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Fusion Biopsy Yesterday-waiting.....

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Posted 7/26/2016 5:54 PM (GMT 0)
I have posted a couple times on behalf of my Dad within the past several weeks. I'm the "concerned daughter" who has been educating myself since my Dad's rapid rise in PSA from last year (3.5 - 6.9) in June.

My Dad has been monitoring his PSA for the past 10 years when it began to go up. After 2 negative biopsies 7 years ago and again 4 years ago, he was diagnosed with BPH and been on Finastaride ever since. (My Dad is 71 years young.)

Dad's most recent PSA rise to 6.9 prompted his Dr. to do an MRI since he said that the PSA shouldn't go up while on Finastaride. Then, he said that you can actually consider the number doubled since the RX reduces PSA by half...so his PSA is closer to 14.

The MRI showed a 1cm "area of slight concern" as the Dr. Quoted, so he was scheduled for the Fusion Biopsy yesterday. According to the Dr. the area of "concern" was contained within the prostate and they gave it a score of 1-3.

Of course reading everything, I am really concerned and the waiting is really the hard part, as everyone on this board can identify...The path report will take 4-6 days for the results.

Has anyone read anything relative to being on Finastaride and the DX of PC? I've heard it can mask symptoms for a while.....

Also, can it be assumed that since the MRI showed the 1cm area contained within the prostate to be a good thing?

Any feedback and information would be appreciated. Thank you all SO much in advanced, for a worried daughter.

Mermaid wink
Posted 7/26/2016 9:04 PM (GMT 0)
What is concerning is any rise in PSA while on finasteride. Because it prevents the PSA arising from BPH, PSA should not go up while taking it. By shrinking the prostate, and by preventing or even reversing some low grade prostate cancer, finasteride may increase the probability of detecting any high grade prostate cancer that may be there. So, it can be thought of as an aid to detection.

I don't know what a "score of 1-3" means. PIRADS is the most widely used scoring system and ranges from 1 (not suspicious) to 5 (highly suspicious). Note- "suspicious" doesn't mean cancer.

A fully contained tumor (stage 2) is certainly a good thing. It means that any of a number of methods may provide a lasting cure.

If any cancer is detected, be sure to have the biopsy slides sent to Epstein or Bostwick for a second opinion.

- Allen
Posted 7/27/2016 12:53 AM (GMT 0)
Allen,

As always, your input and advice is much appreciated!

I should have specified that the score of 1-3 that the. Assigned was based on the PIRADS and he said according to that there was a 50/50 chance of finding cancer in the 1cm area.

I am assuming that IF there were areas outside the prostate, the MRI would have shown this?

As for the Finestaride - I've read some articles which indicated it can mask aggressive cancer symptoms until the disease has progressed. So that was the concern.

Thank you for the suggestion to have Epstein or Bostwick review the biopsy. Where would I find their contact information?

Again, thank you for your input!
M
Posted 7/27/2016 1:04 AM (GMT 0)
But what does 1-3 mean? PIRADS scores are 1, 2, 3, 4 or 5.

MRIs can detect larger, higher grade cancer.

I don't know what you read, but finasteride makes PSA a better diagnostic tool, not a worse one.

Try one of these:
pathology.jhu.edu/department/services/secondopinion.cfm
/www.bostwicklaboratories.com/Services/Consults-Second-Opinions.aspx

- Allen
Posted 7/27/2016 1:37 AM (GMT 0)
The Dr. said the "area" was something between a 1 and a 3 and therefore said that boiled down to a 50/50 chance the biopsy would be positive. Perhaps I misunderstood but I think those were his exact words.

Here is one of the many articles online which indicated the possible risks of taking Finasteride.

http://urology.jhu.edu/newsletter/2009/prostate_cancer_2009_10.php

Thank you for the links for Bostwick and Epstein.

-Missy
Posted 7/27/2016 2:27 AM (GMT 0)
I have no idea why Patrick Walsh said that in 2009 - there are no references, and possibly, he regrets his words now. Analysis of the PCPT showed that it does indeed reduce the risk of cancer by about 30%:

www.nejm.org/doi/full/10.1056/NEJMoa1215932
www.nejm.org/doi/full/10.1056/NEJMoa0908127
www.goldjournal.net/article/S0090-4295(08)01920-1/abstract

And it increases the ability to detect PC:
onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10373.x/full
www.jurology.com/article/S0022-5347(10)04547-7/abstract
jnci.oxfordjournals.org/content/98/16/1128.long


In PIRADS 2.0, each lesion is evaluated separately and given a score. The meaning of the scores are:
PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present)
PIRADS 2 – Low (clinically significant cancer is unlikely to be present)
PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)
PIRADS 4 – High (clinically significant cancer is likely to be present)
PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)

Lesions that are PIRADS 1 or 2 are almost never biopsied, and even a 3 is equivocal. Probably they would take an extra core there if biopsying anyway, or if there is some reason to be suspicious of undetected cancer.

- Allen
Posted 7/27/2016 2:56 PM (GMT 0)
sounds to me like the doc saw it as 3 or less... saw no need to educate the patient further...equivocal/50-50?
Posted 7/27/2016 3:06 PM (GMT 0)
Bolidat and Allen-

Thanks both. Yes, I confirm that is what the Doc saw. 3 or less. Won't have more info until the path report comes in,

Allen - most of what I read regarding the Finasteride did state an overall reduction in PC by 30% BUT most articles mentioned the risk of high risk/aggressive types of PC. This is the part which concerns me. But again, those studies may not be up to date. I'd certainly rather believe the optimistic input from you than the information about the high grade PC.

Thanks again,
M
Posted 7/27/2016 5:02 PM (GMT 0)
M,

There were a small number of studies five or six years ago that seemed to implicate 5-ARI drugs in increased incidence of aggressive prostate cancers. Further analysis has convinced most oncologists that this implication was false. There were no more cases of aggressive cancer in the treatment groups than the controls, the apparent extra cases were due to better detection of such cancers. The drugs shrink the prostate but don't shrink the aggressive tumors. This means that the tumors will make up a larger percentage of the smaller organ than they did of the bigger one and will be more likely to be hit by a biopsy sampling needle.
Posted 7/27/2016 5:13 PM (GMT 0)
Peter- Thank you for clarifying. That certainly makes a lot of sense. I will keep the thread posted with Dad's results. You all are really amazing! It's a wonderful support group. Thank you!!!
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