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Posted 1/17/2017 2:23 AM (GMT 0)
Hello all,
I was recently diagnosed with a couple of tiny foci of G6 prostate cancer. My urologist thinks I'll need treatment sooner rather than later due to my PSA, PSA density, and abnormal DRE. A subsequent MRI was booked in error too soon after my biopsy but it did show a lesion in the transitional zone. I have an appointment with a radiation oncologist to discuss options and a follow up MRI will be done in a couple of months. Unfortunately, where I live in Canada, they don't have the software for fusion mri biopsy, so I suppose the next biopsy will either be saturation biopsy or "best guess" targeted biopsy.
Even though the amount of cancer found was tiny and G6, I think I would be disqualified from most AS protocols(?).. but for now, I'm on an informal AS program. Thanks in part to the wisdom and experience of the members of this site, I'm (mostly) comfortable with that for now.

I did wonder about the frequency of biopsies. How long should one wait to get a 2nd or 3rd biopsy and how effective are targeted biopsies without the benefit of MRI fusion? Would a saturation biopsy be a better option?
Posted 1/17/2017 4:49 AM (GMT 0)
Welcome to HW.

The DRE is concerning. It's likely best to hear what the RO has to say. You've got time to do your research and get more tests. Willing interesting to see if the lesion is still there or if it was an artifact of the biopsy.

Without a targeted biopsy, a saturation is likely the best. But if the doc has an MRI result with a target, you'd think that he be able to at least get close.

Can't comment on the time between biopsy, but I wouldn't think any sooner than a year. If you've got something on the MRI they can see and regular PSA tests, that should be enough to decide on when to start treatment. Radiation would be a good choice.

Hang in there and keep us updated on your progress,
Andrew
Posted 1/17/2017 6:12 PM (GMT 0)
Astronut, IMHO, you should have a 3T mp-MRI within six months, and follow that with a fusion biopsy.

I know that you may have to travel and pay out-of-pocket for that, but that is what almost all AS protocols at US institutions are doing for newly diagnosed men with G 3+3 who are considering AS.

Other questions: have you had an OncotypeDX or Prolaris genomics test on your biopsy slides? Have you had a PHI, 4K Score, or PCA 3 tests? Those can help predict the presence of more aggressive cancer cells.

Treatment leaves some (many?) men with lifelong side effects, so you need to be sure that you really need it. Traveling and paying out-of-pocket to best determine the risk of your PCa may be a good investment for you.
Posted 1/17/2017 7:13 PM (GMT 0)
Thanks for the feedback.

Asadvocate: No to all your questions but I'll ask about them and the 3T MRI at my next appointment.

The initial response of my wife is to get it out but we know that overdiagnosis and overtreatment are real concerns so I want to be as sure as I can be before proceeding to treatment.



As I've read before on this site, there seems to be nothing black and white about this disease. Thanks again for the advice.

Post Edited (Astronut) : 1/24/2017 9:36:16 AM (GMT-7)

Posted 1/17/2017 7:23 PM (GMT 0)
My experience here is that spouses, other family and well-meaning friends generally will tell you "just get it out." They want to be helpful, they want to be encouraging and--most of all--they want you to get better. Getting rid of the bad thing in your body seems like it should do just that.

But the truth is more complicated and throwing the baby out with bath water doesn't always make sense--particularly with G6 guys with a small amount of cancer. I think you have it 100% correct when you say there's nothing black-and-white with this disease.
Posted 1/17/2017 8:41 PM (GMT 0)
It is not uncommon for TZ tumors to cause PSA to increase. That's because of blockage causing urinary retention (a cause of elevated PSA), and not necessarily because of virulent PC. This may already be interfering with your peeing.

So far, you seem to be a good candidate for AS. On an AS program, the confirmation biopsy is usually done within a year. A saturation biopsy would be the gold standard, and is probably an excellent idea in your case, even better than a fusion biopsy.
Posted 2/17/2017 4:49 AM (GMT 0)
Hi Allen, why a saturation biopsy may be better than a fusion one in his case? I thought fusion biopsy can get to he point without unnecessary needles. I am new to this. Thanks.
Posted 2/17/2017 6:36 AM (GMT 0)
Once he is all numbed up, or put out, it won't matter to him if they take more cores. If he really wants a complete picture, a saturation biopsy (called a template mapping biopsy) - systematically taking cores throughout the prostate, including the TZ and anterior - will give him a full picture. If his high PSA is borderline for AS because BPH or low grade tumor is blocking the urethra, a saturation biopsy will give him the info he needs to make a confident decision about AS or treatment.

He's already had an mpMRI, which was done too soon after his biopsy, so I don't know that US fusion guidance would be useful anyway. An mpMRI only identifies area that are suspicious for higher grade cancer. I don't think that US fusion guidance or in-bore matters all that much (I've heard proponents of both).
Posted 2/17/2017 4:14 PM (GMT 0)
Unless my follow up MRI reveals something more suspicious than a PiRads 3 lesion, I agree that a saturation biopsy might be best.

So far, I have 2 G6 cores (one left apex and one right base) , a DRE that indicates left induration, and an MRI that showed a lesion on the right mid TZ zone. I have no symptoms (peeing seems normal), and BPH has been ruled out.

So the overall picture seems very unclear to me and I think a saturation biopsy might be the best option.

For now, I'm glad to be on AS.

Follow up 3 month PSA is next week and RO consult is in March.
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