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Thread: MRI Results

  1. #11
    Quote Originally Posted by Another View Post
    The additional tests are consistent with qualifying the AS, but volume alone disqualifies it.

    An effective method of sharing is to say what you are going to say, say it, and then say what you said.

    So for the doctors part in answer to the question do I have treatable prostate cancer? The answer is yes, yes, and yes at each level of testing.

    Men go through much more to have the good fortune of finding want he found soon enough to have a high probability of successful treatment.

    He's fortunate, at the moment. His age indicates it will not remain this way.
    The reason for the additional tests is that the patient has not disqualified AS. My hunch is, since the genomics test was favorable, only a G7 biopsy core might persuade him to treat.

    Djin

  2. #12
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    Quote Originally Posted by DjinTonic View Post
    The reason for the additional tests is that the patient has not disqualified AS. My hunch is, since the genomics test was favorable, only a G7 biopsy core might persuade him to treat.

    Djin
    One can argue that a small amounnt of G4 is tolerable especially if the patient is self directing his health care and willing to assume the risk. He may be a candidate for Finasteride to hold the G6 at bay for a while. If he has the commitment to stay on the hunt with multible biopsies.

    His PSA is tracking on a solid rising trend and he is young. We return to the choice of having the good fortune of early detection and available treatment. It is his choice to squander and risk. The issue with such an important choice is it is done without experience. It is a one and only opportunity. The temptation is to rely on the technology and not include the risk in the decision matrix. We have the experience. He does not. In hindsight, I would have acted sooner.
    Last edited by Another; 11-12-2019 at 09:46 PM.
    Born 1953
    family w/PCa; grandfather, 3 brothers
    07-12-04 PSA 1.90
    07-10-06 PSA 2.02
    08-30-07 PSA 3.20
    12-01-11 PSA 5.69 Internist recommends urologist, I say no
    05-16-12 PSA 4.76 manipulate w/diet & supplements
    12-11-12 PSA 5.20, Health system changes to 3 years on testing
    03-07-16 PSA 7.20 Internist adamant on urologist
    DRE smooth, enlarged
    03-14-16 TRUS biopsy-prostatic adenocarcinoma 1%-60% across 8 of 12 samples, Gleason 3+3=6
    03-31-16 MRI pelvis w/o dye
    05-04-16 DaVinci prostatectomy, nerve sparing, Dr. Kent Adkins - recommend
    Final Path; weight 65g, lymph nodes, seminal vesicles, capsule, margin all negative, Gleason 3+4=7, Tumor volume 35%, +pT2c
    Catheter out - 16 days
    Incontinence at 6mos is minimal Ė no pad
    Cialis 3x/wk & Viagra on occasion
    Begin self-injection needle therapy for erections, stop after 6 due to onset of Peyronieís
    Erections 100% - 14 months
    5-21-19 PSA <0.02, Zero Club 3.5 years

  3. #13
    Top User garyi's Avatar
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    Quote Originally Posted by Another View Post
    ...The issue with such an important choice is it is done without experience. It is a one and only opportunity. The temptation is to rely on the technology and not include the risk in the decision matrix. We have the experience. He does not.
    Excellent observations, Another!
    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, .081 9/19, .116 11/19
    We'll see....what is not known dwarfs what is thought to be fact

  4. #14
    Experienced User
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    The Dr at Vanderbilt said since all TRUS biopsy were G6 my husband could do AS or surgery. The Dr ordered the Genomics test to make sure the G6 that was found wouldn’t turn aggressive. The MRI & Biopsy wasn’t scheduled till February of next year. But I couldn’t see waiting to have the MRI done since we really didn’t know if they had missed a higher grade Gleason so I talked my husband into seeing if we could ahead now with MRI & Biopsy since we had met total out of pocket for the year. My husband doesn’t want to do surgery but once we get the Artemis biopsy done.I’m hoping he’ll go ahead and get it removed. I appreciate all your comments and I’m praying my husband will see it’s better to take care of this now rather than later.

    Thanks
    Murphy
    Husband 56 DX PC 8/14/19 All DREís normal - prostate 34 cc
    2018 K4 -8% 7/10/19 Free PSA


    PSA
    1/11/16 -2.6
    2/27/17 -3.4
    6/12/18 -4.1
    1/10/19 -4.53
    7/10/19 -5.24

    12 core biopsy 8/8/19
    5 cores positive

    Diagnosis: Adenocarcinoma , G6 ( grade group1) with perineurial invasion

    Left Base 1core 80% involvement (14mm) G6
    Left Mid 1 core 90% involvement (15mm) G6
    Left Apex 2 cores 10% (2mm), <5%(0.5mm) G6
    Right Mid 1 core <5% ( <0.5mm) G6

