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Hair on Fire with MRI results

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Posted 2/15/2018 4:00 PM (GMT 0)
Hello all. Crazy person here again with MRI update...there is a lesion that is 80% cancer on my husbands prostate. Its a 4 out of 5. Whatever that means. You have to understand I got this information from my husband who got this information from his doctor over the phone just now.

We were set up to have a biopsy tomorrow...and bring in a copy of the MRI. The doctor asked me to bring the copy of the MRI in now to decided whether the biopsy could still be done in office tomorrow or whether it would need to be done in an operation room next week. Cue hair on fire. What does this mean? Why?

No clue how big lesion is, etc.

Jenn

Husband is 40.
Psa 5.4, 7.98, 6.71 in past 6 months.
Posted 2/15/2018 4:15 PM (GMT 0)
Crazy,
There must be some mis-communication because the the MRI can not confirm cancer. The MRI does detect suspicious lesions that maybe cancer but can also be benign tissue. You have to go thru the biopsy to confirm
whether the prostate has cancer.
Posted 2/15/2018 4:16 PM (GMT 0)
Probably is PIRADs 4. It means high possibility of significant cancer. Very small lesions of low grade are not usually detected by MRI and they are considered unsignificant cancer that do not require treatment. Consider that: 1) only the biopsy gives a definitive diagnosis; 2) It is 4 out of 5 in a scale that shows the probability of finding something that needs treatment. It does not mean a high risk of bad prognosis or outcome. Good luck with the biopsy.
Posted 2/15/2018 4:17 PM (GMT 0)
Yes, I mean the lesion was an 80% chance it was cancer. Sorry!
Posted 2/15/2018 4:36 PM (GMT 0)
Your doctor probably wants to make sure the biopsy needles are placed into the suspicious area visible on the MRI. If he cannot do that in his office he will refer you to the hospital.

George
Posted 2/15/2018 4:44 PM (GMT 0)
The reason they are probably talking about moving the biopsy from his doctor's office to a larger facility is that your doctor probably doesn't have the equipment needed to use the MRI result to guide the sampling. At the doctors office they can use ultrasound to 'see' the prostate and can take samples from the usual places. With a MRI fusion biopsy a computer overlays the ultrasound image with the MRI results so the doctor can make sure to hit the parts that are most suspicious on the MRI.
Posted 2/15/2018 4:45 PM (GMT 0)
That's not what you want to hear, but as said keep in mind that only a biopsy can confirm cancer. I've been on this board for several years now and I've seen a bunch of guys with suspicious MRIs that do NOT end up having cancer. And...a greater percentage of biopsies are negative than positive. No use shifting into overdrive before you need to.

Along those lines, probably the best advice I got from my dad was "don't make a decision while you're excited." Medical stuff like this can be scary, but to the extent that you can you want to remain as calm as possible. (I know, easier said than done.) So instead of thinking "cue hair on fire," try to think "let's get the fire extinguisher."

I hope the biopsy goes well! (PS, it's not as bad as that darn coil.)
Posted 2/15/2018 4:46 PM (GMT 0)
PIRADs 4 means that image shows a lesion smaller than 1.5 cm. without other suspicious findings. Otherwise it is PIRADs 5. I guess your doctor will decide to perfom a "mentally guided" biopsy in his office or a more sophisticated biopsy guided be a fusion software. It is better if the biopsy is as much accurate as possible. Try to be calmed, it is better to know what is going out in advance than having several negative biopsies and a worse outcome some years later.
Posted 2/15/2018 5:40 PM (GMT 0)
Hang in there, now you need that biopsy to see what's what.
Posted 2/16/2018 2:08 AM (GMT 0)
So does the MRI show if it has spread? When do you find that information out? In the dark here...
Posted 2/16/2018 2:37 AM (GMT 0)
The MRI does not show if any cancer has spread outside of the prostate, nor will a biopsy show that. If warranted, further scans can be taken for that later. But right now, as difficult as it may be, it's best to focus on one step at a time. The biopsy is the next step, and even if cancer is found there are almost certainly excellent treatment options for your husband (if treatment is needed).
Posted 2/16/2018 4:12 AM (GMT 0)
Froggy88 put things very well. I really, really hope your husband doesn't have cancer. But if he does, it's very treatable. That's proven by the fact that so many of us are here posting after many years.
Posted 2/16/2018 8:02 AM (GMT 0)

