mpMRI gives unwelcome downgrade

Not the news you wanted! Bone scans rarely finds any mets when PSA is below 20 so you probably will have RT (w or w/o HT) or RP in your future aiming for cure. I was also a cT3 and had surgery as mono therapy.

If the Decipher suggests genetic inclination (let's say >0.62), Martinez wants HT, and depending on the implied inclination, how long of a course.

Debra Freeman suggested the bones scan (w/out any knowledge of the mpMRI findings). Her thought was to establish a base line so ,years from now, we could distinguish between a suspected met or, for example, an arthritic artifact.

oop ..that was sent by mistake..sorry

steveinErie said...
Despite two institutions assuring me to ignore the 'perineural invasion' comment on my biopsy, I took the advice of yet a third doctor and had an multiparametric MRI. Unfortunately, we find extracapsular invasion to the nv bundles, bilaterally. (no evidence of seminal vesicle involvement, no lymphadenopathy)

My stage is now 3Ta and a bone scan seems now to make sense. The Decipher results are pending, which will help with HT decisions.

Your mpMRI results sound just like mine. I had PNI on biopsy too, and bilateral nv bundle involvement per the MRI. What I've heard about MRI scans is their biggest limit is lack of sensitivity. So, it's likely to miss things, but if it sees them they are very likely there.

It didn't really make any difference in my RT planning volume. They designed it to hit a few millimeters outside the prostate. I believe they went +6mm except adjacent to the rectum, where it was +4mm. With the markers, the machine has that kind of accuracy, which is amazing. I actually took a picture of my planning volume, in case it's of interest. We included the pelvic lymph nodes, visible in that picture. They built that planning volume by integrating my CT scan and the mpMRI.

My PSA was 5.2 at diagnosis, but with my G9 they thought it important to do a bone scan. It did show two concern spots, but plain film x-rays showed them to be likely arthritic in origin, not concerning. So yep, that will also serve as a baseline should it become necessary to look again for bone issues.