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  • First Post and Test Results ... nervous and scared at the same time.

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    Old 09-16-2019, 09:13 AM   #1
    anotherSTAT
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    First Post and Test Results ... nervous and scared at the same time.

    57 male and a bit late getting my PSA test done.

    There is some controversy over if one should even get a PSA test done.
    Never the less I did mine at 57 only to find it is 7.4. Urologist also felt bump in prostate with DRE so ordered further test.

    I go an Multiparametric MRIw/wo contrast with the following results.
    1.3 cm long oval, partially circumscribed low T2 signal lesion of the left posterior medial and posterolateral, mid gland mid gland peripheral zone that exhibits moderately string diffusion restriction and is most likely a clinically significant prostate cancer.

    YIKES!

    Given the degree of diffusion it's likely to be at least a grade 2 cancer. No other abnormalities are seen and overall gland size is within normal limits.

    So bottom line
    1. 1.3 cm triple match low T2 signal with strong diffusion and positive gadolinium enhancement. Like at least a grade 2 cancer.

    2. No define locally advanced disease is seen, although there is a greater than 1 cm contact between the lesions and overlying capsule which predicts significant likelihood of microscopic capsular transgression. (What is that, spearheading?)

    3. Normal size gland 27g.

    PI-RADS 4

    Targeted biopsy recommended.

    Can somebody explain in plain english this for me please, THANKS.
    Results obviously mean prostate cancer so why bother with biopsy if I have it anyway and go right to treating it?

    I also did a 4K blood test and still waiting for those results but this alone seems pretty obvious.

    Last edited by Administrator; 09-16-2019 at 09:02 PM.

     
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    Old 09-19-2019, 02:25 PM   #2
    IADT3since2000
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    Re: First Post and Test Results.. nervous and scared at the same time.

    Hi anotherSTAT and welcome to the Board!

    Don’t feel too guilty about delaying that PSA test. A lot of us have done that, including me. The PSA testing “controversy” is really only among those who haven’t thought things through, but there are a lot of those folks, and they discourage many of us from getting screened in a timely way. You appear to be on the lucky side, in other words, potentially lethal prostate cancer seems unlikely, with proper management (perhaps including active surveillance)/treatment.

    That 1.3 cm long suspicious area is substantial but not a huge area. The T2 signal is the anatomy part of the mpMRI. The water diffusion signal – slower water diffusion through cancer – matches the suspicious area of the T2 imaging, and the third mpMRI component – gadolinium contrast to detect blood vessel growth which tumors need to grow, matches the area of the other two, making it three good clues – the triple match - that there is “significant” cancer in the indicated area (as contrasted with cancer that is so insignificant that no one needs to worry about it).

    The “contact” comment means, I think, that the suspected tumor is adjacent to the capsule, which makes penetration easier. If the capsule is penetrated, then surgery often, but far from always, cannot cure the cancer. However, modern radiation is at least as good as surgery in wiping out cancer in the prostate, and it is also very good at wiping out cancer that has penetrated the capsule and is near the prostate gland. It can also target cancer that has spread regionally. (Surgery can do that too if the surgeon happens to hit the lymph nodes where the cancer has spread.) This is a simple explanation but covers the basics.

    You ask “why bother with the biopsy” instead of going right to treatment. The reason is that the biopsy gives a LOT of information that complements the mpMRI findings. For one thing, it will provide you with a “Gleason score”, which is a vital statistic in understanding the nature of your cancer (with a possibility at this point that you actually have no cancer, despite the mpMRI findings – it’s an odds game). The biopsy also is fairly good (but not perfect because it is a sample) at indicating the location, size and shape of the cancer, which are all important in choosing to manage the cancer with active surveillance or deciding to have therapy, as well as helping in choosing which therapy. Targeted biopsies, based on input from mpMRI scans, are superior to the old blind biopsies.

    My layman’s view is that you have plenty of good information to support having a targeted biopsy. The mpMRI, your PSA level, and the DRE finding are consistent and good evidence that a biopsy is warranted regardless of what the 4K would indicate. That 4K evidence will likely further bolster the other evidence.

    Don’t lose your cool and hustle yourself into a therapy you may not need. You need to get the biopsy data and then learn more about the disease and your options.

    Those findings that your prostate otherwise looks good are encouraging. You need to know that survival for almost all of us who do have prostate cancer is, with appropriate management/treatment, outstanding.

