1. < Prostate Cancer

Questions about the diagnostic process

Posted by happydappy @happydappy, Apr 9 4:53pm

Hello,

I'm a 63 year old male. My dad had prostate cancer at 58 years old in 1990. He had radical prostatectomy (the procedure was pretty rough back then) but he's been cancer free since. About three years ago I noticed common urinary issues that got progressively worse (reduced stream, trouble emptying, etc.). My PSA tests started rising over the past couple of years and finally got referred to urologist when it was over 4. I got put on Flomax. They ran a PHI test which was 47.9 so got sent for 3D MRI with contrast on a 3T machine. Here's the radiologist's impression: Lesion 1: At the level of the mid gland extending into the prostatic apex in the right lateral transition zone, there is a mildly T2 hypointense lesion with associated diffusion restriction measuring up to 1.7 cm with a volume of 1.28 mL (PI-RADS 4). I got scheduled for a transrectal fusion biopsy with a well known urology oncologist. My doctor/hospital is Duke University Medical Center, a national cancer center of excellence. I have several questions...

1. Is it normal to wait over two months to get scheduled for a biopsy after MRI? They said they were unusually backed up because of increased patient volume.

2. I've been immunocompromised in the past due to an autoimmune disease/medications and had numerous serious infections including bacterial meningitis. I'm not currently on immunosuppressing meds. I asked about risk of infections from transrectal procedures because I read they are fairly common. They said almost all the doctors at Duke do transrectal fusion biopsies and that prophylactic antibiotics should keep me safe. But the Nurse practitioner said she'd ask as one doc does transperineal biopsies but I never heard back . Should I press this issue more or just go along with the transrectal procedure?

3. Is a 1.7 cm/1.28 ml lesion large enough to cause the urinary symptoms? Or maybe there's also BPH?

4. I know that biopsy if the only way to officially diagnose malignancy. But with what is known so far, how prepared should I be for the biopsy to be malignant?

Thanks!

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

happydappy | @happydappy | Apr 14 12:50pm
In reply to @kjacko "Since 2015 When they recognized I had an enlarged prostate, I have had 2 rectal biopsies..." + (show)
@kjacko

Since 2015 When they recognized I had an enlarged prostate, I have had 2 rectal biopsies and two MRI’s. My last biopsy in August showed two cores of cancer. I had an RP in November and so far have had two blood tests showing a PSA of < 0.01. When this whole journey started I was scared to death that one day I would hear the “C” word. Since I joined this chat site I learned a lot about prostate cancer from fellow patients. It not only helped me to understand cancer but understand myself. When I learned of my cancer, my first comment to my wife was, “let’s keep learning and beat this crap”. After my RP, I learned my cancer was a higher risk than the biopsy showed. My attitude was, “I’m glad I got this done. Had I waited longer, it could have been much worse.” My point to you is to hope for the best, but prepare for less. If you have cancer, be glad they discovered it, and can put you on the best treatment possible. As my urologist said, prostate cancer is not the death sentence it was back in your Father’s Day. Keep a positive attitude, and praying won’t hurt you! Best of luck!

Jump to this post

Glad your PSA is so low now and hope it stays that way. Thanks for sharing

REPLY
kjacko | @kjacko | Apr 14 9:20am

Since 2015 When they recognized I had an enlarged prostate, I have had 2 rectal biopsies and two MRI’s. My last biopsy in August showed two cores of cancer. I had an RP in November and so far have had two blood tests showing a PSA of < 0.01. When this whole journey started I was scared to death that one day I would hear the “C” word. Since I joined this chat site I learned a lot about prostate cancer from fellow patients. It not only helped me to understand cancer but understand myself. When I learned of my cancer, my first comment to my wife was, “let’s keep learning and beat this crap”. After my RP, I learned my cancer was a higher risk than the biopsy showed. My attitude was, “I’m glad I got this done. Had I waited longer, it could have been much worse.” My point to you is to hope for the best, but prepare for less. If you have cancer, be glad they discovered it, and can put you on the best treatment possible. As my urologist said, prostate cancer is not the death sentence it was back in your Father’s Day. Keep a positive attitude, and praying won’t hurt you! Best of luck!

REPLY
1 reply
happydappy | @happydappy | Apr 14 7:48am
In reply to @colleenyoung "@happydappy, waiting for a biopsy appointment for 2 months can be anxiety inducing. It gives you..." + (show)
@colleenyoung

@happydappy, waiting for a biopsy appointment for 2 months can be anxiety inducing. It gives you time, however, to do your research and you're asking good questions. If getting an appointment at Mayo Clinic, perhaps Jacksonville, is an option to be seen sooner, here's how to submit a request. http://mayocl.in/1mtmR63

Here are a few related discussions in addition to the helpful responses you've already received to help you with your research:
- Transperineal biopsy options & location recommendations
https://connect.mayoclinic.org/discussion/transperineal-biopsy-options/

- Anyone have an Ultrasound-Guided Transperineal Prostate Biopsy?
https://connect.mayoclinic.org/discussion/anyone-have-an-ultrasound-guided-transperineal-prostate-biopsy/

- Your experience during & after Transrectal Prostate Biopsy (TRUS)
https://connect.mayoclinic.org/discussion/your-experience-during-and-after-a-trans-rectal-prostate-biopsy/

Have any additional questions?

