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    Old 04-05-2021, 11:39 AM   #1
    Liliac96
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    PIRADS 3 questions

    My husband received the results of his MRI on Friday.

    One PIRADS 3 lesion was found. He'll undergo a transperineal biopsy under anesthesia next week. (Background info: his PSA is 5.3. I believe his PSA density is .199, which is bothering me a bit.)

    I have a few questions rattling around in my head. So I thought I'd ask them here, in case anyone could help.

    1. What's recovery like from the biopsy? The information packet is helpful but somewhat vague. It says to avoid lifting things over 10 pounds for a week. He works a physical job and is wondering how much time he should expect to take off. (We've put this question to the doctor's office, of course. Just wondering about others' experiences.)

    2. The size of the lesion seems huge to me. It's listed as 1.6 cm. I'm just curious how a lesion this large could be a PIRADS 3?

    3. Next to "extracapsular extension" it lists "broad capsule abutment." I take this to mean that the suspicious lesion is right up against the prostate capsule. Is that right? I haven't been able to find a good definition for it.

    I can't thank everyone on this message board enough. I've read here a million times since this began. You've all helped me so much. Thank you a million times over.

    Lili

     
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    Old 04-05-2021, 12:10 PM   #2
    ASAdvocate
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    Re: PIRADS 3 questions

    Quote:
    Originally Posted by Liliac96 View Post
    My husband received the results of his MRI on Friday.

    One PIRADS 3 lesion was found. He'll undergo a transperineal biopsy under anesthesia next week. (Background info: his PSA is 5.3. I believe his PSA density is .199, which is bothering me a bit.)

    I have a few questions rattling around in my head. So I thought I'd ask them here, in case anyone could help.

    1. What's recovery like from the biopsy? The information packet is helpful but somewhat vague. It says to avoid lifting things over 10 pounds for a week. He works a physical job and is wondering how much time he should expect to take off. (We've put this question to the doctor's office, of course. Just wondering about others' experiences.)

    2. The size of the lesion seems huge to me. It's listed as 1.6 cm. I'm just curious how a lesion this large could be a PIRADS 3?

    3. Next to "extracapsular extension" it lists "broad capsule abutment." I take this to mean that the suspicious lesion is right up against the prostate capsule. Is that right? I haven't been able to find a good definition for it.

    I can't thank everyone on this message board enough. I've read here a million times since this began. You've all helped me so much. Thank you a million times over.

    Lili
    I’ve had seven biopsies, born transrectal
    and transperineal, all under local anesthesia. A transperineal biopsy under general anesthesia is often a saturation biopsy where twenty or more core samples are taken, instead of the usual twelve. Some additional cores may be added from imaging targets. That’s a lot of trauma to the prostate.

    Usually, with a regular biopsy, you have blood in your urine for a few days, and blood in ejaculate for several weeks. Transrectal biopsies also have blood in bowel movements.

    I would think that he shouldn’t plan on any straining activity for a week after a saturation biopsy, due to the extensive needle poking.

     
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    Old 04-05-2021, 12:13 PM   #3
    IADT3since2000
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    Re: PIRADS 3 questions

    Hi Lili,

    It's good to make progress in learning what you are up against. Here are some thoughts:

    Quote:
    Originally Posted by Liliac96 View Post
    My husband received the results of his MRI on Friday.

    One PIRADS 3 lesion was found. He'll undergo a transperineal biopsy under anesthesia next week. (Background info: his PSA is 5.3. I believe his PSA density is .199, which is bothering me a bit.)
    That figure, .199, suggests but does not prove that there is something going on beyond benign enlargement (BPH). If it turns out your husband does have prostate cancer, a density of .199 used to indicate that active surveillance would have lower odds of long-term success, with the desired figure being a density of .15 or lower, based on size from an MRI or other scan rather than the "finger wave". I think that is probably still true but have not checked.


    Quote:
    Originally Posted by Liliac96 View Post
    1. What's recovery like from the biopsy? The information packet is helpful but somewhat vague. It says to avoid lifting things over 10 pounds for a week. He works a physical job and is wondering how much time he should expect to take off. (We've put this question to the doctor's office, of course. Just wondering about others' experiences.)
    My own recovery was quick, but I did not have a physical job that involved lifting. I'm sure the doctor at MSKCC can address this.

