Just diagnosed with Cancer, 3+4, lots of info below.

Age-56
Initial psa test from GP- 5.2, DRE-nothing present
First test from Urologist...
DRE-nothing present

Prostate Health Index 55.35
In the PSA range of 4-10 ng/ml, in men greater than or equal to 50 years of age with non-suspicious digital rectal exam, the following table applies:

phi Range Probability of Cancer 95% Confidence Interval
Hybritech Cal
____________________________________________________________________

0.0-26.9 9.8% 5.2%-15.4%
27.0-35.9 16.8% 11.3%-22.2%
36.0-54.8 33.3% 26.8%-39.9%
55.0+ 50.1% 39.8%-61.0%
P2PSA 19.40
PSA, Total 6.32 ng/mL 0.00 - 4.00 ng/mL
PSA, Free 0.88 ng/mL ng/mL
Free PSA % 13.9 %_of_Total %_of_Total
PSA Free PSA Probability of Cancer
ng/mL % %
------------------------------------------
0 - 2 n/a 1
2 - 4 n/a 15
4 - 10 0 - 10 56
10 - 15 28
15 - 20 20
20 - 25 16
>25 8
>10 n/a >50
---------------------------------------
Percent Free PSA values should not be
interpreted as definitive evidence for the
presence or absence of prostate cancer.

Next test...

POCT Creatinine - Details
Component Results

Creatinine POC- Me= 1.0 mg/dL Standard =0.8 - 1.5 mg/dL

Next test..


MRI PROSTATE WITH AND WITHOUT CONTRAST

CLINICAL HISTORY: 55-year-old man with elevated PSA.

PSA history:
6.32 (2/23/2018)

TECHNIQUE: Multi-parametric 3.0 Tesla MRI was performed using a torso phased-array coil, including multiplanar T2-weighted images, axial T1-weighted images, axial diffusion-weighted images, and volumetric dynamic post-contrast images of the prostate.
Axial in-and-opposed-phase gradient-echo T1-weighted images and pre- and post-contrast fat-suppressed gradient-echo T1-weighted images of the entire pelvis were also obtained.

COMPARISON: None available.

FINDINGS:


Prostate size: 4.3 [CC] x 3.6 [AP] x 4.9 [transverse] cm for an overall volume of 40 cc. The PSA density is 0.16.

There are no findings suspicious for tumor.

Lesion 1
PI-RADS assessment category: 4, High probability
Appearance on T2-weighted images: 4, circumscribed, homogeneous moderate hypointense focus/mass confined to prostate and <1.5 cm in greatest dimension
Appearance on diffusion-weighted images: 4, focal markedly hypointense on ADC and markedly hyperintense on high b value DWI; <1.5 cm in greatest dimension
Appearance on dynamic post-contrast images: Negative - Diffuse enhancement not corresponding to a focal T2W and/or DWI finding
Size: 1.2 x 0.6 cm, series 25 image 19 (ADC map)
Side: Right.
Zone: Peripheral
Level of prostate: Base
location within transverse plane: Posterolateral
Extraprostatic extension: Abuts the prostatic capsule

Lesion 2
PI-RADS assessment category: 4, High probability
Appearance on T2-weighted images: 4, lenticular or non-circumscribed, homogeneous, moderately hypointense, and <1.5 cm in greatest dimension
Appearance on diffusion-weighted images: 4, focal markedly hypointense on ADC and markedly hyperintense on high b value DWI; <1.5 cm in greatest dimension
Appearance on dynamic post-contrast images: Negative - No early enhancement
Size: 1 x 0.8 cm, series 26 image 21 (T2)
Side: Right
Zone: Transition
Level of prostate: Base
location within transverse plane: Anterolateral
Extraprostatic extension: Abuts the prostatic capsule

Additional peripheral zone findings: Diffusely decreased T2 signal bilaterally, likely related to chronic inflammation/fibrosis
Additional transition zone findings: Mildly enlarged and heterogeneous with circumscribed nodules consistent with benign prostatic hyperplasia.

Extraprostatic extension: As above

Seminal vesicle invasion: None.

Lymph nodes: No pelvic lymphadenopathy.

Osseous structures: No aggressive osseous lesion.

Additional findings: The urinary bladder is unremarkable.

