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Thread: 3t MRI test results back tomorrow

  1. #21
    Quote Originally Posted by IceStationZebra View Post
    Thanks for the reply. Maybe it wasn¬’t clear in my post because I replaced the original with the results of my MRI so if you read the op it¬’ll have the details from the report.

    But they did the MRI and found a 5mm module or thing in my right side. Fully encapsulated in the prostate so the fusion MRI biopsy is next. I had a clean 12 core random biopsy in March of last year.

    I want to say that others here have said to get the results reviewed ¬— whether it comes back as cancer or cancer free. As a second set of eyes.

    Just trying to be prepared. I¬’m one of those worrier types and I need to know and have a plan for the what if¬’s. Docs talk so fast and I think my doctor is in the ¬“let¬’s just wait and see what the biopsy shows¬” camp. However, if I¬’m going to ask for a second opinion they probably need to know that up front.

    My wife had some suspicious blood work when pregnant and they didn¬’t save the sample for further testing to see what subset it was. So I¬’m just trying to be prepared.

    Ugggh frustrating, everyone seems to be in island time mode. I want this thing identified and if cancer out by Wednesday! ��
    One of the main reasons for seeking a 2nd opinion is when there is either uncertainty whether the G6 cancer identified is really a G6; or how much pattern 4 there is if the results come back G7(3+4). These questions arise when deciding if you are a good candidate for AS. I don't know if anyone who has gotten a negative biopsy (i.e., not even G6) has sent the same slides for a 2nd opinion.

    What is more common is that a biopsy might be repeated after a sometimes short period when cancer is strongly suspected and it is thought that lesions were missed by the biopsy. Repeat biopsies over time are a very good way of reducing the chances of missing cancer (which is very possible with a single biopsy). The chances of missing cancer go down considerably with each repeat.
    Last edited by DjinTonic; 01-14-2019 at 03:01 AM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. biopsies, PCA3 -
    2013 TURP (90→30 g) path neg, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: negative

    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 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 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018
    09-26-18 (13 m) 0.013 checking rise
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015

  2. #22
    Quote Originally Posted by DjinTonic View Post
    One of the main reasons for seeking a 2nd opinion is when there is either uncertainty whether the G6 cancer identified is really a G6; or how much G7 there is if the results come back G7(3+4). These questions arise when deciding if you are a good candidate for AS. I don't know if anyone who has gotten a negative biopsy (i.e., not even G6) has sent the same slides for a 2nd opinion.

    What is more common is that a biopsy might be repeated after a sometimes short period when cancer is strongly suspected and it is thought that lesions were missed by the biopsy. Repeat biopsies over time are a very good way of reducing the chances of missing cancer (which is very possible with a single biopsy). The chances of missing cancer go down considerably with each repeat.
    Thanks for the info very helpful.

    My sincere hope is that they use the one needle from the fusion biopsy to hit that one area identified on the mri well. Get several samples so we can be absolutely sure the general area involving that lesion/whatever it is is saturated samples. I donít want them sampling the right side if the cancer is on the left or vice versa.

    Maybe I misunderstood about the negative going for a second opinion.

    Youíve been very helpful, thank you for taking time to help me out. This is a great community.

  3. #23
    Quote Originally Posted by IceStationZebra View Post
    Thanks for the info very helpful.

    My sincere hope is that they use the one needle from the fusion biopsy to hit that one area identified on the mri well. Get several samples so we can be absolutely sure the general area involving that lesion/whatever it is is saturated samples. I don’t want them sampling the right side if the cancer is on the left or vice versa.

    Maybe I misunderstood about the negative going for a second opinion.

    You’ve been very helpful, thank you for taking time to help me out. This is a great community.
    I would trust the doc doing the biopsy. As long as you getting the procedure, it usually makes sense to take samples from all the zones of the prostate in addition to any suspicious areas revealed by the MRI. Very small lesions often don't show up on an MRI. You really do want to know the worst thing going on in your prostate, and that sometimes depends on plain luck. As they say, In for a penny...

  4. #24
    Top User
    Join Date
    Aug 2016
    Posts
    1,536
    Propagate cancer is multifocal. Meaning, as a condition, it is not one tumor. It is a condition where multiple cells in multiple places begin to regenerate themselves into cancer cells. It is more a condition of the prostate than one tumor needing to be found and treated.

    An MRI targeted biopsy will target the suspicious area, and also sample an array of the whole prostate. Depending on the size of your prostate, the biopsy may miss detecting cancer in 50 to 75% of peocedures.

    At this point, you want to find the cancer. If it misses it you are left incomplete and may have to wait and perform additional biopsies until you find it.