    Quote:
    Originally Posted by Liliac96 View Post
    2. The size of the lesion seems huge to me. It's listed as 1.6 cm. I'm just curious how a lesion this large could be a PIRADS 3?
    The PIRADS is based on convergence of a number of clues, including, usually, blood flow and water flow as well as size and shape. It's possible that the "object" the scan is seeing is mostly a calcification or other non-cancerous structure. Again, this is a good question for the doctor.

    Quote:
    Originally Posted by Liliac96 View Post
    3. Next to "extracapsular extension" it lists "broad capsule abutment." I take this to mean that the suspicious lesion is right up against the prostate capsule. Is that right? I haven't been able to find a good definition for it.
    I believe you are right, it makes sense, but the doc can confirm that.

    Quote:
    Originally Posted by Liliac96 View Post
    I can't thank everyone on this message board enough. I've read here a million times since this began. You've all helped me so much. Thank you a million times over.

    Lili
    I'm glad you have found help here. I suspect that most of us who are active participants are "paying it forward" for help we once received.

    Good luck!

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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 12/2/2020). (Current T 93 12/2/2020.) 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. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 04-05-2021, 12:14 PM   #4
    Liliac96
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    Re: PIRADS 3 questions

    Quote:
    Originally Posted by ASAdvocate View Post

    I would think that he shouldn’t plan on any straining activity for a week after a saturation biopsy, due to the extensive needle poking.
    Excellent. Thank you so much!

     
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    Old 04-05-2021, 12:28 PM   #5
    Liliac96
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    Re: PIRADS 3 questions

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi Lili,

    That figure, .199, suggests but does not prove that there is something going on beyond benign enlargement (BPH). If it turns out your husband does have prostate cancer, a density of .199 used to indicate that active surveillance would have lower odds of long-term success, with the desired figure being a density of .15 or lower, based on size from an MRI or other scan rather than the "finger wave". I think that is probably still true but have not checked.

    [/SIZE]
    Yes, I've read this about PSA density. (It's really worrying me, if I'm honest with myself.) Thanks for confirming.


    The question about the prostate capsule abutment came to me after our appointment on Friday. I figure that if the biopsy turns out to be problematic, we will have a lot of discussion with the doctor about location, etc.

    Right now, I know, we must wait for the biopsy and waiting is a bit rough. Heh.

     
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    Old 04-16-2021, 09:48 AM   #6
    Liliac96
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    Re: PIRADS 3 questions

    Update.

    My husband underwent his biopsy this week. He had no pain or discomfort after the procedure.

    It was a targeted biopsy. 12 samples were taken. Out of those 12, two came back positive. (see below).


    Adenocarcinoma:
    Prostatic Adenocarcinoma
    Prostate Cancer Grading:
    Primary Gleason grade: 3
    Secondary Gleason grade: 4
    Total Gleason score: 7
    Grade Group: 2
    Tumor Quantifications:
    The total number of cores identified is 1
    The total number of cores with carcinoma is 1
    The specimen is fragmented
    The percentage of tissue with carcinoma is 40%
    The linear amount of tissue with carcinoma is 5 mm
    The percentage of Gleason grade 4 and/or 5 is 25 %


    Adenocarcinoma:
    Prostatic Adenocarcinoma
    Prostate Cancer Grading:
    Primary Gleason grade: 4
    Secondary Gleason grade: 3
    Total Gleason score: 7
    Grade Group: 3
    Tumor Quantifications:
    The total number of cores identified is 3
    The total number of cores with carcinoma is 1
    The specimen is fragmented
    The percentage of tissue with carcinoma is 12%
    The linear amount of tissue with carcinoma is 2.5 mm
    The percentage of Gleason grade 4 and/or 5 is 60 %

    That is all we know right now, the follow-up with the doctor will happen soon. We are researching as best we can. The Gleason score of 4+3 is disheartening but it looks like there are good therapies available.

    I'm sure I'll be reading EVERYTHING this board has to offer. So thanks to everyone who has posted. It's truly helpful.

