That's the part around the urethra. It seems that my PI RADS level 3 means inconclusive. ( it can be from 1 - 5 ,5 being it's pretty sure you have Cancer. My PSA was 6.5 a year ago (it had been slowly creeping up), then 3.5 four months ago. The urologist was all , ' great news', but I was more concerned that it was bouncing around. Then a month ago jumped to 9.5. Then they started talking blind 12 core biopsy, because 'the insurance never covered MRI's prior to the first biopsy'. I raised a stink and told them to submit it anyway, and lo and behold, my plan did cover it. This all started as year ago with intense pain just like my previous ( every 5 years or so) bouts with acute infectious prostatitus. And this time the DRE's were nowhere nearly as painful as in the past. So now they are talking about still doing the normal blind 12 core biopsy. Makes no sense to me, why not target the transitional zone? And my question for all you good folks is what the best kind of biopsy for me now? Or I have the option of doing nothing now and repeating the MRI in six months. And they were perfectly willing to wait three months to check the PSA again. I'm not, if the MRI had been clean I wanted to check the PSA monthly and do the biopsy if it kept rising. Besides, my current COBRA policy expires in four months, and good luck getting insurance with a cancer diagnosis. Please, if anyone has any knowledge or experience in this area, please enlighten me. I just found out about the MRI this afternoon, and need to make informed, good decisions ASAP. So many kinds of biopsy's out there, and I don't think I can afford to make another mistake, my first being sticking with the first sorry urologist for six months. Sorry for the length, I'm just trying to order my thoughts. The battle begins tomorrow.
I would wait and check your PSA in 3 months there is really no hurry this is a very slow moving cancer. If the PSA jumps above the 10 mark I would have the MRI and ultra sound guided biopsy. Just a heads up the more of those biopsy you do the more damage to your nerves and the more ED problems you will have a guided biopsy will hit the spot. Also keep in mind you may still only have a Gleason score that will still make you do a wait and see.
Thanks. I get that it's slow moving, but who knows how long it's been going on? My PSA did jump from 3.5 to 9.5 in the last few months. It's hard to keep a level head with the horrific pain. It's like the worst attack of acute infectious prostatitus I ever had, but instead of it peaking for a day or two it's been 2 to 3 days a week for the last year. And on the 'good' days I still feel like sh*t. And I could be one of the lucky few who actually have cancer without the accompanying skyrocketing psa. (Should I ask for the free PSA test?) Sorry to be so whiny. After a year of my griping it's like the DR's were tuning me out. The only good thing about the MRI is that just maybe they'll start taking me seriously. I also get that they probably get alot of hypocondriacs who present the same way I do. I just cannot continue to function at this level of pain. I'm a computer programmer and need to get back in the game and get another contract. Thanks again for the advice. I really do appreciate it.
Hi Rolf, Yes the rising PSA is a worry. Great you got the MRI and that it was covered by your insurance. Here in Australia, Prostate MRI are never covered by insurance or the Government. We pay the $500.
Your PIRAD3 score gets you into the "not sure if there is some thing" area. Did your report from the radiolgist state they found any lesions? If so, they could be targeted for biopsy. Your report would have mentioned where the less than normal tissue was, also a target for the biopsy. My urologist said he don't do blind biopsies. He prefers a target. If a lesion was reported, then it is back into the MRI machine with a robotic biopsy that needles the dodgy area and takes a sample, then a more definitive result available in a day or so.
My PSA has been steady around 2.4 for 13 years. A few months ago, got a big UTI, and the a few weeks after subsidence, my annual blood test showed my PSA had risen to 7.4, repeat test a month later, 8.2 then 2 months later, 12.0 and a free % of 12.5 Ummm, Not looking good, though the UTI may take a long time to settle. I arranged for a mpMRI. A day later, the report was released. It said I was developing BPH in a few areas of my prostate, and I had a PIRAD2 score as well as a prediction of no Gleeson 5 or 6 was evident. So, sort of good news, but, the rising PSA still needs resolving. Maybe the BPH tissue being created is the cause? In October, I meet with urologist to see how we sort out the reason for the PSA. Other than PSA, I have no problems at all.
Apparently the free PSA is good for a PSA level less than 10, so may assist you with your quest.
Geoff
Hello. In the uk there is a much bigger biopsy available under general anaesthetic.
My other half had the 12 needle biopsy revealing 3+3 Gleason. The consultant did recommend active surveillance, but I said that what if the biopsy had missed a higher grade cancer. The consultant said if my other half wanted to go on active surveillance then he should have the big 50 needle biopsy to see if anything was missed
In the end he had treatment. So the big biopsy was not needed.
