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  • MRI result

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    Old 06-16-2021, 07:54 AM   #1
    Mushin
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    MRI result

    I had an MRI done on 6/15 as part of my AS at JH. My follow up meeting is on the 28th. Is there anything to be worried about in the result below?

    IMPRESSION:
    Enlarged BPH gland with a solitary left-sided peripheral zone lesion. No findings of extraprostatic disease.

    Features of chronic bladder outlet obstruction with trabeculations

    Small volume of free fluid in the pelvis, nonspecific

    Dominant nodule lesion #1, overall PI-RADS = 2/5

    Overall Assessment Categories (PI-RADS V2):
    Likelihood that a clinically significant cancer is present based on MRI parameters
    1. Very low (clinically significant cancer is highly unlikely to be present)
    2. Low (clinically significant cancer is unlikely to be present)
    3. Intermediate (the presence of clinically significant cancer is equivocal)
    4. High (clinically significant cancer is likely to be present)
    5. Very high (clinically significant cancer is highly likely to be present)

    Images and interpretation personally reviewed by: William D. Craig, MD,MBA

    Narrative
    EXAM: MRI PROSTATE W/WO CONTRAST

    INDICATION: prostate cancer surveillance
    PSA 4.7
    Prior biopsy: Potential focus of neoplasia. No Gleason score given.

    COMPARISON: None.

    FINDINGS:

    IMAGE QUALITY: Diagnostic.

    HEMORRHAGE:
    No areas of high T1 signal suggesting hemorrhage.

    PROSTATE VOLUME:
    Prostate measures: 6.1 cm TV x 3.9 cm AP x 6.1 cm CC, volume 76 cc.

    PERIPHERAL ZONE:
    Some faint patchy areas of decreased T2 signal with a solitary measurable focus

    Lesion #1:
    - Side: left
    - Level: base
    - Zone: peripheral zone
    - Location: posterior
    - Diagram - sector: PZpm
    - Size: 6 mm on T2-weighted imaging
    - Relation to capsule: does not abut capsule
    - Series 501 Image 15

    Assessment categories:
    - T2 = 4/5
    - DWI-ADC = 2/5
    - DCE = negative
    - Overall PI-RADS = 2/5


    SEMINAL VESICLES: Normal, symmetric.

    NEUROVASCULAR BUNDLES: Normal, symmetric.

    BLADDER NECK: Normal

    MEMBRANOUS URETHRA: Normal

    LYMPH NODES: None enlarged.

    BONE MARROW: Normal signal intensity.

    OTHER: Trabeculated bladder wall.

    Small amount of free fluid, indeterminate.
    __________________
    Born 1964
    Family history of PC- 1 brother, 1 uncle on father's side, 1 uncle on mother's side
    First Biopsy Feb 2020, No PC, 4 of 12 Atypical cells
    Second Biopsy Nov 2020. Diagnosis 11/20/2020, 1 of 12 core, 3+3, Grade 1 PSA Jan 2021 3.81, PSA June 2021 4.7.

     
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    Old 06-16-2021, 08:32 AM   #2
    ASAdvocate
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    Re: MRI result

    This is nothing to worry about. Ive been in JHs AS program since 2009, and this would be a typical MRI result for me. Possibly a small amount of Gleason 6, if anything.

     
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    Old 06-16-2021, 10:57 AM   #3
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    Re: MRI result

    Airport Security waves you through -- you're good to go!

    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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    Mushin (06-17-2021)
    Old 06-16-2021, 01:19 PM   #4
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    Re: MRI result

    I have concerns. The size of your prostate and at your age I'll wager you in the group of men, 50%, that move on up and out of AS.

    I suspect you have urinary symptoms. How's your DRE? Do you have a PSA history to share?

    The question is do I have a guided biopsy? If this would be your second following one a year ago I'd say yes. if this would be your first biopsy I'd seriously consider it.
    __________________
    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
    7-9-21 PSA less than 0.02; zero club 5yrs

     
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    Mushin (06-17-2021)
    Old 06-16-2021, 09:25 PM   #5
    Mushin
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    Re: MRI result

    Quote:
    Originally Posted by Prostatefree View Post
    I have concerns. The size of your prostate and at your age I'll wager you in the group of men, 50%, that move on up and out of AS.

