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This will be done at Duke University. They are ranked top 10 for prostate cancer. Yes going this route as a baseline plus I met my deductible for insurance.
I am still wondering why psa is high and of there is anything I can do to lower. I have no inflammation, bph either.
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Had the MRI this morning with and without contrast and endorectal coil. It took about 30 minutes. The worst parts 1) Endorectal coil with balloon. Burning uncomfortable for about first 4 minutes. 2) Contrast injection via IV. Weird burning/cooling sensation up and down arm and little around neck. I did not have any issue with noise of MRI machine or being in the tube.
I also received a shot to slow my metabolism down.
Overall not as bad as the biopsy but I would say close to it ironically. The coil in you for 30 minutes was tough, and I am a little sore right now.
Some other side notes insurance contacted me 1 week before and denied the MRI. I fought back and scheduled what is called a peer to peer with my Dr. and Insurance company to get it approved. I got it approved on Friday (last minute). In speaking with the radiologist tech; the Siemems 3T machine costs around 3 million dollars. The one I was in was manufactured in 2011 in Germany. The cost of the room (to make it safe) is about 500k. The MRI if paid out of pocket would cost me $5500, and that does not include the radiologist report and "facility fee", I assume that will be another $1700.
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Born 1981
1.6 PSA on 7/1/16
1.91 PSA. .59 PSA Free 27.7% PSA Free % on 12/19/16
1.98 PSA on 3/9/17
4.9 PSA on 9/11/17
TRUS Biopsy on 10/4/17. Negative for malignancy in all 12 cores.
3T mpMRI on 12/18/17. PIRADS 3 lesion in the right posterolateral peripheral zone.
Fusion Biopsy 2/19/2018. Right lateral base contains Atypical small acinar proliferation.
3.8 PSA .48 PSA Free 12.6% PSA Free % 4/12/18
2.0 PSA 9/12/18
3T mpMRI 01/11/19. Same as last time PIRADS 3 lesion in the right posterolateral peripheral zone. Similar size.
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Top User
CD, great job fighting for good health care! Keep us posted with the results. Happy Holidays!
69 yr at Dx, BPH x 20 yr, 9 (!) negative biopsies, PCA3 -
2013 TURP (90→30 g) then PSA 2x/yr, DRE yearly
6-06-17 DRE nodule R, last PSA rise, on finasteride: 3.6→4.3
6-28-17 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 5% RLM
Bone scan, CTs, X-rays: negative
8-7-17 Open RP, neg. frozen sections, Duke Regional, my Uro, 8-20 RPs/mo. x 25 yr.
SM EPE LVI SVI LNI(16): negative, PNI+, nerves spared
pT2c pN0, bilat. adenocarcinoma G9 (4+5) 5% of prostate (4.5 x 5 x 4 cm, 64 g)
11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%; 10-yr PCa-specific mortality 3.3%
Dry; ED OK with sildenafil
9-16-17 (5 weeks) PSA <0.1; Pomi-T (2 cap/day)
LabCorp uPSA (Roche ECLIA):
11-28-17 (3 mo. ) 0.010
02-26-18 (6 mo. ) 0.009
05-30-18 (9 mo. ) 0.007
08-27-18 (1 year) 0.018
09-26-18 (13 mo) 0.013 (checking rise)
11-26-18 (15 mo) 0.012
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Wow, I just wanted to give you a huge shout out for being so proactive! Im struggling with my father right now who is very passive with his PC diagnosis and its extremely frustrating. Give yourself a pat on the back! 👍
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REsults:
PIRADS 3 lesion in the right posterolateral peripheral zone.
There is low T2 signal in the right posterolateral
peripheral zone at the base measuring 1.0 x 0.6 x 0.3 cm with a volume of
0.2 mL on image 18 of series 12.
Central gland: No focal areas of suspicious low T2 signal identified.
Prostatic capsule: Intact.
Neurovascular bundles: Intact.
Seminal vesicles: Intact.
Lymph nodes: No lymphadenopathy seen.
Bones: No destructive lesions identified.
Extraprostatic findings: None.
Not really sure what that is yet have to talk to dr.