    Good luck!

     
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    Old 09-19-2019, 08:26 PM   #3
    anotherSTAT
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    Re: First Post and Test Results.. nervous and scared at the same time.

    First of all thanks a ton for your detailed reply on how you read it.
    I will be having a targeted biopsy in 2 weeks so hopefully results shortly after.

    What scared me the most was number 2

    2. No define locally advanced disease is seen, although there is a greater than 1 cm contact between the lesions and overlying capsule which predicts significant likelihood of microscopic capsular transgression.

    The MP-MRI predicts microscopic capsular transgression likely. If that did happen then radiation after surgery might be needed?

    It does not seem to show cancer in any other area at the moment, how can they tell if it did go beyond the capsule and what would they do if thats the case?

    Thanks

     
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    Old 09-20-2019, 05:16 AM   #4
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    Re: First Post and Test Results.. nervous and scared at the same time.

    Hi again.

    Having that targeted biopsy strikes me as an excellent course of action!

    A PI-RADS score of 2 is actually pretty good. There is a good chance that, despite the triple match, the area of concern is benign. The odds are more 50/50 when you get to a PI-RADS grade of 3, and so on through 4 up to pretty sure you have significant cancer at PI-RADS 5. The word "significant" can be confusing. It contrasts with "insignificant", meaning the type of prostate cancer that is so indolent that it is not even worth detecting. "Significant" means worth detecting, but still may be a mild form, the kind best managed with "active surveillance."

    I'll check your other thread and what has already been posted about surgery. However, instead of being concerned about "radiation after surgery", you can consider the option of radiation with no surgery. That's what many of us have done in this modern era, when radiation has caught up to surgery in effectiveness if not surpassed it, and has a better side effect burden for most of us. If the cancer has gone beyond the capsule, even surgeons often recommend radiation instead of surgery. (Urologists, who are surgeons, and radiation oncologists tend to be strongly biased toward their own specialties.) A lot of us think surgery first because our first contact is with a urologist who does the biopsy and because years ago radiation was not as good as surgery. Back in the day surgery was considered "the gold standard." That is no longer the case. (I initially chose surgery back when I knew little; fortunately the surgeons rejected me because of the very aggressive characteristics of my case. After that it gets to be a long story, but the conclusion is that I appear to have been cured by radiation supported by hormonal therapy.)

    Take care, Jim

     
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    Old 09-20-2019, 09:44 AM   #5
    anotherSTAT
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    Re: First Post and Test Results ... nervous and scared at the same time.

    Thanks but my PIRAD was a 4 not a 2.

    I was worried about line 2. in the final results:
    "...greater than 1 cm contact between the lesions and overlying capsule which predicts significant likelihood of microscopic capsular transgression."

    My understanding is cancer inside the prostate would be easier to cure than outside the capsule. This lesion appears to be in contact with the capsule and the likelihood of transgressing is what got me worried.

    My 4K came back at 43% with a likelihood prediction of at least a Gleason 7 or higher. This now is leading to my targeted biopsy which seems like the next logical step.

    I did learn that even with a targeted biopsy the Dr. still take between 14 and 20 cores anyway to make sure nothing else is hiding the the MP-MRI did not find.

    Question
    If in fact their is cancer with transgression on the capsule but not gone thru will poking holes on the prostate during the biopsy help the cancer come out quicker?

     
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    Old 09-24-2019, 07:49 AM   #6
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    Re: First Post and Test Results ... nervous and scared at the same time.

    Hi again, I'm sorry I slipped and was thinking "2" for the PI-RADS. This may have already been covered in your other threads, but that targeted biopsy is a sound approach, and 14 - 20 cores has a high likelihood of smoking out any significant prostate cancer.

    Your concern about holes in the prostate has been on the minds of many of us throughout the years, including medical researchers. It is known as "needle tracking", with the idea being that cancer cells might attach to the biopsy needles and follow them outside of the prostate. FORTUNATELY , the research has shown conclusively that that happens extremely rarely - hardly ever.

    The rates of cure with surgery fall off precipitously if the cancer has penetrated the capsule. However, modern radiation does just as good a job as surgery at eliminating cancer in the prostate, AND it also does a fine job of eliminating cancer that has spread beyond the prostate, including the pelvic region (if that is targeted in the radiation plan).

    I hope this helps. Jim

     
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