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MRI,can anyone tell me what does this mean?

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Posted 3/21/2018 12:45 AM (GMT 0)
IMPRESSION:
1. There is diffuse involvement of the prostate gland (peripheral
zone and most of the central gland) with tumor that corresponds to
recent biopsy results. An area of high signal on DWI in the right
mid gland and apex may represent a focal area of higher grade tumor.
2. There is a small focal area of possible trans-capsular extension
in the right base and evidence of bilateral seminal vesicle
involvement. The neurovascular bundles appear to be free of tumor.
3. No lymphadenopathy or bone marrow lesions are identified in the
pelvis.
Posted 3/21/2018 1:25 AM (GMT 0)
1. DWI stands for diffusion weighted imaging, the type of MRI you had. It measures the Brownian motion of water molecules in tissue structure and then maps them. Areas of "high signal" in the map may, as your report says, be areas of higher-grade tumor, i.e. maybe higher than G7. "Diffuse involvement" means cancer throughout much of the prostate, which was already suspected because you had 12 positive cores.

2. I don't think there's any difference between trans-capsular extension and extra-capsular extension (EPE), the term we usually see in this forum. It's the "possible T3" you've noted in your signature. There's evidence that PCa has extended into both seminal vesicles. No evidence of tumor surrounding the nerves and blood vessels.

3. No evidence that PCa has spread to the pelvic lymph nodes or bones (N0 M0).

I hope that's helpful. Standing ready to be corrected by TA and others if I've made any mistakes.
Posted 3/21/2018 1:36 AM (GMT 0)
Thanks for your response
Saipan

Looking like I’m in for a fight
Posted 3/21/2018 2:07 AM (GMT 0)

Sober1 said...
Looking like I’m in for a fight

So are we all. In it with you.
Posted 3/21/2018 2:12 AM (GMT 0)
Sober one.....yes this does sober us up ....and your fight is on....your at the right place to learn now ....stay with us and try and relax through this early stage ,which is so hard for most of us. The " big decision" .....if you ever need info on IGRT , contact me .........we`re with ya ....David
Posted 3/21/2018 2:13 AM (GMT 0)
Well, SP did a good read for you. My interpretation:

Time to start fighting. Pick a treatment mode and get 'er done.

Hang in there, you've every chance of winning this one.

Andrew
Posted 3/21/2018 3:08 AM (GMT 0)
Thanks everyone for the response

I start my 1st of 26 IMRT sessions tomorrow, started Lupron(18 months)in December will also be having HDR brachytherapy am I missing anything? Trimodal approach
Posted 3/21/2018 3:22 AM (GMT 0)
Sounds like a full platter -- or should I say full bladder -- to me. Go for it.
Posted 3/21/2018 3:26 AM (GMT 0)
Yes Saipan, I hope it goes well with the bladder thing
Posted 3/21/2018 3:27 AM (GMT 0)
Sounds like a perfect plan to me. You've got it all covered.

Andrew
Posted 3/21/2018 3:33 AM (GMT 0)

Sober1 said...
Yes Saipan, I hope it goes well with the bladder thing


It's not a big deal. I drink a 20 oz bottle of water during my 25-minute drive to the clinic, and sip some more in the waiting room. By the time I get on the table my bladder's full but not bursting. As long as you stay away from irritants like coffee for a couple of hours before treatment, you won't be uncomfortable.
Posted 3/21/2018 4:03 AM (GMT 0)
Hi Sober...I was also diagnosed at 51 with a very similar diagnosis and I had the same treatment as you. In my case, I was a G9, but I had a lower PSA. Similarly, my MRI was inconclusive for spread, but my doctor chose to treat me as T3. I had 18 months of ADT, in conjunction with HDR brachy and 25 fractions of IMRT. I finished my ADT in 2014 and I'm doing very well so far.

So where are you being treated? In my case I had HDR brachy prior to IMRT, but as far as I understand the order doesn't make a difference. While I had a few short-term challenges with the HDR brachy, ADT was definitely the toughest part of the battle.

I think you can do well! Lots of other high-risk guys here have had the same Triple Play and overall we're doing well. Good luck to you and give me a holler if I can help!
Posted 3/21/2018 4:08 AM (GMT 0)
Thanks Saipan
I’ll try a do the same technique as you.
Posted 3/21/2018 4:23 AM (GMT 0)
Michel T
Yes our numbers are similar, I’m with Kaiser so I have to definitely do all the research as all I was ever offered was surgery with scheduled RT and ht. So I’m a little worried about this place,but with my numbers I need to do something now!
Posted 3/21/2018 4:45 AM (GMT 0)
Well, the default treatment tends to be surgery. But with a potential T3, I think you're on the right track with your treatment. Hope we can be helpful!
Posted 3/21/2018 4:48 AM (GMT 0)
Thanks Michael
You guys already have been a great help to me
Posted 3/21/2018 1:10 PM (GMT 0)
The key for getting your bladder at the right volume before radiation is to stay hydrated! My routine was about five cups of coffee with breakfast then I would drink 20 or 30 ounces of water after breakfast. Most of my treatments were around 10:30 am and I would arrive at MDA about an hour before and I would drink more water.
Posted 3/21/2018 2:24 PM (GMT 0)
Sober1,

You and I have a very similar dx with my PSA double yours. The Triple Play of HDRBT, EBRT and ADT has worked wonders for me as I have recently celebrated 2,585 days of being PSA undetectable and side effect free. I am sure you will do great.

Please let me know if there is any way I can be of assistance.

Jack
Posted 3/21/2018 4:08 PM (GMT 0)
I found that I learned a lot about getting my bladder just full enough but not too full as the treatment progressed. By the end I was a pro. I did have one embarrassing accident, however. The staff, having already seen everything possible, were unfazed.
Posted 3/21/2018 4:47 PM (GMT 0)
Michael T

I see that you had zytiga is this chemo? How long did you take it?
Posted 3/21/2018 5:02 PM (GMT 0)
Sober- good morning you might want to check out the ADT and SRT journey the SRT doesn't apply in your case but ADT and IMRT go right along with it. Lots of info and personal stories there. Wishing you the best in your treatment!

Larry
Posted 3/21/2018 6:18 PM (GMT 0)
Thanks Larry

I’ll definitely look into it
Posted 3/21/2018 6:44 PM (GMT 0)
Zytiga is another drug used in hormone therapy--I was on it for the duration of my 18-month ADT cycle. Its initial application was for guys that had metastatic castration-resistent PCa, but it's increasingly being used earlier as an adjunct in initial hormone therapy--an increasing number of early stage guys here are using it, although it's still a relatively small number. The drug is very expensive and for some insurance coverage is a problem--if you're at Kaiser, I could see that being an issue, but I don't really know for sure. You can find threads here on Zytiga and some here are up to speed on the latest research on it.

Have you had a PSA test since starting your hormone therapy? Hopefully, it's knocked down to near zero at this point.
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