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  • Is Treatment Delay Harmful?

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    Old 06-19-2018, 01:13 PM   #1
    rodgersmail
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    Unhappy Is Treatment Delay Harmful?

    An MRI last month showed I have prostate cancer. A fusion biopsy requiring general anesthesia was scheduled, but I had a TIA (blood clot in vessel leading to eye) a week before. Due to anesthesia concerns--general anesthesia shortly after a stroke increases the risk of a recurrent stroke--the biopsy has been delayed 3 months. I wonder if the increased danger of a perioperative stroke due to anesthesia is greater than the increased danger of delaying treatment. I have no idea how fast prostate cancers grow. If it's aggressive (assuming the worst), will the delay be harmful? Will I need another MRI? Thank you.

     
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    Old 06-22-2018, 10:26 AM   #2
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    Re: Is Treatment Delay Harmful?

    Hi Rodger, and welcome to the Board!

    Actually you may not have prostate cancer. That's because prostate cancer is not diagnosed on the basis of an MRI - a biopsy is the only accepted sure test. I suspect you had a multiparametric MRI that indicated areas of concern. If so, the doctor will have a PI-RADS score, with 1 and 2 indicating very low risk, 3 indicating some risk of cancer, and 4 and 5 - the top two numbers, indicating likely cancer. The MRI also shows details that help the doctor figure out what is likely going on and where the biopsy needs to focus. You are entitled to your MRI report, and you should get a copy from the doctor. Would you care to share that PI-RADS score and comments, once you get them?

    Regarding the aggressiveness of cancer, it can vary from taking more than a century to double in size to doubling in just a couple of weeks. A substantial majority of the time, prostate cancer is slow growing. However, if a patient does have an aggressive case, delay in the biopsy could allow problems to develop. Odds are that a 3 month delay will not be a problem, but that is not a guarantee. I suspect you won't need another MRI right now, but the fact that a fusion MRI/biopsy is planned suggests that you are getting advanced care, and that might involve an MRI at that time, perhaps with a more advanced machine.


    It takes time and effort to learn about prostate cancer. I know a lot now, but I knew next to nothing at the start. Please feel free to ask questions.

    Good luck.

     
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    Old 06-22-2018, 12:18 PM   #3
    rodgersmail
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    Re: Is Treatment Delay Harmful?

    Thanks for your reply. I look forward to further replies and even more info. Additional comments: I contacted my urologist practice and left a message that I'd had a "mini-stroke," thinking someone would call back for a fuller explanation. A nurse called back and told me that prostate cancers grow slowly, so there was no problem. I had the feeling she knew no more than I, hence this post. I’ve had BPH for years. My PSA in May, 2016, was 4.6 and my rectal exam then was negative for a lump. In March, 2018, my PSA, the last one I had, was 6.5. I had a pelvic MRI, which showed that I had a 5-mm tumor with a PIRADS score of 5, which I understand means a 90% probability that it's cancer. My MRI will be over 4 months old by the time of my rescheduled biopsy, and I wonder if it will be out of date. The anesthesiologist dictated the 3-month wait. An allied question I didn't ask but am curious about is whether the anesthesiologist was being unduly cautious in setting the 3-month wait. My TIA wasn't a full-fledged stroke and did not involve the brain. But all she knows is that it was a "mini-stroke."

    Last edited by rodgersmail; 06-23-2018 at 06:08 AM.

     
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    Old 06-23-2018, 05:57 AM   #4
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    Re: Is Treatment Delay Harmful?

    Hi again Rodger,

    I can certainly understand your concern and agree!

    With a PI-RADS 5 and a suspected 5 mm tumor, I would be very uncomfortable waiting. I'm thinking that the nurse doesn't understand prostate cancer and the risk associated with a PI-RADS 5 situation where sometimes tumors do grow quickly, and the same may be true for the anesthesiologist, who may be thinking correctly about the general anesthesia but not taking in this whole picture. Is there a solution?

    Yes! The fusion biopsy would be ideal, generally, as the biopsy probes would be done based on the best information. However, if it must be done under general anesthesia that could pose a stroke risk (I don't know about that.), then the kind of biopsy that has been done for most of us and for a very long time could be done with a local anesthetic (often numbing ointment and shots). For most of us, with a competent doctor, the biopsy is somewhat uncomfortable but not bad, not a big deal. Moreover, yours would actually be superior as the previous multiparametric MRI result would be there to guide the doctor in placement of the probes. It wouldn't be real time, but the doctor would have a pretty good idea where to collect the biopsy samples; this is actually called a "cognitive fusion biopsy", because the information is there for guidance, even if real time fusion of an image and the probe positions is not.

    I am concerned that the doctor did not point all this out. I recommend you talk to the doctor about these concerns and options for going ahead soon. You might want to get a second opinion.

     
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