    9/24/19 Oncotype DX Genomic Score 17

    MRI 11/9/19 3 lesions Bi- Rads 3

    Artemis Biopsy 11/20/19 18 cores / 10 positive cores

    Left Mid - 2 core 20% , 5% Gleason 6
    Left Base - 2 cores 70%, 5 %
    Left Apex - 1 core 5%
    Right Apex - 1 core 30%
    Right Mid - 1 core 10% 3+4 = Gleason 7 with cribriform pattern 45 %
    Left base Peripheral Zone - 2 cores 20%,10% Gleason 6
    Right Mid Peripheral Zone - 1 core 5% Gleason 6

  5. #15
    Experienced User
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    Quote Originally Posted by murphy749 View Post
    The Dr at Vanderbilt said since all TRUS biopsy were G6 my husband could do AS or surgery. The Dr ordered the Genomics test to make sure the G6 that was found wouldnít turn aggressive. The MRI & Biopsy wasnít scheduled till February of next year. But I couldnít see waiting to have the MRI done since we really didnít know if they had missed a higher grade Gleason so I talked my husband into seeing if we could ahead now with MRI & Biopsy since we had met total out of pocket for the year. My husband doesnít want to do surgery but once we get the Artemis biopsy done.Iím hoping heíll go ahead and get it removed. I appreciate all your comments and Iím praying my husband will see itís better to take care of this now rather than later.

    Thanks
    Murphy
    We are very much in the exact same boat except we havenít had MRI yet.
    Wife posting
    Age 51
    PSA 9/2019 - 4.8
    fPSA - 9%
    4K score 12%
    Bx 9/2019
    Final Diagnosis - prostate carcinoma
    Highest Gleason Score - 3+3=6
    Number of cores positive - 4
    Percent of cores positive - 28.6% (4 of 14 cores - 12 samples taken. 2 broke in half)
    Maximum % of tumor in positive cores - 60%
    Overall prostatic tissue involvement - 5.8%
    Perineural invasion - present
    Lymph-vascular invasion - not identified
    Periprostatic fat invasion/extrsprostatic extension - not identified

    Left base - G3+3=6. 4% involved. Perineural invasion present.
    Right apex - G3+3=6. 40% involved.
    Right lateral mid - G3+3=6. 5% involved.
    Left lateral apex - G3+3=6. 40% involved.

    OncoDX score 23. Low Risk.
    High Grade Disease 14%
    Non Organ Confined Disease 16%

  6. #16
    Quote Originally Posted by murphy749 View Post
    The Dr at Vanderbilt said since all TRUS biopsy were G6 my husband could do AS or surgery.
    Sounds like a plan. So if the biopsy gets upgraded, he'll get the surgery.

    Since I was diagnosed in January 2014, they've seem to have relaxed the criteria where doctors are comfortable with AS.

    Your husband does seem to have a pretty high volume of cancer for AS, however.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  7. #17
    Experienced User
    Join Date
    Jun 2012
    Posts
    81
    We are definitely in the same boat. Do you know when your husband will be getting the MRI? Is your husband not wanting to do surgery also? I think my husband just wants to be sure the surgery is definitely necessary before going through such delicate surgery. I’ll pray everything goes good for your husband, and when your husband gets his MRI that it’s really good news.

    Thanks
    Murphy
    Husband 56 DX PC 8/14/19 All DREís normal - prostate 34 cc
    2018 K4 -8% 7/10/19 Free PSA


    PSA
    1/11/16 -2.6
    2/27/17 -3.4
    6/12/18 -4.1
    1/10/19 -4.53
    7/10/19 -5.24

    12 core biopsy 8/8/19
    5 cores positive

    Diagnosis: Adenocarcinoma , G6 ( grade group1) with perineurial invasion

    Left Base 1core 80% involvement (14mm) G6
    Left Mid 1 core 90% involvement (15mm) G6
    Left Apex 2 cores 10% (2mm), <5%(0.5mm) G6
    Right Mid 1 core <5% ( <0.5mm) G6

    9/24/19 Oncotype DX Genomic Score 17

    MRI 11/9/19 3 lesions Bi- Rads 3

    Artemis Biopsy 11/20/19 18 cores / 10 positive cores

    Left Mid - 2 core 20% , 5% Gleason 6
    Left Base - 2 cores 70%, 5 %
    Left Apex - 1 core 5%
    Right Apex - 1 core 30%
    Right Mid - 1 core 10% 3+4 = Gleason 7 with cribriform pattern 45 %
    Left base Peripheral Zone - 2 cores 20%,10% Gleason 6
    Right Mid Peripheral Zone - 1 core 5% Gleason 6

  8. #18
    Experienced User
    Join Date
    Jun 2012
    Posts
    81
    That’s the plan if the new biopsy comes back higher grade we’ll be scheduling surgery. I’m still wanting it removed even if it’s still all G6 because their just so much of it. I can’t see waiting & watching.