    Lili

     
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    Old 04-16-2021, 10:20 AM   #7
    Prostatefree
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    Re: PIRADS 3 questions

    Can someone address why it says G4 and/or 5?
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    1-15-21 PSA less than 0.02; zero club 4.5 yrs

     
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    Old 04-16-2021, 10:34 AM   #8
    IADT3since2000
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    Re: PIRADS 3 questions

    Hi Lili,

    I’m sorry you and your husband have now officially joined our club , but it does have many good members, and now you are entitled to all the rights, privileges, benefits and honors that go with membership. One of the benefits is an extremely high survival rate for patients with your husband’s case characteristics; he will almost certainly outlive the cancer, and he and you have a good shot at good quality of life.


    Perhaps the greatest problem confronting those facing a new diagnosis of prostate cancer is the abundance of information out there. It’s not like having a broken arm, where the options are straightforward and few, and the patient does not have to be at all well informed, just needs to do what the doctor orders. And it’s not like some major cancers where there has been little progress and there isn’t much doctors or patients can do to change the odds of a good outcome. Indeed, there has been enormous progress in dealing with prostate cancer, leading to really impressive rates of success for the vast majority of us, but all that progress means there is a flood of information out there, as well as both expert, highly talented, caring doctors but also doctors who are biased in favor of their own specialties or who have not kept up with the fields of other specialties involved in prostate cancer treatment. That means we patients and our loved ones will often do better if we can separate the wheat from the chaff.


    Fortunately, there are excellent books, videos, and other resources that are a major help in navigating to key information and viewpoints. The one I like best is a 2018 book, still quite current, “The Key to Prostate Cancer,” by medical oncologist Mark Scholz, MD, and 29 others who contribute their own chapters. As this is a disease where “one size fits all” does not at all apply, the book provides a short quiz to guide you to the chapters that apply to a particular kind of case, which cuts down on what you need to study. You just need to know the PSA at the time of diagnosis, whether a tumor can be felt by digital rectal exam (DRE) and those findings, whether the cancer has been previously treated, whether there is any indication from a scan (often none done/none needed) of distant metastases, and the highest Gleason score from the biopsy (4+3=7 for you). Based on that, you (your husband) falls into one of five shades of blue of increasing intensity with the acronym STAIR - Sky, Teal, Azure, Indigo, and Royal, corresponding to increasingly challenging disease. It appears your husband’s shade would be Teal, for intermediate risk prostate cancer. There are ten chapters about Teal, and patients should also look at a number of other chapters common to all patients.


    Also, while it’s good to get started now, it is very important that the biopsy Gleason score is sound. It will be sound if it was done by an expert who specializes in prostate cancer pathology, but chances are it may be either under graded or over graded if done by a general pathologist who does pathology for many diseases for men, women and maybe even children. Getting a second opinion from an expert is par for the course unless an expert did the original interpretation. In your case, if the true Gleason is a 6, that would open up the option of “Active Surveillance,” which is widely considered the best approach for “low-risk” prostate cancer. On the other hand, if, for example, the Gleason is really 8 instead of 7, that makes some options much more promising than others.


    Keep you spirits up! A diagnosis is a wrenching life change, but you both are still the same people you were weeks ago, and chances are you will have many good years ahead of you. Good luck, and I hope the Board will be able to help you sort your way through this.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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 12/2/2020). (Current T 93 12/2/2020.) 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. What I experienced is not a guarantee for all but shows what is possible.

    Last edited by IADT3since2000; 04-19-2021 at 05:32 AM. Reason: Typo - the original was kind of funny.

     
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    Old 04-16-2021, 10:37 AM   #9
    IADT3since2000
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    Re: PIRADS 3 questions

    Quote:
    Originally Posted by Prostatefree View Post
    Can someone address why it says G4 and/or 5?
    I'm fairly sure the language before the percentage in this part of the report is standard for all biopsies this pathologist reports. The idea is to indicate the degree of concern with the Gleason grades that run the risk of metastasis, grades 4 and 5 as you know.

    Jim

     
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    Old 04-16-2021, 01:43 PM   #10
    Liliac96
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    Re: PIRADS 3 questions

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi Lili,

    Also, while it’s good to get started now, it is very important that the biopsy Gleason score is sound. It will be sound if it was done by an expert who specializes in prostate cancer pathology, but chances are it may be either under graded or over graded if done by a general pathologist who does pathology for many diseases for men, women and maybe even children. Getting a second opinion from an expert is par for the course unless an expert did the original interpretation. In your case, if the true Gleason is a 6, that would open up the option of “Active Surveillance,” which is widely considered the best approach for “low-risk” prostate cancer. On the other hand, if, for example, the Gleason is really 8 instead of 7, that makes some options much more promising than others.


