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  • MRI found a 6mm lesion pirads 3

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    Old 09-24-2020, 02:41 PM   #1
    RobertS1963
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    MRI found a 6mm lesion pirads 3

    I'm new to the board, i'm 57 years old and my Dad had PC when he was 65. My Dad had his prostate removed and hasn't had much trouble since, he is 87 now.

    My PSA has been up and down over the last 10 years, averaging around 4-5 sometimes lower and the highest was 5.9. I also have Diverticulosis and when I get a flair up the PSA goes up, and i've heard that is common.

    A recent MRI discovered a 6mm lesion on the prostate, which is 50%-50% cancer or not. The urologist wants to do a biopsy and i'm scheduled to do it in November.

    I feel like it would be very hard for him to get a biopsy from such a small lesion? I would like to wait and check the PSA for another year or two and if it goes up I could have another MRI in a year or two?

    Does anyone have any recommendations or insight into this?

    Thank you
    Robert

     
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    Old 09-24-2020, 03:53 PM   #2
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    Re: MRI found a 6mm lesion pirads 3

    Quote:
    Originally Posted by RobertS1963 View Post
    ...I would like to wait and check the PSA for another year or two and if it goes up I could have another MRI in a year or two?

    1. i don't think it's a good idea to "wait and check the PSA for another year or two and if it goes up, have another MRI in a year or two" the MRI found something and the fact that it's a PIRAD's 3 is an indicator that you need it to be biopsied to find out what exactly it is. while it's true that PCa is a slow growing tumor, you don't want to wait 'til it grows to a point where you're having any issues, IF IN FACT IT IS CANCER.

    2. call and ask exactly what type of biopsy R you scheduled to have. then, look into having a MRI-guided prostate biopsy. MRI guided biopsy uses advanced, real-time imaging to reveal the lesion, location, size, and shape so your doctor can guide a small number of needles through the rectal wall into the core of your lesion. this type of procedure is done by a interventional radiologist. a urologist won't recommend these types of doctors for many different reasons. but with an MRI guided biopsy, this type of doctor can reveal a much more accurate diagnosis of your lesion than a fusion biopsy.

    whatever you decide please know that waiting is a bad idea.
    __________________

    D.O.B. | 12/18/1973
    02.28.2019 | Dx 45
    Elev. PSA | 11.9
    GS | 4+3 = 7
    Treatment | HDR Brachytherapy & 6 mths of Casodex 50mg

     
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    Old 09-24-2020, 05:27 PM   #3
    RobertS1963
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    Re: MRI found a 6mm lesion pirads 3

    Thank you very much, this is good advice. the biopsy will be done with an ultrasound guide.

     
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    Old 09-24-2020, 05:56 PM   #4
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    Re: MRI found a 6mm lesion pirads 3

    Do the biopsy!

    If you have a health reason that puts you at greater risk from the biopsy then consider thoughtfully.

    If not, do the biopsy!

    "Early Detection Early Treatment" is the mantra. Prostate cancer is treatable. Screen Screen Screen! And, that includes biopsies.

    PS: MRIs are fallible.

     
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    Old 09-24-2020, 06:18 PM   #5
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    Re: MRI found a 6mm lesion pirads 3

    6 mm isn't that small of an area to target. They aren't doing it blindly and the doctor know where to aim the biopsy needle.

    I think he can be pretty certain to get a real good core or two from the suspicious area.

    Biopsies are a urologists bread and butter, this is their area of expertise, their forte.

     
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    Old 09-24-2020, 09:33 PM   #6
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    Re: MRI found a 6mm lesion pirads 3

    You would be wasting your time if you did not do as suggested, having MRI biopsy. Anything else and it's a hit and miss with a area that small. I had a rads 4, 16mm big and it turned out to be benign.

     
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    Old 09-25-2020, 04:41 AM   #7
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    Re: MRI found a 6mm lesion pirads 3

    My PSA was up and down between 3.5 and 5.3. My URO told he did not believe I had prostate cancer and did not want to do a biopsy. I though I did. We did this test that said the risk was 60%. The rest is history,

    https://consultqd.clevelandclinic.org/the-isopsa-test-is-available-and-it-could-change-the-diagnostic-paradigm-for-prostate-cancer/

     
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    Old 09-25-2020, 05:56 AM   #8
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    Re: MRI found a 6mm lesion pirads 3

    Robert, all good advise above, why would you want to put off finding the results for simple test. If its early PCa your way ahead, it not you can sleep better.
    steve d

    _________________
    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI yes ,Multicentricity multifocal
    Margins Not Present inked margins 5 neg.LN stage pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34
    7/19 0.06 8/19 0.08 9/19 0.056 10/190 0.08 11/19 0.07 12/19 0.07
    7/19 Continue Trelstar, Add Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 20 0.06 2/20 0.04 3/20 0.02 4/20 <.02 5/20 <0.02 6/20 <.02
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    Old 09-25-2020, 07:18 AM   #9
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    Re: MRI found a 6mm lesion pirads 3

    Hi Robert. If the lesion identified is indeed cancer, there is is a reasonably good chance there are other lesions, thus increasing the chances of finding it with a biopsy.

