MRI ReRead (Now Possible EPE)

Posted by broderbund1 @broderbund1, 21 hours ago

So my initial MRI (which was reread twice) by Advent Health to confirm Pirad 4 in Orlando mentioned nothing in regards to possible extracapsular extension (EPE).

I just received a reread from MSK citing the following: "Broad capsular abutment with possible extra capsular extension" They reading also changed my prostate size from 55 cc to 74 cc. Frustrating and scary to say the least.

I'm favorable intermediate.....10% and 5% pattern 4, psa of 3.5 and recieved what I thought was great news with Artera score of 2%. (Waiting on Decipher)

I'm 59 and was strongly leaning/prefer radiation to surgery. I have read that a large % of the time this finding is not accurate if prostate is removed.

Should this finding change my thoughts in regards to radiation...??

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Jeff Marchi | @jeffmarc | 19 hours ago

Some places want your prostate to be smaller rather than that large but it’s probably not too big.

About the only difference that removal of the prostate makes is they get a better idea of what actually was going on inside of it, with the biopsy? Are you saying you’re not sure the size of the prostate was measured correctly?

If you have radiation, they can treat the EPE as well or better than surgery, they can radiate the spots that it could’ve spread into. They do that a lot with metastasis that are near the prostate or in the lymph nodes.

The only reason you should change your thoughts about radiation is if your doctor says there’s a problem.

broderbund1 | @broderbund1 | 18 hours ago

In reply to @jeffmarc "Some places want your prostate to be smaller rather than that large but it’s probably not..." + (show)

@jeffmarc

I’m not sure if it was read correctly or not but seems like a huge discrepancy……seems like the measurement would be relatively straightforward.

heavyphil | @heavyphil | 5 hours ago

The problem with PCa is that there are a lot of ‘BUTS’ to be wary of.
Your original MRI read/Artera Score/biopsy looked pretty straight forward and uneventful…
…BUT broad capsular contact with possible EPE does, at least, change your view about what might be going on.
I don’t think it automatically changes your treatment - as Jeff Marchi points out, RO’s can target this area in 3D and hit even extracapsular cells.
But you may want to have a sit down with the RO and ask him what type of radiation is the BEST for your case; sometimes, old fashioned EBRT might be better than SBRT since they can target a wider area and not cause good tissue to become damaged.
Or even a combination of the two - with perhaps 1 or 2 SBRT sessions to the tumor area and then EBRT to the gland and nodes…Best,
Phil