Discouraging MRI Report

@sorensend58
First time I’ve ever seen a biopsy map like that. Really nice feature to have with your biopsy results. Your 4+3 does give you a good chance of being able to have a long-term Remission. I am a 4+3 i’m still around after 16 years even though I have BRCA2.

The fact that there are no aggressive issues found is really good. Your PSA is a little high, Once it hits 20 NCCN includes that as an aggressive issue In some cases.

Prostate cancer is a chronic disease for almost all of us, and a deadly disease for just a few. With the right treatment, you should have a lot of years in front of you.

@ezupcic @wheel1 @jeffmarc For anyone who would want to recreate this I did it with ChatGPT. Which I believe is free but only with a limit on number of uses per day. I use it all the time for work so pay a monthly charge, similar to what we old folks would remember as our AOL charges.

All you need to do is copy the attached PDF, copy your MRI report, copy your biopsy information and then in the box to ask chat a question just type in use the PDF file as my prompt and create the requested information. You should get the same picture with your information.

@brianjarvis appreciate your comment. With this MRI I’m proceeding straight to biopsy as soon as possible. In the past I’ve had second opinions when they were Pirads 2 or 3 but this one has many things that are concerning. I’m just hoping the EPE that is threatened is not yet out of the prostate. Odds are not in my favor.

I certainly don't have the expertise or experience that most of the folks on here do. But from an elevated PSA in April (11.3) to an MRI 3 weeks later, to coordinating a visit to Mayo in Rochester in June to a July Biopsy (I wanted Trans perineal to reduce risk of any infection) to the follow up visit to discuss the Biopsy in August to PSMA / Pet Scan then meeting with a Surgeon early September who ordered an ARTERA report, to meeting with the Radiologist a few days after the Surgeon to having a another MRI and a Cystocsopy and Urogram because in one of the my urine tests they find a microscopic amount of blood, that's scheduled for 9/29. To meeting with the Radiologist again on October 1 to decide whats' next.

My MRI was PIRADS-5, the biopsy puts me at unfavorable intermediate - Gleason 7 (4+3), no cribifrom, no extracapsular and no seminal vesical invasion. Grade T1c. PSA in July was 19.3, another PSA is now 23.1 as of 9/19. Artera Score with the 19.3 indicated a 10 year estimate of Metastic disease was 2.2%, Artera also indicated negative for ADT, which indicates that there is (based on Artera) minimal need for ADT. Also the PSA at 23.1 moves you from unfavorable intermediate to what is considered high risk. However high risk winds up being a pretty big group, Gleason 8 and 9 so I'm awaiting to hear how the Radiologist looks at the PSA and the "clinical" rating of high risk rather than how it applies to me!

I know that was a lot but I am pretty positive that everything will work out. However, I've watched videos from PCRI, I've done a lot of research.

I've used ChatGPT to help analyse things so I did download the medical reports and asked or prompted ChatGPT with questions like.

"What does this mean, what should I be concerned about, what options do you think I should look at" I have kept that Chat conversation going, something new comes up I can just type it into the Chat and it remembers and knows all of the things I've already brought up.

What I would tell you for me this has been a marathon, it's not a sprint and at times it's overwhelming. But this group and all of the questions and answers has been invaluable. Keep your positive attitude it really helps.

@ezupcic
Just want to chime in here to say that although it seems like many people here extol transperineal over transrectal biopsies, I had mine done the latter way about a year ago at a local center of excellence, and it really wasn't bad at all, and I was able to just drive myself home as there was no general involved. If you feel like you'd like to take care of this, just go ahead with that approach. Also, yes, you're best to not assume the worst, and wait until you have all the information available before arriving at conclusions.
Best of luck!

@sorensend58 So here’s the weird thing: your PSA places you in the aggressive category, yet Artera says no need for ADT…who’s correct??
Can you have an aggressive cancer with a low chance for metastasis?🤔
All these different standards and categories can make you nuts!
Phil

@heavyphil All the standards, all the acronyms, all the numbers. There are even more things to look at when you start down this rabbit hole. You look at the PSA doubling rate, Sloan Kettering has a nomogram where you plug in your dates and PSA. If I looked at mine 2024 was 8, 3 tests this year, april 11, June 19, 3 days ago 23, if you plug in just april and june, doubling rate of 2 months, you plug in june to september doubling rate of 54 months, plug in all of them doubling of 20 months. Then throw in that an increase may or may not indicate cells outside the prostate. So now you can go to another nomogram Briganti which you plug in a bunch of numbers and it gives you a percentage chance that there is something that is outside the prostate that wasn't picked up on the Pet scan and it shows a 3.3% chance. You can drive yourself nuts, but at this point where I'm at right now is to see how much weight the Radiologist puts in any of these "clues" because that's what they are, they are nothing more than here are averages or studies that indicate if you do X then Y happens. The one sure thing that I know is that everyone is different and I'm glad I'm going to the Mayo Clinic, I need to see what the "real experts" have to say in my specific case.

@jeffmarc how much does the PSA number matter compared with the nature of the lesion identified in an MRI? Just curious if you've seen any data on that. For example my PSA is 8.8 and prostate density is 0,10 but my MRI identified two Pirads 5 lesions and two Pirads 4 lesions with "Threatening EPE". Not sure if the lower PSA is reassuring at all.

@ezupcic
The PSA may not matter at all, or it may be really important. If the PSA is above 20 That is considered more aggressive. Of course Mayo Clinic says they’ve had PSA’s up to 20,000 so 20 doesn’t seem too high. I’ve been to meetings where people had PSA’ s in the thousands, but treatment got them back down.

If you have four lesions that are rated that high, you really need a biopsy. Until you get that biopsy, you won’t really know for sure How aggressive your case is.

Some people don’t produce any PSA at all so 8.8 is significant enough to want to do a biopsy when you have all those PIRADS 4 and 5.

@jeffmarc I agree. My next challenge is to decide whether to do a standard transrectal 12 core office biopsy in one month or a MRI fusion transpareneally with a delay of 8-10 weeks. I’m definitely worried about the “threatening EPE” observation in my MRI.