    The "random" core taken from different prostate zones aren't truly random. The uro uses the ultrasound image not only to sample lesions identified by the MRI, but also areas that area suspicious to his eye on the screen. Abnormal tissue -- including but not limited to cancer -- relects ultrasound differently than healthy tissue. Uro's become very experienced in interpreting the image they see and sampling the suspicious areas.

    While PIRADS 3 lesions fall in the intermediate or gray area for suspicion of cancer, almost all studies agree that they warrant investigation by biopsy, along with PIRADS 4 and 5.

    Djjn
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 09-25-2020, 10:28 AM   #10
    RobertS1963
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    Re: MRI found a 6mm lesion pirads 3

    Thank you all very much, i'm convinced and I will have the biopsy.

     
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    Old 09-25-2020, 01:44 PM   #11
    IADT3since2000
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    Re: MRI found a 6mm lesion pirads 3

    Hi Robert and welcome to the Board!

    I’m glad you have already had a number of thoughtful responses. I’m going to respond directly to your desire to wait and defer a biopsy.

    Like others who have responded, I have had quite a battle with this disease, and part of the reason is that I did not get appropriate testing (the PSA test) in a timely way; I got a nasty, abrupt shock when I realized I was facing life-threatening disease that had snuck up on me. That has tended to make me wary and extra vigilant, which is probably true of most active participants on forums like this. This is a long way of saying that, while my emotional response is that you should get that biopsy, my mind is telling me that you can also make a good case for deferring the biopsy, though with more aggressive monitoring than you mentioned in your initial post.

    First though, I’ll add my 2 cents about getting a biopsy now. The normal TRUS (Trans Rectal Ultra Sound technology) biopsy is really designed to show the doctor who inserts the biopsy needles where the prostate is, with sketchy information on where any cancer might be. There is some information in the image - dark, deeper shadow areas – that suggests where there might be cancer, but it is not reliable , and I’m thinking that has got to be especially true if the lesions are really small, as indicated in your MRI. Therefore, with such a small area that you would really like to be included in the sampling, location clues from MRI imaging would help. Perhaps the existing MRI is sufficient for that purpose, using an approach called “cognitive fusion”, which simply means studying the MRI image and then using that mental image to target higher risk areas with the biopsy needles. If the doctor does not plan even a cognitive fusion biopsy, I’m wondering if the likely value of a biopsy, the likelihood of getting meaningful results, would not be very small indeed, small enough to warrant deferring the biopsy or finding another doctor and MRI team to do it.

    Now let’s focus on the merits of getting a biopsy in your situation. I have never had an MRI that resulted in a PI-RADS score, so what I have learned is from layman’s interpretation of presentations by experts and reading medical papers. Here are some key points from a presentation and supportive research that may help you think this through. At the Prostate Cancer Research Institute’s 2018 Prostate Cancer Conference, a very well-known and distinguished urologist/professor of urologic surgery/prostate cancer researcher, Dr. Gerald Andriole, gave a presentation that included a substantial segment on multiparametric MRI for assessing the need for a biopsy, targeting biopsies, and case assessment. One of the research papers he featured captured results from the PRECISION Study Group collaborators, a long lest that includes some prominent heavy hitters. The paper was published in 2018 and entitled “MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis”, first author Dr. V. Kasivisvanathan. The study included 468 men, a respectable number for a study like this, who underwent assigned randomization to MRI guided or standard biopsy. Here’s a link to an abstract of that paper: https://pubmed.ncbi.nlm.nih.gov/29552975/ . If you use the link, you will see a red and black button on the right labelled “NEJM Full Text.”. I was able to click that button and get a complete copy of the paper for free, including some excellent graphics. Figure 3 has the data most relevant to you.

    Figure 3 is a graphic comparison of PI-RADS 3, 4 and 5 situations showing the amount of clinically significant cancer in red, clinically insignificant cancer in yellow, and no cancer in gray. As you would expect, the percentage of clinically significant cancer – the kind we should be concerned about – goes up in large steps as you have higher PI-RADS scores: only 12% for PI-RADS 3, but 60% - five times as much – for PI-RADS 4, and 83% for PI-RADS 5. “Clinically significant cancer” is the kind of cancer that needs to be found and treated. Now patients with a PI-RADS of 3 also have a fairly substantial portion, 22%, of “clinically insignificant” cancer, the kind that does not need to be treated and would actually be better left unfound according to what I’ve heard from a number of experts; the proportions of clinically insignificant cancer for PI-RADS 4 and 5 are much smaller, at 9% and 11% respectively. Of course the best situation is “no cancer,” which is the largest proportion of cases for PI-RADS 3 patients, weighing in at two thirds of all such cases (67%), compared to just 31% and 6% for PI-RADS 4 and 5 patients, respectively.