All the best.
Hi Rolf, I'm in the UK so maybe the procedures are a bit different, but if the standard 12 needle biopsy finds nothing (and they suspect something) they move you up to a template biopsy where they knock you out, and map and "spear" the prostate with a special grid through the perineum.....I am currently due for that any time soon.....Can't wait
Sounds fun!!!. I saw a youtube on this procedure. If you have to have a biopsy, while this is a serious way to get one, it looks the best way.
So, Tony, do you go on a waiting list for this procedure, and if it is classed as urgent is it done within so many days of original presentation to the clinic?
Geoff
Hi Geoff, I only had the neg results from the 12 needle biopsy yesterday, (don't know if there is a prescribed amount of time to wait between biopsies). The doc says that they'll be sending me an appointment letter....The NHS stumped up for an MRI unbidden and have spotted a small lesion which they have graded as PIRADS 4 (ie likely to be malignant), which begs the question why not do the saturation biopsy in the first place?....It's the waiting that gets to you...It's getting depressing.....plus you can't help but think that why they are dicking about this thing is getting bigger....Just want to get it sorted....They obviously think there's something there....Why not cut to the chase and get me to sign on the dotted line and get the prostate out? (I'd do it tomorrow)
Tony
Dude I don’t know what kind of doctor you are seeing but he isn’t very good. I hope he is at less a urologist. That said, any doctor will order you a PSA test. You are not reading my responses. That pain isn’t coming from a cancer. I have been waiting out my high PSA for 12 years it was only last November that it spiked to 11 that I did the MRI. Along the way I had 2 biopsies that I now wish I never had. I never had any pain except from the biopsies. If you can get a MRI, you will find the cancer but it will not tell you a Gleason score without an ultrasound-guided prostate biopsy using soft image fusion ultra sound. One other thing before you go off halfcocked. Anyone can give you a MRI, but there are only a few places that are good at it. You will need to find one. I live in Savannah Ga and had to drive to the Mayo clinic in Jacksonville Fla. This is want you need and you can google it. (MRI and ultrasound-guided prostate biopsy using soft image fusion). Find a doctor that can do the biopsy then get him to send you to the right MRI imaging center. I am going to say it one more time. THAT PAIN IS NOT COMING FROM CANCER That is a whole different problem.
Hi Tony, If they have found a lesion, then this should be biopsied, which will give them and you the Gleeson score, which in turn will give you the urgency or otherwise action to be taken. Your cancer, if you have one, could be very slow growing.
If you are a NHS patient, like a public health patient here, you are some what limited in your demands of the system. In Australia, if you present to a public hospital with a 'high' PSA, and a MRI indicating a lesion in the prostate, the hospital urology clinic will, within 14 days arrange a detailed biopsy of the lesion. Depending on the biopsy of the lesion, action to remedy the prostate will be carried out within a further 14 days if the biopsy indicated urgency.
Good luck
Geoff
Hi Geoff, as you will see, I've already had a 12 core biopsy which found nothing, but aparently there is a false negative rate of about 30% on 12 needle biopsies....I have a 70cc prostate so it's 2 and a half times larger than the norm.....My PSA which I have read every 6 months because I'm on the cusp at 3.1 (I'm 58) has been constant for the last 3 years...I got complacent and left it a year, went to the doc and had a nasty surprise 7.5!!! .....while waiting for the NHS to get into gear, I went to a private clinic to get retested with a free PSA reading and it came back 4.3 with a free PSA of 23% (two weeks later)....I thought then that I was out of the woods.....Then the NHS got hold of me and after a cystoscopy, a CT urogram, an mpMRI which showed up the small suspicious lesion and now a biopsy I'm still in the dark......From what I read anything that shows up on an mpMRI is "significant" (assuming the radiologist is doing his job), so I want to get this sorted sooner rather than later....especially as I'm now getting a pain in the lower back and hip which is freaking me out (hopefully it's just my age, but the mind starts to imagine the monster under the bed).....Plus joy of joys, in the last three weeks I have incurred an inguinal hernia.....Someone somewhere is having a cosmic joke at my expense....To be fair the NHS has been pretty good and fast, but when you hear the word "Cancer" you can't find stuff out quickly enough.
Rolf....Sorry for Hijacking your thread, but this may help someone out re :Pirads and tests etc.
Tony
I mean that they should biopsy the lesion by a guided biopsy, as this is the spot that has lit up the MRI.
My brother's PSA over a 3 month period went up to 37, then over three years came back down to 3. Apparently, chronic prostatitus. Mine from 2.4 to 12(at present), so, maybe the same issue.