    Keep you spirits up! A diagnosis is a wrenching life change, but you both are still the same people you were weeks ago, and chances are you will have many good years ahead of you. Good luck, and I hope the Board will be able to help you sort your way through this.

    ….Jim
    Thanks. The pathology was read at MSK. While I think this is head and shoulders above our local hospital, we still plan on sending the slides to Johns Hopkins (Epstein) for a second opinion.


    You're 100% correct on the overwhelm of options. We've listened to a lot of videos from Mark Scholz and have ordered his book. Based on what he said, we were leaning toward radiation. Then we were (really) surprised to hear both ROs from MSK and MUSC say that often recommend surgery for men in my husband's age range.

    The good news (and please correct me if I'm wrong) is that we have at least several weeks to make a decision.

    Lili

     
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    Old 04-16-2021, 02:05 PM   #11
    DjinTonic
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    Re: PIRADS 3 questions

    Hi and welcome to the Forum! The next steps will likely be imaging. With a G7 (4+3) a bone scan may be ordered, in addition to the standard imaging, usually a CT. It can provide some hints as to whether the cancer is prostate-confined, in addition to much other information that is important before undertaking either radiation or surgery.

    The imaging (in addition to the 2nd path opinion on the biopsy) should complete the standard diagnostic workup. You might bring up genomic testing (e.g. Decipher or Oncotype) of the biopsy tissue with your husband's docs. It can provide a score as to whether his specific cancer is low-, intermediate-, or high-risk for metastases within 5 years. This information might be useful in coming to a decision on primary treatment.

    My feeling is it's good to have as much specific information as possible about one's cancer.

    All the best,

    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 04-16-2021, 02:30 PM   #12
    Liliac96
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    Re: PIRADS 3 questions

    Quote:
    Originally Posted by DjinTonic View Post
    Hi and welcome to the Forum! The next steps will likely be imaging. With a G7 (4+3) a bone scan may be ordered, in addition to the standard imaging, usually a CT. It can provide some hints as to whether the cancer is prostate-confined, in addition to much other information that is important before undertaking either radiation or surgery.

    The imaging (in addition to the 2nd path opinion on the biopsy) should complete the standard diagnostic workup. You might bring up genomic testing (e.g. Decipher or Oncotype) of the biopsy tissue with your husband's docs. It can provide a score as to whether his specific cancer is low-, intermediate-, or high-risk for metastases within 5 years. This information might be useful in coming to a decision on primary treatment.

    My feeling is it's good to have as much specific information as possible about one's cancer.

    All the best,

    Djin
    Thanks for the welcome. I really appreciate it.

    Spread to the bones is what I'm the most nervous about, of course. With his PSA (5.3), I was hoping it was going to be either Gleason 3+3 or 3+4. The 4+3 is really bothering me. But I'm sure as the days pass and we know more, I'll get over the shock.

     
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    Old 04-16-2021, 04:45 PM   #13
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    Re: PIRADS 3 questions

    Quote:
    Originally Posted by Liliac96 View Post
    Thanks for the welcome. I really appreciate it.

    Spread to the bones is what I'm the most nervous about, of course. With his PSA (5.3), I was hoping it was going to be either Gleason 3+3 or 3+4. The 4+3 is really bothering me. But I'm sure as the days pass and we know more, I'll get over the shock.

    A biopsy Gleason score is based on a very small sampling of prostate tissue, and it scores each individual lesion. The predominant Gleason pattern is listed first for each lesion. A biopsy path report is a therefore a sampling.

    Men who chose surgery have their entire prostate sampled and examined. That allows for the most common and second-most common prostate-wide pattern to be accurately determined (whereas a biopsy just lists the G score of each lesion, and the most serious is taken as a kind of overall score, since treatment needs to be based on the worst lesion.

    Many men have their G scores down- or upgraded at this exam. If we could look at all the malignant tissue in your husband's prostate, the percentage of pattern 4 could just as easily be under 50% as over. In other words, your husband could have G7 (3+4) or G7 (3+4) disease.