    So there you have it: only a 12% chance of “clinically significant” cancer for PI-RADS 3, or an 88% chance of a standard 10 to 12 core biopsy not finding the kind of cancer we want to find. I suspect that the odds would be even lower for men who have very small lesions on the MRI image, as you do, but again, that’s just my layman’s hunch.

    If you decided to forego a biopsy at this time, in my layman’s opinion you would be wise to get a PSA at least every half year, and perhaps every four months, which would give you a good look at the PSA pattern over time. Your thought that you could wait to get your “PSA for another year or two“ strikes me as unwise and potentially dangerous – like telling the sentry in a temporarily quiet but still dangerous battlefield to get some sleep if he feels like it. You could also do one or more of the tests that have been approved in recent years to gauge the likelihood of aggressive cancer, such as SelectMDX, 4K, or PHI. Recent research suggests that getting a genetic test for the BRCA2 gene mutation is important, especially for patients who may be eligible for active surveillance, and I’m thinking for patients like you who might want to defer a biopsy; patients without a BRCA2 mutation who have mild case characteristics usually do very well, but those with otherwise mild characteristics who have the mutation may experience a sudden explosive growth in their cancer, a real sucker punch.


    Another point is that a subsequent MRI would be a good guard to catch in a timely way a clinically significant cancer that is growing substantially. Having that baseline from your previous scan helps the radiologist interpret what is going on as it enables him to see a trend, which is not possible from a single snapshot in time. My layman’s hunch is that a PI-RADS 3 cancer would be very unlikely to become a threat over the next year, even if it were clinically significant, but keep in mind that I have had zero enrolled medical education and therefore speak with zero medical authority.

    On the other hand, doing a biopsy now would provide a baseline that might help interpret any trend with a later biopsy.

    Whether or not to get that biopsy – making sure it is well planned if done – is, of course, a call that only you can make. My bottom line is that either alternative is reasonable, and considering the full array of risks we take in our lives, the risks and stakes at this point are probably fairly low, but not zero.

    Good luck!

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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    Old 09-25-2020, 08:53 PM   #12
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    Re: MRI found a 6mm lesion pirads 3

    I think your decision to biopsy is a wise one. Waiting a year or two does not strike me as a prudent option. If you wait and clinically significant PCa is found, you will be asking yourself if your chances would have been better if you had diagnosed it now. Early diagnosis is the biggest weapon in the PCa arsenal.

    My PSA had been slowing rising from BPH over two decades. Nine biopsies found nothing. Then my uro felt a new nodule (along with a slightly higher than expected PSA rise). We did another biopsy, 16 cores in total, with several in the nodule. The nodule turn out to be benign; however, 2 of the cores in other areas hit cancer, a G10 and a G9.

    The path report on my whole prostate estimated that my cancer occupied only about 5% of my prostate, which was a rather large 64 cc. Given that data and knowing a biopsy samples a tiny amount of prostate tissue, I believe it was less luck and more my uro's skill that he hit my cancer.

    If you biopsy is negative or you have G6 cancer that you can monitor, you have a baseline, as Jim pointed out. If you have intermediate PCa, you can still be confident that treatment will be definitive. And if there is serious cancer, you'll know you found it early. A biopsy now is IMO playing your strongest card.

    Keep us posted and good luck!

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 09-26-2020, 10:25 AM   #13
    IADT3since2000
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    Re: MRI found a 6mm lesion pirads 3

    Post Script

    Hi again Robert,

    What I posted contrasted with what some other thoughtful, knowledgeable and experienced board participants had posted, which always urges me to take some time to review to see if I have missed something. Basically, I think I got it right, with the bottom line being that you have a reasonable option to defer the biopsy. But here’s where you could dig a little deeper: (1) check the quality of the multiparametric MRI (mpMRI) scan that you had, since the foundation of a high probability of a “no cancer” or “no clinically significant cancer” case rests on having a PI-RADS score of 3, which was what was recorded, or lower, and (2) the experience of the radiologist doing the scan. An inadequate reading could fail to reveal that your situation was actually a PI-RADS 1 or 2 – no biopsy needed, or a 4 or 5, where a biopsy would clearly be wise.