Geoff
And...thinking about your comment pains in the lower back etc. When you had the MRI, he would have used a contrast late in the test. As I sit here, my lower back sore as well as bum bones. Radiologist made a point of saying, the contrast test will show any hot spots in the pelvic area bones. His report said no hot spots. I am sure your guy would have said if he saw any. Don't worry...too much.
Geoff
Hi Geoff, I don't even know if that kind of guided biopsy is available in the UK....I know we're not quite a third world country (yet) but I've never seen that option mentioned anywhere in the UK, either Privately or on the NHS....Even the fancy Harley St Clinic where I got my PSA retest only offer a standard or saturation biopsy on their website.....As for Prostatitis I have offered that possible explanantion to 4 different urologists now...The guy who did my cystoscopy, the guy who gave me the MRI results, the guy who gave me the biopsy and the Harley St consultant (who happens to be one of the worlds leading experts on the prostate) and they have all sort of shrugged and remained very non-commital...When I told the doc yesterday about my inguinal hernia and whether I should go for the consultation with the surgeon, as I had read that inguinal hernia repair and prostate surgery (should it come to that) don't really go together....he said "you've done your homework".....I said "why wouldn't I? this is my life"...I nearly added that it "shouldn't be just left to the trust of doctors", but thought better of it. No matter how good the doctor if something happens to you, they'll still go home at the end of the day and have their dinner......Cynical Moi?
Regards and thanks for the post.....Tony
Hi Geoff, Just noticed this....You may be right but I thought that the test for hot spots in the bones was different......They use a radioactive medium and then a special camera as I understand it......It's probably just paranoia (hopefully).....
NP... Call me a cynic, but I suspect it's all about the money, not getting the best (more expensive) test first. Tho I get the 'greater good' argument, that more tests lead to unnecessary surgeries. (Though, come to think of it, that's all about the money too, if you're a doctor or hospital). I'm getting herded to a transrectal biopsy, getting nowhere telling the urologist that I can show him 20 studies showing the sepsis/infection rate vs transperineal is significant. And that there are areas of the prostate much more accessible via the transperineal. I guess I'm in the 'lesser' of the 'greater good' equation. No financial incentive for the transperineal approach, yet... thanks for the input guys, it's a tough learning curve.
Hi Rolf, I had the same feeling that the transperineal was better, but of course, much more cost involved. The transrectal is more like the conveyor belt stuff. While it can be guided via the MRI image, still not an ideal way. IF you have to have a biopsy, then it should be the one that gives you, the patient the best result(biopsy and infection control) for the least cost. So far, I have not considered the need for the biopsy...yet. Also, it depends where your lesion is. If not accessable to the transrectal method, then should use the transperineal method.
To biopsy or not is a good question. Do you rely on the MRI findings? The biopsy could say the lesion is deadly, but very slow and could be watched for several years before it needed attending to. Many men do not like the fact it is there...get it out of me. Though, the aftermath of the treatment choice needs great consideration before getting on the table.
Geoff
Thanks Geoff, my psa has tripled to 9.5 this year, and I have the 'pirads of 3 in the intermediate zone'. Nice lady that the urology asst is, she only read the words, and noted that no areas of specific interest were indicated. I was a little p*ssed that for a positive screening result the doctor didn't feel the need to make himself available. Probably because he knew from experience that anyone in my place would ask a bunch of fool questions and put him off schedule. Well, that was two days ago and she hasn't made the promised call with answers for the questions I did have. So tomorrow she's hearing from me. Dammit, I have to be polite... I need their full attention and cooperation. Tho I did make an appt with a urologist at the Cleveland clinic for next week. Had a l2/l2 nerve block today for the prostate area pain which I cannot see helping (there should have been temporary pain relief I think, tho maybe the steroid component of the shot will kick in - I'm not optimistic). But I had to start playing their pain game so I can say ' yes, I've tried that...'.
medical issues don't seem to have the common decency to wait for their turn, but instead gang up on you. The pain thing has worsened over the last year - the PSA jump just a month ago.
Rolf, Here in the UK where our treatment is "free" (paid for by taxes) I assume that it is a cost issue (although they gave me an mpMRI which surprised me). To do the transperineal is obviously more expensive as it involves more personnel, anaesthesia etc.....I would have thought that irf you were paying they would give you the best treatment straight away.....Especially when you consider the mental angst every time you have to have a test and then wait for the results....Tough learning curve is right
Best Wishes
Tony, So, from walking into the hospital,how long did it take them to start the diagnosis train, and did they jump straight into the biopsy and did you give up or not trust them and went to the Harley street guys?
Geoff