Opinion on Prostate: 3T MRI, Biopsy, PSA, Prolaris tests

Would appreciate some opinions/thoughts.  

Age: 71

PSA gradually increasing last 15 years. Feb 16 PSA =4.1, Mar 17 PSA = 6.6.  

May 17 Needle biopsy, 14 cores, 4 cores indicated abnormality with less than 25%involvement, Gleason=6

May 17 Prolaris test from biopsy, result 3.3 "consistent"

Sep 17 decreased PSA=5.4

Jan 18 decreased PSA=4.4

Feb 18 3T MRI with contrast: "enlarged gland, lighted areas looked hypertrophied rather than malignant"

So...opinions, thoughts?  do I have prostate cancel or just an enlarged gland???

Thanks

 

Hello,

The 4 cores diagnosed with gleason 6, please consider a second opinion from another pathologist.

The size of the prostate. Divide the psa into the cc size fo the prostate for  "prostate density" below .15 is considered somewhat normal.

Information is Key. 

 

I Would get a 3 TMR And send it to an intervention will radiologist In reading them To say what is the conclusion on cancerous lesions in the Gland then I would have a single needle focal biopsy of that tissue and consider having focal laser ablation of the cancer tissue. If you want a recommendation on a doctor that does this and is the best at it then ask for it and I will personal message you. He will not charge you to read your film or to give a consultation. You can get your film done locally where you live and upload it on his website with a one button touch. Good luck let me know.

Had a fusion biopsy after a 3TMRI showed an area of concern. The first doctor's review of the MRI indicated I had an 80 percent chance it being cancer. Two other doctors not so sure. They all recommended I do a fusion biopsy which I did on Dec. 26.. 16 cores with 8 in the area of concern. all were negative. 

If you had an MRI then you should have the actual size of your prostate with details such as whats the size of each lobe including medium lobe. 

You could have both an enlarged Prostate and cancer. A fusion biopsy is the only way to know for sure on the cancer,   My prostate size at the time of the biopsy was 97 which is pretty large and my PSA was 8.1 

 

My PSA is above 12. Doctor not worried. Biopsy showed benign. I do CIC with no problems. My Canadian urologist commented that American doctors are way too aggressive with their treatments. For what this is worth from the Great White North.   Best.  Paul

Just enlargement.

Chris,

If your Gleason pattern was 6 it is possible you have some cancer, but may uros believe 6 is NOT cancer and shouldn't be reported as such. The problem with cores is that they are only random samples, and they miss a lot. The decrease in PSA might just be from some sort of irritation. The less than 25% involvement is encouraging. So, the only thing you can do at this point is to wait - active surveillance. In 18 months your uro will likely recommend a second biopsy. These are not fun, as you know.

I had similar results after my first biopsy, but after the second I had more cores involved and a higher percentage of each core involved, so the docs said there was "progression" and recommended treatment, which I eventually had. I never did get a Gleason 7 score, but the idea that my symptoms were "progressing" and the number of cores involved and percent in each core was increasing was causing me anxiety, so being treated (in my case radiation) not only reduced the anxiety, but, apparently, eliminated the cancer, if that was what it was. My PSA is now consistently 0.1 and I get tested every 6 months. I am not a doctor, just someone who has gone through exactly what you are experiencing. 

My best to you on your journey,

Tom

Chris,  I am about the same age as you.  I'm 69 years old.  My urologist, told me that it takes an average of 13 years for cancer in the prostate to become deadly to the point where it will become terminal.  The only exception, is that if you have the fast growing one, than, it's a different story.  Most prostate cancer is slow growing.  So my thinking is if you are 71 years old, I would suggest what they call "watchful waiting"  Odds are something else will be your ticket to heaven.  Good luck, Dennis

Thanks, I'll look into a second opinion.

Thanks.  Let me consider this option.

Thanks.  I need to get the detailed 3TMRI report to see prostate size.  My my urologist visit is in 2 months.  I'll discuss a fusion biopsy with him.  Appreciate the input.

I would agree that US docs tend to be aggressive (read "CYA&quot at times.  My 41 year old daughter just went through similar situation with a breast exam.  After being told she was high risk (docs wanted more tests), 3 other doctors, when pressed, thought, well probably not much risk at all.  I blame it mostly on the lawyers.  Nevertheless, thanks for input.  Education is the key.

Tom, thanks.  Just wondering what type of radiation you had; needles or external, and if external, the 5-7 week daily routine or the 5-6 day higher intensity routine?  I've had friends with all of these and I'm curious about reactions/side effects, in case I have to go that way.  Regards.

Dennis, yep I'm hoping to buy that ticket for a way in the future date.  I've got a few good years of golf left in me.  Thanks for the thoughts.

Chris, 

I interviewed many doctors and researched the various procedures for a couple of years before deciding on treatment. I eventually had HD Brachytherapy. It consisted of two treatments spaced two weeks apart. I was also considering Proton Beam. My treatment was fully covered by my medical insurance and I didn't have to travel far for treatment. 

The only side effect was that after each treatment there was prostate swelling, as there is with other treatments. But, the swelling after treatment two closed off my urinary flow, so I had to have Foley catheters for five weeks until the swelling went down and I could urinate on my own. I actually got used to the Foleys and didn't get a UTI. 

Hope this helps...

Tom