prostate cancer

Posted by jnj @jnj, Dec 4 2:31pm

I did the MRI and found that i have cancer. The cancer is still in the prostate and has not spread. PI- RADS 2- assessment 4. and going to do a biopsy. The cancer has not left the prostate and the research i have done is to take it out or have radiation done. I don't know if one is better than the other. The radiation does not work it is hard to do a surgery. Both ways will stop you from having sex?

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

jeff Marchi | @jeffmarc | Dec 4 4:53pm

Actually, after radiation, most people can have sex for at least a couple years before they start to lose their erection. After surgery, if they can save the nerves people usually get back the ability to get an erection..

The biggest problem is most people are put on ADT and once you’re put on that you lose the desire for sex.

After the biopsy, if you have a Gleason score of 3+4 or more, You want to get a PSMA pet scan so you can see if the cancer has spread anywhere else in your body.

What you decide on can depend on your age and the extent of your cancer. Hard to say now, what would be best because you need that biopsy and the pet scan To really know where you are. Your doctor will probably offer you to do either treatment . You Definitely want to speak to a urologist and a radiation oncologist to see what they think.

Long-term the results are the same, But as you now have knowledge about it, if you have surgery and it comes back, you can have radiation. It doesn’t work quite as easily the other way around.

I had surgery at 62 16 years ago. It has come back four times but I’m still around and you would never know looking at me that I have anything wrong. Prostate cancer grows very slowly and people usually die of something else, if they have it.

stldadof4 | @stldadof4 | Dec 4 5:17pm

I'm at a similar place. (MRI with pirads 4. Just had a biopsy and waiting on results.) My understanding is that we don't have an actual cancer diagnosis with just the MRI. It takes a biopsy to confirm a diagnosis. At least that's what I've been told.

jc76 | @jc76 | Dec 4 5:44pm

@jnj
The biopsies will give you Gleason Score and risk level. Asked your doctors about the Decipher test which is genetic test to determine your risk level which is much more accurate than Decipher which can be subjective.

Radiation will not stop you from having sex. The ability to have erections for sex is a individual one with some having serious problems, some minor, etc. I had 30 rounds of proton radiation. The affects of hormone treatments have much more effect on your sex life than radiation will.

Even if you get ED there are many medical prescriptions to help with ED along with medical procedures and devices if needed.

Please know in today's treatments many many new things have been develop to address both radiation and RP treatments along with if you have ADT which I did not.

It is why I brought up the Decipher test to you. Originally my Gleason score indicated radiation and hormone treatment plan as was classified as intermediate risk. I had the Decipher test (Mayo R/O recommended it) and it came back low risk. That removed the need for hormone treatments and I had radiation only.

brianjarvis | @brianjarvis | Dec 4 8:32pm

Note that an MRI only indicates the probability of having prostate cancer, and indicates that probability by assigning a PIRADS score (1 - 5). An MRI-guided fusion biopsy needs to be performed for a definitive prostate cancer diagnosis.

A PIRADS 2 means that it is unlikely that clinically significant prostate cancer is present.

Typically, a biopsy is not performed for a PIRADS 2, but it will be done if requested.

Depending on whether or not the biopsy finds prostate cancer, you’ll have a number of options to choose from.

You’re thinking about treatments way too soon. However, IF you do have prostate cancer, and IF you do choose external radiation as initial treatment, and IF you do have a recurrence (that’s a lot if IFs),
choice of salvage treatment would depend on the nature of the recurrence; there are other salvage options preferable to surgery - focal therapy (e.g., cryo), brachytherapy, SBRT, and yes even re-radiation in some cases.

(I had 28 sessions of proton radiation + SpaceOAR Vue + 6 months of Eligard with no impact on sex life. There are precautions that can be taken to minimize the risk.)

jcf58 | @jcf58 | Dec 4 9:21pm

You are early in the process, and you will know a lot more once you get the biopsy done. Surgery and radiation are not your only options for mild or intermediate risk cancer. There are focal therapies. I chose Tulsa Pro at Mayo in 2024 due to the low risk of side effects.

ezupcic | @ezupcic | Dec 5 7:49am

How do you know you have Cancer if you have not had a biopsy? Was your MRI a Pirads 2 or a Pirads 4?

jnj | @jnj | Dec 5 8:59am

In reply to @ezupcic "How do you know you have Cancer if you have not had a biopsy? Was your..." + (show)

@ezupcic it says high suspicion for malignancy pi-rads 4, i have not met with my doctor. I am new to this so I don't know. I am 68

jnj | @jnj | Dec 5 9:03am

In reply to @brianjarvis "Note that an MRI only indicates the probability of having prostate cancer, and indicates that probability..." + (show)

@brianjarvis it says high suspicion for malignancy pi- rad score of 4. i don't know much about this but it sounds bad. also states it in just in the prostate. i am 68 years old

brianjarvis | @brianjarvis | Dec 5 9:51am

In reply to @jnj "@brianjarvis it says high suspicion for malignancy pi- rad score of 4. i don't know much..." + (show)

@jnj When you indicated “PI- RADS 2- assessment 4”, I didn’t quite understand what that meant.

If it’s PIRADS 4, that indicates “ High (clinically significant cancer is likely to be present).”

But, that is still not a diagnosis of prostate cancer - it represents a statistical probability. (Many of us had PIRADS 4 (or PIRADS 5); I was 65y when I had treatment for that.)

You still need the biopsy for a diagnosis.