    As an example, I had two out of 14 positive cores in my biopsy. One was a G10 (5+5), the other a G9 (4+5). Since I chose surgery, I got a path report back after my RP and the definitive Gleason score was G9 (4+5).
    __________________
    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 04-16-2021, 04:49 PM   #14
    IADT3since2000
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    Re: PIRADS 3 questions

    Hi again Lili,

    Here are some added thoughts responding to your latest post and Djin's comment:

    Quote:
    Originally Posted by Liliac96 View Post
    Thanks. The pathology was read at MSK. While I think this is head and shoulders above our local hospital, we still plan on sending the slides to Johns Hopkins (Epstein) for a second opinion."
    With MSK my own opinion is that you are good to go with no further interpretation. Their expertise is world class. That said, if it will increase your peace of mind to get an opinion from Hopkins, then getting that second opinion makes sense.

    Quote:
    You're 100% correct on the overwhelm of options. We've listened to a lot of videos from Mark Scholz and have ordered his book. Based on what he said, we were leaning toward radiation. Then we were (really) surprised to hear both ROs from MSK and MUSC say that often recommend surgery for men in my husband's age range.
    You are really on a great information highway.

    It does seem to me that surgery is an option as well as radiation for your husband's case circumstances, but I'm a bit surprised that MSK thinks young age is a factor. As I understand it, that is not a negative for radiation, but MSK has done outstanding pioneering research on radiation (and surgery) for many years, and they may have a reason for concern that has escaped me from my viewpoint as a layman. That would be a great question for this fall's Conference on Prostate Cancer in Los Angeles.

    Quote:
    The good news (and please correct me if I'm wrong) is that we have at least several weeks to make a decision.

    Lili
    You almost certainly have much more time than that, but the smart course is to gather the information you need, then decide on an approach, and then follow-through without putting it off indefinitely.

    Use of genetic testing makes sense to me. This represents progress against prostate cancer that is now serving you!

    As for the conventional (Tc technetium) bone scan and the CT scan, both make a lot of sense for patients like Djin and me because of a fairly strong likelihood of metastases that would be large enough to be caught with such scans. However, for a case like your husband's, unless there are special circumstances, many doctors no longer believe the scans are of value; this is a change, based on research findings, from the past when these scans were done routinely. Neither scan is very sensitive: for the CT scan it takes a tumor about the size of a pea, pretty large, to trigger a positive result, and for the bone scan, cancer needs to occupy about 10% of the bone at a spot in order for it to be positive. This means that it is extremely unlikely that a patient like your husband will have either test that turns out positive, and, even if a patient does have a distant metastasis in bone or soft tissue, it will likely be missed if it isn't large enough to show up on the scan, which is likely for men who have case characteristics like your husband. Far better scans are available - highly sensitive, highly specific, but the likelihood of metastasis at this point is so low that they are not judged cost effective for patients like your husband. Sometimes major research institutions like MSK will do the Tc bone and CT scans for research purposes, but I'm thinking they may well think that no scans are needed other than that multiparametric MRI which was already done, which made a lot of good sense. I would really like to know if MSK does want a CT or technetium bone scan, and, if so, what they tell you about the role of those scans.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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 12/2/2020). (Current T 93 12/2/2020.) 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. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 04-16-2021, 05:00 PM   #15
    DjinTonic
    Veteran
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    Location: NC
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    Re: PIRADS 3 questions

    The CT scan serves purposes other than checking for mets, and I believe that it is still fairly routine. For example docs want to know whether there is primary cancer of any other organs, such as the bowel or bladder, any anatomical abnormalities, adhesions or other sequelae of past injuries or surgeries, other medical conditions, etc. In addition the CT scan can sometimes provide clues as to the whether or not the cancer is locally advanced (spreading out from the prostate) and can check for enlarged lymph nodes. The results of a CT scan can influence treatment choices and decisions. Surgeons don't want surprises after the procedure begins, and radiologists want to know exactly what they are irradiating.

    While bone scans are no longer done for low-risk PCa, i.e. G6 (3+3) and G7 (3+4), I'm not sure about G7 (4+3). I would say that the majority of 4+3 men do have a bone scan done. Let us know what your husband's docs want to do in terms of imaging.

    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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