    You want to consider this is something you want to find and treat it is there. Wishing or missing it away will fail you as a strategy.

  5. #25
    "My sincere hope is that they use the one needle from the fusion biopsy to hit that one area identified on the mri well. Get several samples so we can be absolutely sure the general area involving that lesion/whatever it is is saturated samples. I donít want them sampling the right side if the cancer is on the left or vice versa."

    The MRI, even a 3T mpMRI with contrast can miss a lot and can provide misleading information where it does show something. That is why you want lots of biopsy samples from many different areas.

    My PIRADS 3 MRI understated the tumor size by a factor of 20 ( reported 0.32cc but was actually 7.0cc), understated the Prostate size by a factor of 2 (MRI=18cc but surgical pathology found 37cc), and reported a single lobe tumor while surgical pathology found cancer cells in both lobes.

    Additionally, the MRI reported NO extracapsular extension but surgical pathology found G6 cancer cells outside the prostate capsule.

    The single most important thing I have learned about PCa diagnosis and treatment during the last seven months is how ambiguous, non-specific, and mis-leading is all the data, all the tests, and all the assumptions. At this point in my PCa journey the only thing I really trust is the surgical pathology report and the post-RALP PSA tests.

    Keep an open mind about everything you are told or read and consider all your information with a healthy skepticism.
    DOB: July 1947
    PSA: 2.0/2004 4.0/2010 5.8/2010 4.5/2012 5.6/2013 ALL Normal DRE
    5/18 PSA: 9.2
    6/18 PSA: 10.2 & 8.4% Free
    6/28 3T mpMRI PIRADS 3
    18 cc gland=PSD 0.57 ng/cc
    0.32 cc lesion in apical PZ with subtle T2 signal hypointensity
    mild restricted diffusion of contrast into lesion prostate unremarkable intact capsule
    7/18 4KScore 34% Probability Gleason =>7

    8/03/18 Bx: Adenocarcinoma 6 of 13 cores ONLY L lobe
    T1c / Grade II / unfavorable intermediate
    extent of G3-G4 tissue far greater than indicated by MRI
    G6 (3+3) 70% LL Base 50% L Lateral Mid 20% L Base
    G7 (3 +4) 100% LL Apex 20% L Mid 60% L Apex
    8/15/18 Clear CT scan and Bone Scan
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported

    PSA Post Surgery
    10/3/18 0.021
    01/4/19 0.018
    04/03/19 0.022
    06/26/19 0.028

  6. #26
    Quote Originally Posted by OldTiredSailor View Post
    "My sincere hope is that they use the one needle from the fusion biopsy to hit that one area identified on the mri well. Get several samples so we can be absolutely sure the general area involving that lesion/whatever it is is saturated samples. I donít want them sampling the right side if the cancer is on the left or vice versa."

    The MRI, even a 3T mpMRI with contrast can miss a lot and can provide misleading information where it does show something. That is why you want lots of biopsy samples from many different areas.

    My PIRADS 3 MRI understated the tumor size by a factor of 20 ( reported 0.32cc but was actually 7.0cc), understated the Prostate size by a factor of 2 (MRI=18cc but surgical pathology found 37cc), and reported a single lobe tumor while surgical pathology found cancer cells in both lobes.

    Additionally, the MRI reported NO extracapsular extension but surgical pathology found G6 cancer cells outside the prostate capsule.

    The single most important thing I have learned about PCa diagnosis and treatment during the last seven months is how ambiguous, non-specific, and mis-leading is all the data, all the tests, and all the assumptions. At this point in my PCa journey the only thing I really trust is the surgical pathology report and the post-RALP PSA tests.

    Keep an open mind about everything you are told or read and consider all your information with a healthy skepticism.
    Said tongue in cheek.... well ainít this a ray of sunshine? 😀

    I think Iíll just have everything below my belly button amputated as a precaution! 😀. If these tests are this wrong how is it that weíre not all dropping dead from everything they missed?