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Born 1981
1.6 PSA on 7/1/16
1.91 PSA. .59 PSA Free 27.7% PSA Free % on 12/19/16
1.98 PSA on 3/9/17
4.9 PSA on 9/11/17
TRUS Biopsy on 10/4/17. Negative for malignancy in all 12 cores.
3T mpMRI on 12/18/17. PIRADS 3 lesion in the right posterolateral peripheral zone.
Fusion Biopsy 2/19/2018. Right lateral base contains Atypical small acinar proliferation.
3.8 PSA .48 PSA Free 12.6% PSA Free % 4/12/18
2.0 PSA 9/12/18
3T mpMRI 01/11/19. Same as last time PIRADS 3 lesion in the right posterolateral peripheral zone. Similar size.
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Spoke to Dr. via email. Said MRI biopsy next step if I wanted. I followed up with a bunch of questions so naturally he wants me to come in so he can take my co-pay. Anyone had experience with MRI biopsy? Is this more or less the same as TRUS? I assume they only do a few cores near the site that was identified as suspicious. Ahhh... I hate the idea of a biopsy again and the after effects. Bad Christmas news I guess.
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Born 1981
1.6 PSA on 7/1/16
1.91 PSA. .59 PSA Free 27.7% PSA Free % on 12/19/16
1.98 PSA on 3/9/17
4.9 PSA on 9/11/17
TRUS Biopsy on 10/4/17. Negative for malignancy in all 12 cores.
3T mpMRI on 12/18/17. PIRADS 3 lesion in the right posterolateral peripheral zone.
Fusion Biopsy 2/19/2018. Right lateral base contains Atypical small acinar proliferation.
3.8 PSA .48 PSA Free 12.6% PSA Free % 4/12/18
2.0 PSA 9/12/18
3T mpMRI 01/11/19. Same as last time PIRADS 3 lesion in the right posterolateral peripheral zone. Similar size.
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 Originally Posted by cdtechman
Spoke to Dr. via email. Said MRI biopsy next step if I wanted. I followed up with a bunch of questions so naturally he wants me to come in so he can take my co-pay. Anyone had experience with MRI biopsy? Is this more or less the same as TRUS? I assume they only do a few cores near the site that was identified as suspicious. Ahhh... I hate the idea of a biopsy again and the after effects. Bad Christmas news I guess.
CD; had a MRI guided biopsy on 12/26/17. Don't know what your Dr has planned but I had 32 cores taken this time. First biopsy I had 6 months ago was 12 cores (positive with Gleason 6 in 9 cores). Procedure was the same as first biopsy other than taking a bit longer. As far as side effects, unfortunately they were slightly worse than first go around. First biopsy had blood in urine for about 1/2 day, this time blood in urine for 6 days. With first biopsy had blood streaked stools with first BM. This time around it lasted 3 times, with the first BM a real blood and clot gusher. Not sure how long blood in semen will last as I am only one week out. Having said all of that, when looking at the whole picture, it wasn't that bad, and hopefully will give me a good confident idea as to my next step. Dr said it might take a bit longer to get results as he is going to get confirmation from second pathologist on results. Best of luck to you in 2018.
DOB - 07/05/1949 Age-68
PCa Family History - Father, Paternal Uncle (Both died from cardiac issues)
PSA- 1997-2013 Gradually increasing from 1.4 - 3.2,
PSA 2014 3.5
PSA 2015 4.7
PSA 06/08/2017 8.8
PSA 07/19/2017 9.88 DRE-smooth, normal
Biopsy - 08/15/2017
Biopsy results:
9 of 12 cores positive - Gleason 6 - Percent Tumor Involvement 10-95%
Left mid Prostate - Adenocarcinoma of prostate. Gleason Score 3+3=6. Involving 10-95% of the length of 5 cores.
Right mid Prostate - Adenocarcinoma of prostate. Gleason Score 3+3=6. Involving 25-80% of the length of 4 cores. Perineural Invasion Present.