    Number (1) is not rocket science. First, check to confirm that the mpMRI was done with equipment generating a 3 Tesla (3T) magnetic field. The radiologist’s office, or even the report itself, will be able to indicate that right off. It’s a routine matter. The issue here is the resolution of the image. It used to be that 1.5 T was typical for MRI; that generated many useful images, but a fair proportion of the time, insufficient resolution compromised the ability of the radiologist to make observations and draw conclusions. mpMRI with 3T is now fairly common, but the old rule-of-thumb was that it cost about $1 million for each boost of 1T in Tesla level, so some facilities may just not have been able to afford the higher level. Some facilities offer up to 7T, which can be helpful for some kinds of research rather than routine clinical practice, but apparently 3T is just fine. If your image was based on a lower T, then that introduces some uncertainty, and would move the scale a bit toward getting that biopsy. On the other hand, a 3T image would tilt the scale a bit toward deferring the biopsy, adding confidence.

    Number (2) is something I have just learned about, and I have posted what I learned as the second lesson learned from the annual PCRI conference, virtual this year and available to you online now. In essence, you want a radiologist, at this point in 2020, who has read at least 200 prostate mpMRIs and ideally 500, likely much of that 200 acquired in a formal training program, and who also is reading an average of 2 to 3 prostate MRIs a week to maintain competence and as an indicator of being in a facility that does an adequate amount of prostate cancer business. If your mpMRI image set was read by such a radiologist, especially with a 3T magnetic field as described above, that increases confidence that deferring a biopsy would be reasonable based on a high-confidence finding of a true PI-RADS 3 situation. On the other hand, if the radiologist is less experienced, while it does not at all mean that he misread the scan, confidence is not as high, and this would tilt the scale a bit toward getting a biopsy or increasing the priority of biomarker and/or genetic testing. You have the right to ask the radiologist’s office how many he or she has done and how many he or she does per week.

    Of course, getting that BRCA2 gene test and one of the other tests I mentioned could also weight the balance in favor of a deferred biopsy or not.

    One other point: the expert radiologist, Dr. Daniel Margolis, MD, who was the conference speaker, also emphasized the importance of the working relationship between the radiologist and the doctor, usually your urologist, who orders the scan. This is what he said about 1 hour and 27 minutes into his presentation: “You want to find a radiologist that your surgeon or your medical oncologist or your radiation oncologist trusts. That’s a crucial part.”

    You are in the enviable position of being concerned about possible prostate cancer in the new era when mpMRI, “biomarker” tests, and gene tests are available to help determine whether to get a biopsy and whether the case is mild, likely not needing treatment but rather active surveillance, or more serious, needing treatment. This new era is very young - only two to four years old, depending on how quickly doctors and facilities that you can access came up to speed. Many of us on the board, including me, were diagnosed before these new sources of evidence were available; we and our doctors had to make decisions that rested on a lower level of confidence. On the other hand, some of us on the board, like me, had the opportunity to get a biopsy when the risk of a serious infection was extremely low; the risk is still low, and there are countermeasures to lower it further, but that risk is no longer something so low that it can be disregarded. If a patient clearly needs a biopsy, it is by far worth that small risk; if he does not clearly need a biopsy, it’s more of a judgement call, a balancing of risks.


    I’m sorry if this information complicates your decision, but in the long run, whatever you decide, you will feel if you have done your “due diligence” based on the facts that are available at the time.

    Again, good luck sorting this all out and reaching a decision that is best for you, unfortunately something that does not become clear until years later.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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    Old 09-26-2020, 03:37 PM   #14
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    Re: MRI found a 6mm lesion pirads 3

    Reading MRIs for PCa definitely requires specialized training plus experience. Clearly if you are taking cues from MRI PIRAD scores you want them to be accurate (just as a biopsy result needs to be accurate because a treatment decision may be based on it). However, if you don't get a 2nd opinion on and the reader has erred, that could likely mean it's a PIRADS 2 or a 4. If you split the difference, you're back at a 3.

    If you take that as a point of departure, as I mentioned, the consensus appears to be that a PIRADS 3 lesion should be investigated by biopsy.

    If you have DNA (blood) testing for known mutations that can increase the risk of PCa, you'll have more information to aid your decision. Perhaps your father had low-grade, non-aggressive PCa or perhaps it was more serious but, fortunately, treated early with a very good outcome. Coupled with your MRI results as they stand, I think a biopsy is prudent. Also, if your PSA is slowly increasing, you may just be putting a biopsy off.

    When others post that their uro said something like "We can biopsy now, or we can wait to see if..." I always vote for the Do it Now approach. But that's just me

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 11-14-2020, 09:34 AM   #15
    RobertS1963
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    Re: MRI found a 6mm lesion pirads 3

    I had the biopsy this week and all was Benign, but one core said;

    C) RT. BASE
    (NEEDLE CORE BIOPSY):
    - PROSTATIC ADENOCARCINOMA, GLEASON GRADE 3 + 3 =
    6 OF 10 (GRADE GROUP 1), INVOLVING 2 CORES (5%,
    5%).
    - NEITHER PERINEURAL INVASION OR EXTRAPROSTATIC
    EXTENSION ARE IDENTIFIED.

    What does this mean??

     
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