be the best thing to do At this point.

Can you speak to a Radiation oncologist about getting this treated. Insurance would definitely pay for it and SBRT only requires five sessions.

It might be a good idea to get a PSMA pet test. As long as this has been going on, the cancer could’ve spread somewhere else in your body and you want to find that out.

Where are you being treated? It sounds like you’re not getting treated properly and it might make a lot of sense for you to go to a center of excellence and get a second opinion on what’s being recommended. Though it does seem like nothing’s being recommended, since you can’t get a hold of a doctor.

Us prostate cancer patients have to be proactive with our treatment, Get out there and get results even if you have to go somewhere else.

Been treated at Kansas University Medical Center which is also a training hospital. I think I will call the K.U. Cancer Center tomorrow instead of dealing with the Urology Department at the hospital. They have Nurse Navigators at the cancer center that were excellent and fast responses when wife had breast cancer. They had answers and plans within days. All went well and they worked as a team.

I believe the cancer center will be better equipped than the urology department. It is a 71 mile one way trip to either location, but Topeka KS is just behind the times and really short of physicians.

@diverjer Your life is worth that drive!
Phil

Well it looks like I am toast! The MRI showed only one Lesion like shown above. Had biopsy done yester, they did 3 from the Lesion and 6 from each side. I wondered why they did more biopsy that were outside the lesion, but didn't ask. Got report today- not good. The lesion look better than areas where MRI saw nothing. They took 15 samples total.
Results:
Final Diagnosis
View trends
A. Prostate, "LLB", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 30% of needle core tissue.

B. Prostate, "LMB", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 70% of needle core tissue

C. Prostate, "LLM", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 60% of needle core tissue.

D. Prostate, "LMM", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 60% of needle core tissue.
Large cribriform glands present.

E. Prostate, "LLA", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 60% of needle core tissue.

F. Prostate, "LMA", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 50% of needle core tissue.

G. Prostate, "RLB", biopsy:
Benign prostatic tissue.

H. Prostate, "RMB", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 10% of needle core tissue.

I. Prostate, "RLM", biopsy:
Benign prostatic tissue.

J. Prostate, "RMM", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 50% of needle core tissue
Large cribriform glands present.

K. Prostate, "RLA", biopsy:
Benign prostatic tissue.

L. Prostate, "RMA", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 25% of needle core tissue

M. Prostate, "ROI#1", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 3 of 3 cores involving 70% of needle core tissue

@diverjer

You have a Gleason 4+3 7 BUT you have large cribriform and doctors a UCSF say that puts a 5 in your Gleason score.

It is quite aggressive and must be treated properly.

If you have SBRT radiation it is not sufficient to get rid of large cribriform. In that case you would need to have brachytherapy in addition.

IMRT radiation may work, but they recommended using ADT as well if you do it this way. Back

Proton radiation could be sufficient to handle it, discuss this with the radiation oncologist.

Having surgery may work but it is not guaranteed, you may need radiation as well.

You need to discuss this with a radiation oncologist and a urologist that has done a lot of prostatectomies.

It would make sense to get a second opinion on this treatment as well from a center of excellence, even if you are already going to one.

I don't know what a cribriform even is, it's not mention in report. From googling around it can only be determined by sieve-like or "Swiss cheese" appearance under a microscope and I don't see that in report? Doctors haven't talked to me yet, who knows when they will call or make appointment, took long time to get MRI and even longer to get the biopsy done. Sure were fast getting results, they said 7 - 10 days and they gave them to me the next day.

My first thought is just get the thing cut out, not sure how that is done, as seems they got to leave something in there for urine to flow threw. So they couldn't take 100 percent of prostate out. Then I read about nerve sparing or not and not sure what that means. No doctors have discussed this with me yet. Seems if they take it out there shouldn't be any prostate cancer left? But then I read where people get it out and still have a PSA level, so like I said earlier, they must leave some in there, even when they call it total. Had to drive 150 miles to get MRI and biopsy They could have done that in Topeka). KUMC is ranked as number 50 in top of prostate treatment so I went there Topeka doesn't have a Proton device, that would be back up to KUMC 150 miles RT. One of those radiations therapy is only a few days, not 30 some days. They do have SBRT radiation in Topeka, but I know of someone who had SBRT or maybe it was IMRT and it screwed up several other organs around the prostate, like bladder, kidneys and intestines.
Then some tell me I am lucky to have them all in grade group 2 or 3. But seems like I had a lot of them (12 of the 15) . So I would guess if they did 25 I would had had more grade group 2 or 3.
All confusing and stressful, other that this I am 78 years old healthy as a horse- no other issues and very active.

@diverjer CRIBRIFORM IS mentioned and it makes your case more aggressive.
You need to sit down with a surgeon AND a radiation oncologist.
You need to ask them WHY their treatment is BEST for you - no one else.
And you need to ask them what happens if their treatment FAILS.
Phil