IMPRESSION:

Lesion 1: 1.2 x 0.6 cm right posterolateral base peripheral zone lesion, corresponding to an assessment category of PIRADS 4 - High (clinically significant cancer is likely to be present).

Lesion 2: 1 x 0.8 cm right anterolateral base transition zone lesion, corresponding to an assessment category of PIRADS 4 - High (clinically significant cancer is likely to be present).

Findings of chronic inflammation/fibrosis and BPH.

The prostate gland was segmented and the suspicious lesion(s) were annotated on the DynaCAD system for UroNav guidance.


Component Results

There is no component information for this result.

Next test-Biopsy

Final Diagnosis
A. Prostate, right base, needle core biopsy:
· Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade Group 2, 10% Gleason 4 tumor),
involving 2 of 2 cores (80%, 70%).
· Perineural invasion present.


B. Prostate, left base, needle core biopsy:
· Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group 1), involving 2 of 2 cores
(20%, 15%).

C. Prostate, right mid, needle core biopsy:
· Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade Group 2, 10% Gleason 4 tumor),
involving 2 of 2 cores (90%, 60%).

D. Prostate, left
mid, needle core biopsy:
· Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group 1), involving 2 of 2 cores
(50%, 15%).
· Perineural invasion present.

E. Prostate, right apex, needle core biopsy:
· Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade Group 2, 10% Gleason 4 tumor),
involving 2 of 2 cores (95%, 70%).

F. Prostate, left apex, needle core biopsy:
· Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group 1), involving 3 of 3 cores
(30%, 10%, 10%).

G. Prostate, target 1, needle core biopsy:
· Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade Group 2, 10% Gleason 4 tumor),
involving 2 of 2 cores (65%, 60%).

H. Prostate, target 2, needle core biopsy:
· Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade Group 2, 10% Gleason 4 tumor),
involving 2 of 2 cores (65%, 60%).

Note: This case was reviewed at the Intradepartmental Quality Assurance Conference and t
hose
present concur with the above diagnosis.

Clinical Information
Scheduled Procedure: prostate biopsy
Clinical history: elevated psa

Specimen/Gross Description
A. Received in formalin, labeled with the patient 's name and designated on the requisition
as "right base," are two cores of pink-tan tissue ranging in length from 1.7 to 2.1 cm and
averaging 0.1 cm in diameter. The specimen is submitted in its entirety in cassette A1.


Specimen/Gross Description

B. Received in formalin, labeled with the patient 's name and designated on the requisition
as "left base," are three cores of pink-tan tissue ranging in length from 0.4 to 1.7 cm and
averaging 0.1 cm in diameter. The specimen is submitted in its entirety in cassette B1.

C. Received in formalin, labeled with the patient 's name and designated on the requisition
as "right mid," are three cores of pink-tan tissue ranging in length from 0.3 to 1.7 cm and
averaging 0.1 cm in diameter. The specimen is submitted in its entirety in cassette C1.

D. Received in formalin, labeled with the patient 's name and designated on the requisition
as "left mid," are four cores of pink-tan tissue ranging in length from 0.2 to 1.6 cm and
averaging 0.1 cm in diameter. The specimen is submitted in its entirety in cassette D1.

E.
Received in formalin, labeled with the patient 's name and designated on the requisition
as "right apex," are three cores of pink-tan tissue ranging in length from 0.3 to 1.7 cm and
averaging 0.1 cm in diameter. The specimen is submitted in its entirety in cassette E1.

F. Received in formalin, labeled with the patient 's name and designated on the requisition
as "left apex," are three cores of pink-tan tissue ranging in length from 0.4 to 2.0 cm and
averaging 0.1 cm in diameter. The specimen is submitted in its entirety in cassette F1.


G. Received in formalin, labeled with the patient 's name and designated on the requisition
as "target 1," are two cores of pink-tan tissue ranging in length from 1.6 to 1.7 cm and
averaging 0.1 cm in diameter. The specimen is submitted in its entirety in cassette G1.

H. Received in formalin, labeled with the patient 's name and designated on the requisition
as "target 2," are two cores of pink-tan tissue rang
ing in length from 1.7 to 1.8 cm and
averaging 0.1 cm in diameter. The specimen is submitted in its entirety in cassette H1.

I have an appointment in 10 days to go over treatments. I live in Chicago, read about a few facilities/doctors in my area that I should talk to, any help would be greatly appreciated. Really not sure what to do at my age, lots to take in.