    To me it’s a ticking time bomb. It’s not like the cancer is just going to disappear.

    Thanks
    Murphy
    Husband 56 DX PC 8/14/19 All DREís normal - prostate 34 cc
    2018 K4 -8% 7/10/19 Free PSA


    PSA
    1/11/16 -2.6
    2/27/17 -3.4
    6/12/18 -4.1
    1/10/19 -4.53
    7/10/19 -5.24

    12 core biopsy 8/8/19
    5 cores positive

    Diagnosis: Adenocarcinoma , G6 ( grade group1) with perineurial invasion

    Left Base 1core 80% involvement (14mm) G6
    Left Mid 1 core 90% involvement (15mm) G6
    Left Apex 2 cores 10% (2mm), <5%(0.5mm) G6
    Right Mid 1 core <5% ( <0.5mm) G6

    9/24/19 Oncotype DX Genomic Score 17

    MRI 11/9/19 3 lesions Bi- Rads 3

    Artemis Biopsy 11/20/19 18 cores / 10 positive cores

    Left Mid - 2 core 20% , 5% Gleason 6
    Left Base - 2 cores 70%, 5 %
    Left Apex - 1 core 5%
    Right Apex - 1 core 30%
    Right Mid - 1 core 10% 3+4 = Gleason 7 with cribriform pattern 45 %
    Left base Peripheral Zone - 2 cores 20%,10% Gleason 6
    Right Mid Peripheral Zone - 1 core 5% Gleason 6

  9. #19
    Experienced User
    Join Date
    Oct 2019
    Posts
    81
    Quote Originally Posted by murphy749 View Post
    We are definitely in the same boat. Do you know when your husband will be getting the MRI? Is your husband not wanting to do surgery also? I think my husband just wants to be sure the surgery is definitely necessary before going through such delicate surgery. I’ll pray everything goes good for your husband, and when your husband gets his MRI that it’s really good news.

    Thanks
    Murphy
    We don’t have it scheduled yet. We see his uro the day before thanksgiving and will ask him to order it. He originally said he’d do it in like 6 months but we said we’d rather do it before the end of the year since we’ve met his deductible. Then we found out about this program through his insurance with MDA that if we go there, everything is covered at 100%. No copays, no deductibles, no out of pocket to us ever. We scheduled a consult with them for Dec. 16th. We talked to them about just doing the MRI there which they were fine with but then they scheduled it for the 19th. 4 days after our consult. That would mean us just sitting in Houston for 4 days just to have the MRI. So I called the uro’s office and talked to them about it. Made sure the MRI they would do is the same kind MDA would do and that they could get it scheduled before our visit to MDA. The answers were yes. So the plan is to have it sometime after the 27th of this month but before our visit to MDA on dec 16th.

    My husband wants to do AS if at all possible. But he’s pretty much resigned himself to surgery if they find anything more than the 6. Everything so far has been encouraging but for ME with it being found in all 4 quadrants and one location being in the right base and having perineural invasion, I won’t be comfortable until after we have the MRI and another biopsy.

    I detest all this waiting!
    Wife posting
    Age 51
    PSA 9/2019 - 4.8
    fPSA - 9%
    4K score 12%
    Bx 9/2019
    Final Diagnosis - prostate carcinoma
    Highest Gleason Score - 3+3=6
    Number of cores positive - 4
    Percent of cores positive - 28.6% (4 of 14 cores - 12 samples taken. 2 broke in half)
    Maximum % of tumor in positive cores - 60%
    Overall prostatic tissue involvement - 5.8%
    Perineural invasion - present
    Lymph-vascular invasion - not identified
    Periprostatic fat invasion/extrsprostatic extension - not identified

    Left base - G3+3=6. 4% involved. Perineural invasion present.
    Right apex - G3+3=6. 40% involved.
    Right lateral mid - G3+3=6. 5% involved.
    Left lateral apex - G3+3=6. 40% involved.

    OncoDX score 23. Low Risk.
    High Grade Disease 14%
    Non Organ Confined Disease 16%

  10. #20
    Star, I have been trekking in the jungles of Suriname and French Guiana, and havenít had the Internet access to read what advice you have received on the many other forums we both frequent.

    However, I do see here that you are choosing between AS and RP. Perhaps you have already seen this new video from medical oncologist Mark Scholz. If not, it is being widely circulated, and it is, IMHO, essential to your decision.

    https://m.youtube.com/watch?v=Pya8N78bR7s
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

 

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