Prostate Cancer complicated by anal stenosis: Any suggestions?

Posted by sambon @sambon, Jan 3 9:34am

2016 scar removal from colon. Diagnosed with anal stenosis
2023 PSA 14 and MRI lesion PIRADS 4
Saw 2 Urologists in Vegas for transperineal biopsy first only rectal. Second consulted with my colon surgeon. Probe too large likely to cause rectal / colon injury. Wanted to go through into my bladder. Told not accurate. Moved on
Mayo Clinic’s urologist Phoenix next. Exam, discussion, schedule MRI fusion guided. Thought he could get the probe in. Didn’t have much to offer on possible treatments due to the stenosis. My clean up after DRE blood on the wash cloth. My PCP consulted with my colon surgeon and I canceled the biopsy. Told rectal probes likely to cause injury. Letter sent from PCP to Mayo Dr for options. Answer. Without a biopsy we cannot treat the cancer and options if any with a biopsy very limited. Any thoughts would be greatly appreciated. Thanks
Cons

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jsh327 | @jsh327 | Jan 4 9:12am

Just in case helpful or not already considered, PSMA PET scans have been considered for diagnosing prostate cancer in Europe when a biopsy is not possible. However, I assume that getting a health insurance company to pay for a PSMA PET scan at this stage of treatment would be challenging. Hopefully, others will be able to provide you with more helpful input. I am frustrated for you, because scans such as PSMA PET are used for PC location confirmation and treatment actions after the initial treatment, radiation or surgery, is completed.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9421196/

sambon | @sambon | Jan 4 9:47am

Thanks for the reply. I know I havePC. Even without a biopsy. I have looked at the PSMA. My problem becomes biopsy or pet scan, there just aren’t any treatment options that I know of that do not require a rectal device which would create an injury and another serious and immediate problem

jsh327 | @jsh327 | Jan 4 3:17pm

In reply to @sambon "Thanks for the reply. I know I havePC. Even without a biopsy. I have looked at..." + (show)

If a Transrectal and Transperineal biopsy are not possible, did the Mayo Clinic urologist state why they would not accept PSMA PET scan data? I recommend escalating at Mayo until you find someone that will help you find an alternative to a biopsy. A quick search of medical literature shows examples in Europe where a person could not get a biopsy and scans were used for treatment planning (https://www.europeanurology.com/article/S0302-2838(21)02194-1/fulltext). Hopefully others during the next few days will offer some better ideas for next steps. One thing that all of us with PC learn is that you have to be the person in charge of your own treatment plan and we never give up.

sambon | @sambon | Jan 4 4:05pm

Your replies are greatly appreciated. I am not giving up and I know that I have to be in charge. My MRI shows the location and size (13mm) of the lesion and Mayo read it , providing more information than my first read. However the Dr reply to my PCP letter was basically “sorry “ need biopsy. I want to know treatments available for me without a rectal device at any time larger than 16mm … not getting any answers.
Bottom line other than RP ,every treatment I have looked at requires a rectal device. I am moving on to talk to Huntsman in Salt Lake. I will not treat if a rectal device puts me at risk. Living my daily life with anal stenosis, can only be understood by me (just isn’t easy). Your thoughts and comments are truly appreciated. Thanks Sam

gently | @gently | Jan 4 8:09pm

Sam, nor should you--give up or risk injury. I would think you could have radiation without the biopsy. But maybe you have to go to West Virginia. This case is from 2020. Schliffler Cancer https://wvumedicine.org/about https://www.weirtonmedical.com/blog/provider/gregory-merrick-md/
"Patients without rectal access have undergone prostate biopsy via transperineal and transabdominal ultrasound and CT or MRI-guided transgluteal biopsy approaches.1, 2, 3, 4, 5 Herein, we describe a CT-planned transperineal approach with fluoroscopic guidance for prostate biopsy in a patient who underwent a total colectomy (including he distal rectum an anal canal)."https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574335/

sambon | @sambon | Jan 5 5:34am

Thank You ... very good and new information. I will work on this
My best regards for your help

gently | @gently | Jan 5 9:03am

Someone might use a pediatric probe. The traducer may not be strong enough. And, I think, safer without any probe.
Unsolicited, I add that you may have better luck at a university cancer center and you'll best consult with the director. I would also contact Carl Rossi at CAProton Center in San Diego, because of his extensive experience with prostate cancer and because everyone with cancer should look at the possibility of proton treatment.
I think you'll have luck.