    I feel like prostate cancer care is a government operation....weíre not sure of what weíre unsure of it but make no mistake....weíre certain weíre not sure if it. 😀

    So I guess in your case the biopsy resulting from the MRI found cancer and you had the prostate removed which verified how wrong the MRI was?
    2006: 1.6 PSA age 36
    2007: 1.3 PSA age 37
    2012: 2.2 PSA age 42
    2013: 2.6 PSA age 43
    2014: 2.8 PSA age 44
    2015: 3.1 PSA age 45
    2016: 3.5 PSA age 46
    2017: ? N/A
    3/18Ė 4.1 PSA at 48 YO. u/s measured 46 ml prostate
    3/18Ėfree PSA 10%
    3/18Ė12 core all negative
    9/18Ė 4.5 PSA
    9/18Ė negative pca3
    12/18- 4K at 17%
    12/18- 3t MRI, 5mm pirads 3-4 and a pirads 1-2
    2/19- Fusion biopsy. G6 (3+3) 20% of a single core
    AS for now
    4/19-PSA at 7.21 (up from 4.5 in September 2018! Gulp

  7. #27
    Quote Originally Posted by Another View Post
    Propagate cancer is multifocal. Meaning, as a condition, it is not one tumor. It is a condition where multiple cells in multiple places begin to regenerate themselves into cancer cells. It is more a condition of the prostate than one tumor needing to be found and treated.

    An MRI targeted biopsy will target the suspicious area, and also sample an array of the whole prostate. Depending on the size of your prostate, the biopsy may miss detecting cancer in 50 to 75% of peocedures.

    At this point, you want to find the cancer. If it misses it you are left incomplete and may have to wait and perform additional biopsies until you find it.

    You want to consider this is something you want to find and treat it is there. Wishing or missing it away will fail you as a strategy.
    So what is the solution?

    Iíve had the 12 core random and it was clean. The MRI which will only show clinically significant ďthingsĒ showed a ďsomethingĒ. My takeaway from the good doc was that we will biopsy it and if itís cancer, get rid of it with HIFU. Sounded like a wham bam thank you maíam type operation and Iíd be back to life.

    So if the MRI fusion biopsy shows the lesion isnít cancer thatís good but not an indication that itís not elsewhere undetected.

    Why donít we just rip the freaking things out at the first worry to be sure? Because it sure as heck doesnít seem like we can visualize it, or find it with specificity or eliminate it with any certainty. Sorry each time I get my mind wrapped around a treatment / diagnosis plan someone comes along and tells me what that plan is totally useless. Donít get me wrong, thank you for the information it is GREATLY appreciated.. Iím just a worrier type and I find comfort in knowing the plan, the what ifís for each potential outcome and this just seems like trying to guess at an answer. There really are no answers, short of ripping it out and doing pathology...is there?

    Thereís no rest in a negative result. Thereís no rest in a positive result (because the grade could be wrong or the reallt worrisome cancer could have been totally missed). Thereís no rest or definitive answers in anything short of just taking it out.

    I swear itís like Freddie Krueger and Jason both teamed up and are stalking us. We just canít get away from it no matter what we do.
    Last edited by IceStationZebra; 01-14-2019 at 05:22 PM.

  8. #28
    Top User garyi's Avatar
    Join Date
    Apr 2017
    Posts
    1,229
    Your high level of angst and worry will not IMHO serve you well, ISZ.

    Your confusion and anger is understandable. Prostate cancer is a maddening disease. Most of us and the 200,000 men diagnosed with it very year go through similar emotions. It’s important to harness that energy and better evaluate your options.

    You are demanding nonexistent absolute answers for treating this maddening disease. Keep digging and your path and understanding will become much clearer.

    Best of luck on your journey.
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19
    We'll see....what is not known dwarfs what is thought to be fact

  9. #29
    Quote Originally Posted by IceStationZebra View Post
    Said tongue in cheek.... well ain’t this a ray of sunshine? ��

    I think I’ll just have everything below my belly button amputated as a precaution! ��. If these tests are this wrong how is it that we’re not all dropping dead from everything they missed?

    I feel like prostate cancer care is a government operation....we’re not sure of what we’re unsure of it but make no mistake....we’re certain we’re not sure if it. ��

    So I guess in your case the biopsy resulting from the MRI found cancer and you had the prostate removed which verified how wrong the MRI was?
    I can understand and appreciate your concern and distress. I spent most of June, July, and August in that mental state! I was angry and frustrated. I trained as a scientist and statistician, computers and precision measurements/data was my life. Then I fell into the PCa quagmire where the more I learned, the more tests I had (PSAx2, Free PSA, 4KScore, DREx3,MRI,12-core biopsy, CT scan, bone scan), the less certain I was about anything.

    In my case the 3T mpMRI DID NOT confirm the presence of PCa.

    A PIRADS 3 area of abnormal tissue (my Medical Oncologist/Urologist was quite adamant that it could not be called a tumor and certainly could not be called cancer) is defined as:

    - "intermediate (the presence of clinically significant cancer is equivocal)"
    - "Of 127 men with at least one P3 lesion, 29 (22.8%) had csPCa on the biopsy of P3 lesions. "

    That last quote said to me that over 77% of men with a PIRADS 3 lesion DID NOT have a clinically significant PCa.

