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New and Need Guidance: What questions to ask about prostate cancer?
Prostate Cancer | Last Active: Apr 28 6:50pm | Replies (52)Comment receiving replies
Thank you guys for your replies. I will definitely look into that book.
When and why is the PSMA scan used?
What is the reason you guys are choosing RALP over treatment?
Does having radiation disqualify you in any way from having RALP later on?
I do have one main concern. The urologist that we are working with seems pretty young. I did a quick search and bringing up that he has been practicing since 2016. This does not make me feel very comfortable. I felt ok early on seeing this urologist but now that things seem to have gotten more serious I honestly don't feel comfortable. Not that he's done anything wrong because I think at this stage it's more of just following the motions of run this test and run that test. In looking online I see that he's been practicing since 2016, this does not make be feel very comfortable at all. How would you guys feel being in my shoes and what would you do in this situation?
One thing seems odd to me is that the doctor said that a lesion of 8mm was found (didn't mention where exactly) and a Pi-RADS 4 category was assigned, and that there's about a 40%-45% chance that it could be cancerous. In looking online however, I'm seeing that chances of cancer with a Pi-Rads 4 are more like 60%-75%. Does this strike anybody as odd for a doctor to give it such a drastically different % chance or is there more taken into account that I might not understand?
So far I understand the process of blood test PSA, the range you should be in, I understand why an MRI was performed, getting a Pi-RADS category, I understand why a biopsy is needed, ordering a biopsy (this seems tricky as everybody seems to talk about different kinds which I still am not too sure what to do), I also understand that the results of the biopsy will come with a pathology report which will provide a Gleason score if anything is found (I also understand the different scores and how they are assigned, though not educated yet on treatment options for each score).
As far as getting a pathology report. What exactly would happen if a biopsy comes back showing no cancer? Does this mean all is good and on you go, or does this mean you continue monitoring PSA regularly and most likely continue performing biopsies until something is found?
Replies to "Thank you guys for your replies. I will definitely look into that book. When and why..."
@vulcan, I'd like to add my welcome. I agree with the others who have posted helpful replies. You are asking all the right questions. As you search for information and experiences about prostate biopsies, you may appreciate these related discussions:
- Is a biopsy only way to diagnose prostate cancer? https://connect.mayoclinic.org/discussion/is-a-biopsy-only-way-to-diagnose-prostate-cancer/
– Anyone have an Ultrasound-Guided Transperineal Prostate Biopsy?: https://connect.mayoclinic.org/discussion/anyone-have-an-ultrasound-guided-transperineal-prostate-biopsy/
– Prostate transrectal biopsy https://connect.mayoclinic.org/discussion/prostate-transrectal-biopsy/
Have you considered getting a second opinion from a cancer center?
Hoping your father does well throughout this ordeal.
My Urologist told me the PSMA scan, done after the Biopsy, showed where the cancer was; simply within the prostate gland and NOT anywhere else. Fusion Biopsy was not mentioned during my treatment.
He DID send my biopsy tissue for a Decipher test, which took a few agonizing weeks, showing the biopsy results from different sections of the gland. This provided the Gleason scores where the latter number shows the aggressiveness of that "snip;" while the first number indicates the most predominant pattern. I had several 3+4 scores, prompting my Urologist to go further and I had the PSMA test.
On the issue of the experience of the doctor, I would tell him that I am concerned about your short length of experience and, this is MY FATHER whom I am very worried about. I hope you are not offended but I would like someone more experienced to handle his case. Just be honest.
There are a LOT of questions to ask. But some cannot be answered until more steps are taken. With a high PSA, I expect a biopsy would be scheduled, and the snips would/should be sent off for a Decipher test. That takes a few weeks, agonizingly slow when one is very anxious to get results.
Wishing the best for all.
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Psma pet scans give a clearer image of cancer cells. If you can see it, you can treat it.
I chose radiation because of the potential side effects of RALP. I had identified Dr Patel in Celebration Fl who had done 18,000 of the RALP’s but felt the MRIdian Viewray specifically was a choice that would work, with minimal side effects and better quality of life. For me, I made the right choice. We will see over the next few years. There are lots of grey areas with these choices.
I understood that RALP later on, after making the radiation choice, complicated the procedure but felt I made a good choice, especially after the Mirage randomized trial results on the MRIdian:(https://www.prnewswire.com/news-releases/mirage-phase-iii-randomized-controlled-trial-demonstrates-superiority-of-mridian-mri-guidance-in-stereotactic-body-radiotherapy-sbrt-for-localized-prostate-cancer-301660815.html. By the way, there is a machine in Lansing, MI.
I encourage you to get the Decipher test or similar. I felt that it acted as a backup to whatever my Urologist or the Pathologist said. It’s like a second opinion and the doctors consider it when they have it available. It shows an aggressive score and also indicates a single mode of treatment or more. Since your already unsure about the Urologist and they pick the pathologist, it makes even more sense.
Finally, I was put under Propenol for my biopsy so basically, I was out. Why not minimize discomfort when possible.