CrazyLady said...
The doctor asked me to bring the copy of the MRI in now to decided whether the biopsy could still be done in office tomorrow or whether it would need to be done in an operation room next week. Cue hair on fire. What does this mean? Why?

Some locations in the prostate are more difficult to biopsy than others. When the most common biopsy method (transrectal) does not allow good access to the suspicious area, an alternative method (transperineal) is sometimes used. Some doctors use general anesthesia in an operating room when using the transperineal method.

The urologist will probably load the images from the MRI onto his software to better visualize the location of the suspicious area(s), to determine whether the usual biopsy method can be used, or whether the more complicated method is called for.
Posted 2/16/2018 8:17 AM (GMT 0)
I think pirads4 means that there is not evidence of extension outside prostate. Otherwise it would be pirads5. As others have said, image does not give a diagnosis, just gives a strong clue of what it can be found.
Posted 2/16/2018 12:23 PM (GMT 0)
What you're experiencing is way too common--where a doctor or nurse tells a patient what you heard. That the MRI (or PSA, or PHI, or Free PSA) indicates "80% chance of high grade cancer" or something similar. This is so much baloney. These tests are indicators, suggestors, point to places to dig deeper. They are not, never have been, never will be truly diagnostic.

Hang in there, using the MRI to indicate where to biopsy is a great thing to do, and then get the biopsy done. That IS the right thing to do.
Posted 2/16/2018 9:31 PM (GMT 0)
Thank you all so much. I have put the fire out for now smile

Found out today, that the lesion was classified as T2. Not sure what this means....
Posted 2/17/2018 2:15 AM (GMT 0)
T2 is a clinical stage that means the tumor could be felt by the DRE and was within the prostate and in only one lobe. There are four stages. T1 says the tumor was not felt by the DRE. 3 and 4 indicate the tumor has extended outside the prostate. Each stage has several variants. For instance, I was T2b, which meant the tumor was felt and extended to either more than half of the prostate or cold be felt over both halves.
Posted 2/17/2018 2:20 AM (GMT 0)
But it wasn’t felt on DRE....only showed on MRI. Also, is this a “good” thing to be contained within the prostate? Or does it matter less than the Gleasons score?
Posted 2/17/2018 4:27 AM (GMT 0)

Michael_T said...
I've seen a bunch of guys with suspicious MRIs that do NOT end up having cancer. And...

I'm one of those.

Take a deep breath, Crazy Lady, slow down.

There's a lot to learn.

Read this link carefully, then read it again.

https://www.healingwell.com/community/default.aspx?f=35&m=2652250

There is a ton of information in that link that can be hard to digest all at once.

Take your time, you likely have plenty of time to digest the info and determine the best course for you and your husband.

Hope things go well for you guys.
Posted 2/17/2018 11:37 AM (GMT 0)
T2 doesn't mean the tumor was actually felt on DRE, but can be felt by digital rectal exam or seen with imaging. In your husband's case the T2 is the radiologist's finding.
Yes, the MRI finding that it's confined to the prostate is good, but not conclusive. Typically EPE can only be confirmed after surgical pathology, although there are several findings on biopsy that can predict the risk of EPE. Only a biopsy can give you the Gleason and that should be subject to confirmation by a leading pathologist. You only have part of the story now that's not conclusive by any means. The biopsy will provide a lot more information from which you'll be able to proceed to several good treatment options or perhaps Active Surveillance, depending on a number of factors. Do not give up on a negative finding on the biopsy.

Post Edited (hrpufnstuf) : 2/17/2018 4:40:54 AM (GMT-7)

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