Welcome. I'm in Chicago. I'm not a medical professional but it appears you have intermediate risk prostate cancer. You have some Gleason 7 cores. You cancer is highly treatable, and a "cure" is likely.
Surgery or radiation are options. You have time to research both and make a decision. Don't rush.

Chicago has excellent surgeons at places like U of Chicago, Northwestern, Loyola, and North Shore University Health. Those institutions also have radiation oncologists experienced in that area. You should have the resources available to start your education process. This forum has some very knowledgeable members who can help you as well.

Talk to your urologist, make notes, then start your research. Ask questions, get other opinions, and take your time.

Use this forum. Good luck

They only paid 15%, I forked out the balance. Figured it was the best way to go, in hopes that I would not have to get a Biopsy.

RobLee -- "And at your young age probably prostatectomy (though some with strongly disagree)."

is this still the belief? sounds like something a prostate snatcher might say right before he tells you with surgery you always have radiation as a back-up but not vice versa.

Welcome to HW,

You've got something there. It's an emotional shock to suddenly find yourself here.

The good news is that it's treatable and all the main line treatments will work. You have time to get the consults to figure out what you want to do.

The bad news is that treatment isn't fun and there will be side effects. Normal will change, but you'll be around for a long time to tell the story.

Keep us updated on your progress and let us know what you find out from the doctor,
Andrew

Thanks for all the words and info. I have read so much in the past 5 months that its a tad overwhelming to say the least. But what stands out based on my numbers is that active surveillance is pretty much out the window with my scores, unfortunately? I have my first appointment in person with my urologist in 10 days about specific treatments, what's interesting is that I pretty much know what they are since we live in the age of Google, etc.
My big question is this, and I know this is a question that is tough to answer, but do I have say a year to figure this out, or maybe even more, or is that wishful thinking? I'm not one of those people that has to have it out or the stress will kill me. If say I do go the route of holding off, what's the protocol? Do I have my PSA checked every 3 months, if so when does that start since I pretty much just had a biopsy?
I have been taking supplements for the prostate, no idea if they do a thing except decrease the amount of money in my account. And before this all started I had zero issues with my prostate.
I do not want to take my prostate out, like I'm sure most don't, but I guess if I have to then I will. But why is it that I have read numerous people who have had theirs removed, only to have their psa numbers start to rise, or am I missing something?
Thanks much.

ldog said...
My big question is this, and I know this is a question that is tough to answer, but do I have say a year to figure this out, or maybe even more, or is that wishful thinking? I'm not one of those people that has to have it out or the stress will kill me. If say I do go the route of holding off, what's the protocol? Do I have my PSA checked every 3 months, if so when does that start since I pretty much just had a biopsy?

I do not want to take my prostate out, like I'm sure most don't, but I guess if I have to then I will. But why is it that I have read numerous people who have had theirs removed, only to have their psa numbers start to rise, or am I missing something?

You've covered a lot of ground here, and I will try to answer what I can here. I will repeat my earlier reply here, as I was trying to be brief...

RobLee said...
With that grade 4 component in your biopsy I'd say treatment is definitely in your near future. And at your young age probably prostatectomy (though some will strongly disagree)... You were fortunate to have had that MRI early on so they could target the suspicious lesions.

Of course, first off it didn't take long for someone to strongly disagree, as predicted. You have a significant amount of grade 4 in your biopsy cores. Fortunate for you it was the secondary number. You may, MAY have time to ponder this, but I think a year might be pushing it.

It was about two years for me between my first biopsy and the MRI which finally found my tumor. Most guys are lucky and their tumor can be easily found, and they can get treatment before it grows significantly. They have time to consider options. What happened to me was that by the time I found a doctor willing to do an MRI, the tumor had grown out of the prostate and my choices were limited.

So that's why I'm saying that you will probably need treatment in the near future. Also, as the tumor grows, the number of viable options decreases. Eventually even prostatectomy would become ill advised as excising a high grade tumor could lead to additional spread of cancerous cells.

So basically, the longer you wait, the fewer choices you will have. Some of the guys here have "hard and fast" opinions of both surgery and radiation. I have had both. If surgery fails to get all the cancer cells, adjuvant or salvage radiation can be used to eradicate cancer cells that remain within the prostate bed. When those cells have spread beyond the prostate bed and into the lymphatic system or has metastasized into the bone or organs it can be treated with chemotherapy, but typically with lesser success.