Prostate size 37gm
Stage T1c
Oncotype Dx Genomic Prostate Score - 10/19/17 - GPS 22 (Low Risk), Prostate Cancer Death within 10 years <1%, Meatastasis within 10 years 1%, Adverse Pathology (Gleason=>4+3 and/or pT3+) 22%
MRI scheduled - 12/15/2017
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Wow 32 cores. I hope they put you to sleep for this? I will request to be knocked out.
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Born 1981
1.6 PSA on 7/1/16
1.91 PSA. .59 PSA Free 27.7% PSA Free % on 12/19/16
1.98 PSA on 3/9/17
4.9 PSA on 9/11/17
TRUS Biopsy on 10/4/17. Negative for malignancy in all 12 cores.
3T mpMRI on 12/18/17. PIRADS 3 lesion in the right posterolateral peripheral zone.
Fusion Biopsy 2/19/2018. Right lateral base contains Atypical small acinar proliferation.
3.8 PSA .48 PSA Free 12.6% PSA Free % 4/12/18
2.0 PSA 9/12/18
3T mpMRI 01/11/19. Same as last time PIRADS 3 lesion in the right posterolateral peripheral zone. Similar size.
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Originally Posted by cdtechman
Wow 32 cores. I hope they put you to sleep for this? I will request to be knocked out.
Asleep,,,nope,,,,counted every core sample taken until I lost track somewhere around 24! Only had two cores taken near the base that really got my attention. They felt slightly worse than pain from numbing shots. Other than those two, the remainder of cores taken I only felt pressure and maybe a slight sting on a few.
DOB - 07/05/1949 Age-68
PCa Family History - Father, Paternal Uncle (Both died from cardiac issues)
PSA- 1997-2013 Gradually increasing from 1.4 - 3.2,
PSA 2014 3.5
PSA 2015 4.7
PSA 06/08/2017 8.8
PSA 07/19/2017 9.88 DRE-smooth, normal
Biopsy - 08/15/2017
Biopsy results:
9 of 12 cores positive - Gleason 6 - Percent Tumor Involvement 10-95%
Left mid Prostate - Adenocarcinoma of prostate. Gleason Score 3+3=6. Involving 10-95% of the length of 5 cores.
Right mid Prostate - Adenocarcinoma of prostate. Gleason Score 3+3=6. Involving 25-80% of the length of 4 cores. Perineural Invasion Present.
Prostate size 37gm
Stage T1c
Oncotype Dx Genomic Prostate Score - 10/19/17 - GPS 22 (Low Risk), Prostate Cancer Death within 10 years <1%, Meatastasis within 10 years 1%, Adverse Pathology (Gleason=>4+3 and/or pT3+) 22%
MRI scheduled - 12/15/2017
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Originally Posted by cdtechman
... Anyone had experience with MRI biopsy?
Yes, my second biopsy was an MRI guided biopsy. It was much more uncomfortable than my first. But that was because of the location of the tumor imaged. The doctor had to get the "gadget" where it needed to be to properly hit the mark. Overall they did 12 cores, with three of them exactly where they needed to be. When I went back to my urologist after that procedure, with a smirk he asked how the biopsy went. When I told him it was rather uncomfortable he said he figured it would be. I think they know if it'll be more uncomfortable or not by the images. I'm not sure I'd want to know in advance or not.
I have no doubt a second "blind biopsy" would have turned up negative again. So kudos to you for getting the imaging done.
PSA 12/12 3.74
PSA 3/14 3.2 DRE neg
PSA 9/14 2.68 DRE neg
PSA 12/15 3.92 DRE neg
Biopsy 2/16 negative
PSA 3/17 7.5 DRE neg
3T MRI 4/17
PSA 5/17 5.9
Fusion Biopsy 5/17
Positive PCa 6/5/17, Diagnosed @ 56
T1c N0 M0
Left Lateral Base, 4+3
Left Lateral Mid, 3+3
MR Lesion 3+4, PI present
RALP performed 8/30/17
Gleason re-graded to 3+4, pT2c pN0
Margin focally involved by one tumor over a length of <.1 cm at left posterior superior margin
PCa found in right mid as well (surprise to Surgeon & Uro)
Cath for 2 weeks, dry since removal
Post op PSA; 3mo <.04, 6mo <.04, 9mo <.04, 12mo <.04
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