Jump to this post

Thanks for sharing these resources. Waiting is hard for sure but I'm trying to balance between seeking information to become informed with information overload that burns too much energy. I'm going in figuring they're going to find malignancy of some sort and hoping the treatment plan options make sense and are straightforward.

A couple other questions.

The urologist doing the biopsy specializes in robotic surgery and ablations. If they find malignancy, should I seek out other options? Seems like docs are prone to recommend what they do most.

I've only seen the urology oncology nurse practitioner through this whole process and the biopsy is the first time I'll meet the doc. My post biopsy appointment is with the NP. At what point do I insist on seeing the doctor?

Thanks!

REPLY
happydappy | @happydappy | Apr 14 7:39am
In reply to @proftom2 "I switched to an NCI Designation Cancer Center. It really helped. I created a simple "Notes"..." + (show)
@proftom2

I switched to an NCI Designation Cancer Center. It really helped. I created a simple "Notes" treatment tracking timeline on my phone to use before, during, and after my oncology sessions, helps me and oncology/cancer team with communication treatment planing/process.

Jump to this post

Thanks for sharing. I actually am fortunate to have two centers nearby, Duke and UNC, so if malignancy is found I'm getting a second opinion before deciding on a treatment plan.

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happydappy | @happydappy | Apr 14 7:36am
In reply to @bjroc "The two month wait is no big deal in medical care today, that is how things..." + (show)
@bjroc

The two month wait is no big deal in medical care today, that is how things work. But one thing that hasn't been mentioned on why you should go transperineal is the location of your lesion. You list a lesion in apex area, they can't even reach that tranrectally, they can, but not well with a good set of samples. In your case with location of the lesion, plus the past medical history, you want transperineal.

Jump to this post

My MRI report indicated most of the lesion is in the transition zone with part reaching the apex.

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happydappy | @happydappy | Apr 14 7:35am

Thanks for sharing this study.

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handera | @handera | Apr 14 7:04am

The very latest (February 1, 2024) ProBE-PC randomized clinical trial results comparing infectious complications of Transrectal prostate biopsy versus transperineal prostate biopsy produced clear results.

Results of the randomized trial:

“A composite infectious complication event occurred in 9 participants (2.6%) in the transrectal and 10 participants (2.7%) in the transperineal group (odds ratio, 1.06; 95% CI, 0.43 to 2.65; P = .99). None of the participants developed sepsis in either group. There were no between-group differences in any of the individual component infectious events.”

Conclusion from the report:

“Among men undergoing transperineal or transrectal prostate biopsy, we could not demonstrate any difference in the infectious or noninfectious complications. Both biopsy approaches remain clinically viable and safe.”

https://www.auajournals.org/doi/abs/10.1097/JU.0000000000003788

Maybe the MRI based location of your lesion would indicate a transperineal procedure is better suited…but I’d go with the recommendation of your doctor.

However, regarding the potential for infection between the two procedures…follow the data…

REPLY
bjroc | @bjroc | Apr 14 6:34am

The two month wait is no big deal in medical care today, that is how things work. But one thing that hasn't been mentioned on why you should go transperineal is the location of your lesion. You list a lesion in apex area, they can't even reach that tranrectally, they can, but not well with a good set of samples. In your case with location of the lesion, plus the past medical history, you want transperineal.

REPLY
1 reply
ozelli | @ozelli | Apr 13 6:17pm

I am with heavyphil here. Certainly given your history, that seems like the only way to go.

REPLY
Moderator
Colleen Young, Connect Director | @colleenyoung | Apr 13 2:22pm

@happydappy, waiting for a biopsy appointment for 2 months can be anxiety inducing. It gives you time, however, to do your research and you're asking good questions. If getting an appointment at Mayo Clinic, perhaps Jacksonville, is an option to be seen sooner, here's how to submit a request. http://mayocl.in/1mtmR63

Here are a few related discussions in addition to the helpful responses you've already received to help you with your research:
- Transperineal biopsy options & location recommendations
https://connect.mayoclinic.org/discussion/transperineal-biopsy-options/

- Anyone have an Ultrasound-Guided Transperineal Prostate Biopsy?
https://connect.mayoclinic.org/discussion/anyone-have-an-ultrasound-guided-transperineal-prostate-biopsy/

- Your experience during & after Transrectal Prostate Biopsy (TRUS)
https://connect.mayoclinic.org/discussion/your-experience-during-and-after-a-trans-rectal-prostate-biopsy/

Have any additional questions?

REPLY
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