    I suspect you have urinary symptoms. How's your DRE? Do you have a PSA history to share?

    The question is do I have a guided biopsy? If this would be your second following one a year ago I'd say yes. if this would be your first biopsy I'd seriously consider it.
    DRE has been good, no sign of lump or hardness.

    PSA prior to 2018 has always been normal.

    8/30/2018 4.35
    12/20/2018 4.37
    9/13/2019 3.16
    1/16/2020 4.58
    1/28/2021 3.81
    6/9/2021 4.7

    I had two biopsies in 2020, one in February and the other in November. The first was negative and the second 1 of 12 <5% 3+3 Grade 1.
    __________________
    Born 1964
    Family history of PC- 1 brother, 1 uncle on father's side, 1 uncle on mother's side
    First Biopsy Feb 2020, No PC, 4 of 12 Atypical cells
    Second Biopsy Nov 2020. Diagnosis 11/20/2020, 1 of 12 core, 3+3, Grade 1 PSA Jan 2021 3.81, PSA June 2021 4.7.

     
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    Old 06-17-2021, 03:37 AM   #6
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    Re: MRI result

    Thanks. BPH may be reason enough to consider surgery and you may not need to wait for a serious case of intermediate cancer to get it. I have a friend with a serious case of BPH who has had one procedure to improve urination (clips)and may soon have a TURP. He is not a happy camper. Eventually an enlarged prostate will not only cause incontinence, it can also cause ED.

    Any PC cancer that is enough to allow PC removal with the insurance companies may be preferable to a prostate that no longer plays nice.

     
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    Old 06-17-2021, 05:59 AM   #7
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    Re: MRI result

    Quote:
    Originally Posted by Prostatefree View Post
    Thanks. BPH may be reason enough to consider surgery and you may not need to wait for a serious case of intermediate cancer to get it. I have a friend with a serious case of BPH who has had one procedure to improve urination (clips)and may soon have a TURP. He is not a happy camper. Eventually an enlarged prostate will not only cause incontinence, it can also cause ED.

    Any PC cancer that is enough to allow PC removal with the insurance companies may be preferable to a prostate that no longer plays nice.
    There are now less destructive procedures for a man with low grade cancer and an enlarged gland.

    Both aquablation and prostate artery embolization can greatly reduce the prostate volume without using radical surgery.

     
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    Old 06-17-2021, 09:41 AM   #8
    Gary I
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    Re: MRI result

    The prostate artery embolization (PAE) is worthy of some serious research, and has shown excellent results.

    I came very close to having it five years ago, when it was in clinical trial.

    A TURP, at least for me, was a serious procedure,=.
    __________________
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    Second 3T MRI 1/17
    RALP 7/17, G3+4, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over next 4 months
    DCFPyl PET & ercMRI @NCI - 11/17
    One inch tumor still in prostate bed
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    SRT, 2ADT, IMGT 70.2 Gy, complete 5/18
    PSA 0.066 1/20, .059 6/20, .077 9/20, .099 11/20,.075 1/21 .079 4/21, .077 7/21

     
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    Old 06-18-2021, 05:33 AM   #9
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    Re: MRI result

    Are any of those procedures permanent solutions to BPH?

     
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    Old 06-18-2021, 06:01 AM   #10
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    Re: MRI result

    Quote:
    Originally Posted by Prostatefree View Post
    Are any of those procedures permanent solutions to BPH?
    PAE has about seven years of history. Interventional radiologists think it is a long term solution.

    Aquablation is quite new, the most experienced providers have only 100 procedures. But, it is being learned and offered at a fast pace. I belong to a BPH social media group, and there is much excitement about it. Of course, those are potential customers, so doctors are quick to learn it.

    Short term studies on aquablation show impressive results with no side effects. But, there is no long term data yet.

     
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