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Totally confuse-How to move forward with my RO & 2nd opinion
Totally confused
67 years, Had HolEP (March 2025) biopsy 3+4=7 Decipher 0.17 TNM=0, PSA 1.2 (8/10/25) PSMA all clear except a small liaison ECE
2nd opinion says its a small and nothing to worry about for next 8–10 years, here is the caveat but schedule me of Cyberknife prep work for CT for placement of fiducial
My RO at UCSF says he does see nothing drastic in my PSMA- scans and reviewed it with me, and that I have nothing to worry about the next 10 years, this small liaison was already there before, and we just happen to have caught it due to HolEP. I also discussed with him the 2nd opinions advise with him, I was by RO to be careful with Cyberknife, due to the fact that HeLEP has a left a hole in the prostate and cyberknife will make it worse and may cause excessive bleeding. He told me that in order to really determine if there is cancer, it would be advisable to have another biopsy done and take next steps then and referred me back to my urologist.
Totally confused with the findings …and what to do next ,,any advice will be greatly appreciated
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@jeffmarc my renown urologist had a MRI done first , then laid image with ultrasound . Then could take good samples of the instead of somewhat blind samples
Most do a biopsy first ,due to insurance old protocols.
@mauk , I'm being treated by Sloan Kettering and had second opinions by Mayo and MD Anderson and I told my doctors and they seemed happy that I did.
You only have one life and do what you need to do to make it last as long as you can. My Medicare paid for most of my second opinions and I'm very happy I had them done. You shouldn't be hurting others feelings if they are professionals as saving someone's life shouldn't be competition.
Do what you need to do!
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3 Reactions@jeffmarc
Jeff
You’d think with ultrasound guided biopsies of today they would be fairly accurate? Thoughts ?
Pat D
@packman7
Ultrasound is good and readily available. MRI overlay you get little more detail
@pcfightclub
Actually the MRI first is becoming more and more common. I’ve seen it done in multiple places.
@packman7
Even with ultrasound guided biopsy, they only get about one percent of the prostate. If an MRI showed Pirads 3-5 And they got those specific spots then it definitely increases the chance of Having relevant information. You just find so many people that have a biopsy and find they are 3+4 or 4+3 after a prostatectomy find it’s much higher. Not all the spots in the prostate appear to be showing a PIRADS visible Tumor.
I still consider that kind of biopsy much better and gives you a really good chance of getting accurate information.
@jeffmarc
Jeff
The multi parametric MRI is a good tool for moderate to advanced tumors however small foci are not picked up and they may have an aggressive nature which may play a role contributing to the +/- 25-30 % that have a higher Gleason after prostatectomy ? Pat
@packman7
I figured the ultrasound question was related to this technique
An MRI/ultrasound fusion technique is a common advanced method that combines the detailed MRI images with real-time ultrasound guidance for even greater precision.
Could be I was wrong. I agree with you though. Small stuff that doesn’t show up in the MRI could be aggressive cancer yet not seen or easy to biopsy.
Update-Both RO and urologist recommending AS
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