One of the advantages of surgery is that the surgeon is actually there inside your pelvis, can examine the gland and surrounding tissues to determine the extent of the cancer and the prostate is fully analyzed in a pathology lab. Radiation is administered using external scans. There are side effects to radiation. Some will not tell you about those until after you already have them.

So I think in short, it would be best to not plan on waiting too long before starting treatment. Evaluate your available alternatives and make your choice and hope for the best. Good luck!

You do have some time to thoroughly investigate your treatment options. A year or longer seems too long to wait before treatment. Try not to think and plan now how long you can avoid treatment. I think that after you talk with your doctor in 10 days and other specialists in surgery and radiation in the coming weeks you will know the answer to how long you can safely wait before treatment.

In the meantime, I doubt very seriously that any supplements you are taking will do anything to change your situation except leave you will less money.

This thread is getting away from being useful to the original poster. Just sayin.

IMO, a year would be pushing it. But I think you can pretty comfortably take several months to make a decision. I took about 2 months as a G9 to sort through my options, although I was also feeling pretty antsy to get on with things. But you should spend that time checking your options to see what treatments you're most comfortable with. And as you can see, sometimes guys can get a bit heated with their preferences.

Welcome to our club, I'll add my thoughts...

I'll agree that a year may be pushing it..but a few months more won't make much difference. I'm a surgery guy, and I've had a great outcome. But, not everyone does. And the outcome, as far as side effects goes, seems to be a significant crapshoot. There don't seem to be any hard and fast rules that will suggest which guys will have miserable post surgery side effects, and which ones won't.

I'd agree that you need to consult with multiple treatment specialists. The most experienced surgeon you can find. Plus specialists in all the different radiation methods. What I believe--and what a lot of guys here will say when pressed--is that when you meet "your team", you'll know it. It will just suddenly "be" the right choice for you.

Oh, and sometimes, we can spend way too much time on google, and we get so caught up in either the horror stories or the "do this!!!!" stuff that we loose sight of what is really important TO US.

For me, surgery was the right decision. Because (in no particular order): I lived in a rural area, and I had to seriously consider how much time I would be spending getting to and from treatment. 40+ round trips of 2 hours each way for IMRT? Not happening. SBRT wasn't available nearby at the time. Classic brachytherapy honestly creeped me out (carrying radiation pellets inside me for life?) So I did RALP.

Other guys have other values. I liked surgery because I knew that when it was done I'd get a 'for sure' pathology report. With radiation, you don't know for sure. Lots of guys are OK with that.

So, the real questions to ask yourself: What side effects am I willing to risk? How much time do I have available to deal with treatment? (If you're working, what is your sick leave policy like?) What do I want to KNOW after treatment? How active is your current lifestyle? How fast do you want to get back to that activity level? I'm sure there are more similar questions to consider.

Best of luck to you, the answers will come.

Something else to consider. After surgery your psa gives a precise indication of where you are with respect to a possible recurrence. With radiation some years may pass before you know that a recurrence is going on. Moreover, if the treatment is succesful psa can oscilate with radiation showing some bounces before it goes definitely down. This is a double edge sword too, it depends of your personal preferences about whether you want a very close follow up to act promply or not.
Surgery generally gives worse ED secondary effects, and it has the worrisome possibility of urinary incontinence, though in most cases it is solved in a few months. Radiation may cause urinanry difficulties or rectal inflamation, that are usally temporary as well.
In the case of recurrence, you have different options for each treatment. Some guys take in consideration that a salvage surgery after radiation is not generally recommended (this is the big point usually made by surgeon which is refused here by many with some good reasons). Others argue that with radiation as the primary treatment you are more safely covering the case of local extension that will probably need radiation anyway. The quality of your local specialists is also a key factor. Good luck with this difficult decision.

All I can really add is to say. Read everything everyone here has to say. Talk to a "SPECIALIST" in every form of TX. Study the SE's from every TX. Study yourself and be honest when considering who you are and what you want for the remainder of your life.

ALL TX's have their positives and negatives. There is NOT a single best TX.

Sucks but it turns out it is a crap shoot. So take a few months, learn everything you can, be skeptical about everything you learn/read/hear and then sit down in a nice quiet space and decided what is best for you. Best for you physically and emotionally. Then go get it done.

May you choose wisely.

Roger