Prostate lesions found, biopsy results, No symptoms

Posted by fredz @fredz, Oct 13, 2022

Hi everyone, I’ve no symptoms as frequent urinating or erection issue nor stop start urinating, my PSA is gone up for the last 6 years from 4 to 6 to 8 … and now @ 12 , did an MRI ( not coil/ sound type though ) it came out that I have two lesions one on inferior top part and one in the bottom of my prostate gland, hate to do biopsy, any idea ? Anyone have the same issue ?
Ps no blood in urine either

Thanks so much for all the feedback 🙏🏼

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@kujhawk1978

That's a tough one...with a GS 3+3, you would normally continue to actively monitor.

The rising PSA is the question along with the confirmed spots in your imaging and DRE.

You have options:
surgery
either internal or external radiation to the prostate
radiation and add short term ADT, six months. That may address any micro-metastatic disease that may have escaped the prostate.
continue to actively monitor.

One thing to do is calculate your PSA doubling time, MSKCC has a online calculator - https://www.mskcc.org/nomograms/prostate/psa_doubling_time. This will give you an additional piece of clinical data

General rule of thumb is if PSADT:
> 12 months continue to actively monitor
6-12 months the grey zone, consider treatment
<6 months time to treat

DO some more homework and look at three things:

Doublet therapy - here's one link to get started - https://www.urologytimes.com/view/the-role-of-doublet-and-triplet-therapies-in-prostate-cancer
NCCN Guidelines for patients - https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients/guidelines-for-patients-details?patientGuidelineId=49

Kevin

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Thanks for your reply, PSA doubling time as you suggested came at 33 months

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@melcanada

Get it out robotic or surgery and get on Zolodex to stop testosterones

Your delay is playing with fire

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What I’m most concerned is the problems after the surgery as sexual dysfunction and bladder control , also how accurate are these biopsies when they call it a 1 mm and another at 2mm (10% of the cells has been examined ) !!!??

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Bladder control no issues Check cancer not in Apex near bladder then if so do radiation 40 times

Sex Forget it Stay this side of the grass Testostorone is the fertilizer of prostate cancer Get on Zolodex

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@fredz

Thanks for your reply, PSA doubling time as you suggested came at 33 months

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Just another piece of the puzzle...good news, it may indicate continued active surveillance.

Kevin

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@kujhawk1978

Just another piece of the puzzle...good news, it may indicate continued active surveillance.

Kevin

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Did you see the attached document?

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@fredz

Did you see the attached document?

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Sorry, didn't see it, will look for it now

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@fredz

Did you see the attached document?

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If you're talking about the biopsy results, yes, the high PIN is another piece of clinical data in trying to decide to treat or actively monitor.

I still think with the clinical data you have, GS, PSADT, imaging results and biopsy, you may be ok with not treating and continuing to actively monitor.
I would consider a MRI vs TRUS biopsy, imaging every six months, PSA tests every three months.

Doing those may enable you not to treat for sone period with all the side affects while enabling you to treat if and when the data says so without a great degree of risk of it getting out of control.

Not your medical team and no medical training or certification so just my thoughts based on what I have learned in my journey.

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@kujhawk1978

If you're talking about the biopsy results, yes, the high PIN is another piece of clinical data in trying to decide to treat or actively monitor.

I still think with the clinical data you have, GS, PSADT, imaging results and biopsy, you may be ok with not treating and continuing to actively monitor.
I would consider a MRI vs TRUS biopsy, imaging every six months, PSA tests every three months.

Doing those may enable you not to treat for sone period with all the side affects while enabling you to treat if and when the data says so without a great degree of risk of it getting out of control.

Not your medical team and no medical training or certification so just my thoughts based on what I have learned in my journey.

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Thanks again , and this attachment is also another test of biopsy ( which I couldn’t upload due to upload size limitations) I don’t understand this one at all .
Do you have any ideas ?

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Fredz,

Read Dr. Walsh's Surviving Prostate Cancer:

https://www.publishersweekly.com/9780446526401

I also have Gleason 6 3+3. Found this book to be very reassuring, also helpful in calming my wife's legitimate concerns. Have decided on Protein Beam SBRT Radiation Therapy at Mayo Clinic Rochester.

Most important is to NOT panic and make decision without complete knowledge of your options.

Best wishes,

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@fredz

Thanks again , and this attachment is also another test of biopsy ( which I couldn’t upload due to upload size limitations) I don’t understand this one at all .
Do you have any ideas ?

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Seems like your medical team did some additional testing of the prostate tissue from your biopsy..

Immunohistochemical tumor markers are proteins that help doctors tell the difference between different types of cancer.

Here's a link to the three your medical team tested for in trying to determine your diagnosis given the GS 3+3 and low volume in the biopsy samples.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753827/

Key note from this link - "In recent period, basal cell markers high molecular weight cytokeratin (HMWCK), P63 and prostate biomarker AMACR have been used as adjuvant to morphology in diagnostically challenging cases with a very high sensitivity and specificity."

Again, just my layman thoughts. It would seem another clinical data point leading to a discussion with your medical team about active surveillance vs treatment.

Kevin

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