    The deciding factor for me was the PSA score of 10.2 coming from what was erroneously measured as small prostate by DRE, and 18cc by MRI and TRUS biopsy. And the tiny little 0.32cc lesion or area of abnormal tissue in the MRI could not account for a PSA score > 10. As my very experienced MO said "there is WAY too much PSA present to be accounted for by what the measurements are telling us!"

    Despite all the scientific knowledge and magical technology the decision really came down to trusting the the clinical experience and subjective feelings of my MO who had been diagnosing PCa for over 25-years. He "KNEW" there was more going on with my prostate than the objective measures were showing us. I agreed with that reasoning and went for the 100% CERTAINTY of a prostatectomy.

    I was very fortunate to choose, with no good data to go on, an MO/URO who despite being plain spoken, aggressive, and a little curt, I trusted and was able to listen to with my heart. If he knew something - I believed it.

    My anger, frustration, confusion greatly diminished once I decided on the course of treatment. And, after the surgical pathology report was evaluated I again found peace and stability in my life.

    Diagnosis and decision making in the PCa world is difficult and a mental challenge. Eventually it gets easier to accept and move on.
    Last edited by OldTiredSailor; 01-14-2019 at 07:15 PM.
    DOB: July 1947
    PSA: 2.0/2004 4.0/2010 5.8/2010 4.5/2012 5.6/2013 ALL Normal DRE
    5/18 PSA: 9.2
    6/18 PSA: 10.2 & 8.4% Free
    6/28 3T mpMRI PIRADS 3
    18 cc gland=PSD 0.57 ng/cc
    0.32 cc lesion in apical PZ with subtle T2 signal hypointensity
    mild restricted diffusion of contrast into lesion prostate unremarkable intact capsule
    7/18 4KScore 34% Probability Gleason =>7

    8/03/18 Bx: Adenocarcinoma 6 of 13 cores ONLY L lobe
    T1c / Grade II / unfavorable intermediate
    extent of G3-G4 tissue far greater than indicated by MRI
    G6 (3+3) 70% LL Base 50% L Lateral Mid 20% L Base
    G7 (3 +4) 100% LL Apex 20% L Mid 60% L Apex
    8/15/18 Clear CT scan and Bone Scan
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported

    PSA Post Surgery
    10/3/18 0.021
    01/4/19 0.018
    04/03/19 0.022
    06/26/19 0.028

  10. #30
    Quote Originally Posted by OldTiredSailor View Post
    I can understand and appreciate your concern and distress. I spent most of June, July, and August in that mental state! I was angry and frustrated. I trained as a scientist and statistician, computers and precision measurements/data was my life. Then I fell into the PCa quagmire where the more I learned, the more tests I had (PSAx2, Free PSA, 4KScore, DREx3,MRI,12-core biopsy, CT scan, bone scan), the less certain I was about anything.

    In my case the 3T mpMRI DID NOT confirm the presence of PCa.

    A PIRADS 3 area of abnormal tissue (my Medical Oncologist/Urologist was quite adamant that it could not be called a tumor and certainly could not be called cancer) is defined as:
    - "intermediate (the presence of clinically significant cancer is equivocal)"
    - "Of 127 men with at least one P3 lesion, 29 (22.8%) had csPCa on the biopsy of P3 lesions. "

    That last quote said to me that over 77% of men with a PIRADS 3 lesion DID NOT have a clinically significant PCa.

    The deciding factor for me was the PSA score of 10.2 coming from what was erroneously measured as small prostate by DRE, and 18cc by MRI and TRUS biopsy. And the tiny little 0.32cc lesion or area of abnormal tissue in the MRI could not account for a PSA score > 10. As my very experienced MO said "there is WAY too much PSA present to be accounted for by what the measurements are telling us!"

    I agreed with that reasoning and went for the 100% CERTAINTY of a prostatectomy.

    My anger, frustration, confusion greatly diminished once I decided on the course of treatment. And, after the surgical pathology report was evaluated I again found peace and stability in my life.

    Diagnosis and decision making in the PCa world is difficult and a mental challenge. Eventually it gets easier to accept and move on.
    Well my situation is nearly the opposite. I have what appears to be a significantly large prostate of 46-47ml thatís pushing a PSA of 4.5 at last measurement.

    Iíd just like an answer. I hope this lesion or too-mah or whatever it is isnít cancer. But if it is Iíll deal with it. If itís not Iíll deal with it.

    I fully expect an answer if ďI dunnoĒ. 😀

    Best of luck to you. If you donít mind sharing how has your recovery been since the surgery? Are you 100% back?

 

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