MRI Results

I was diagnosed last Feb with GL6 from a biopsy. I just had an MRI last week and the results are PI RADS=1. The synopsis from the radiologist is: "Impression: No prostate lesion identified".

Specifically, the Findings are: No areas of restricted diffusion are seen in the peripheral zone. The transitional zone is heterogeneous. No distinct lesion is seen. Seminal vesicles are symmetric.

Does this mean that the MRI can see 'no' cancer/tumor? Or does it mean what was there if Feb is still there but not growing? The urologist didn't elaborate, but did say I should continue on AS with another biopsy in Jan. This in spite of my PSA going up to 8.7 a month ago and now at 7.6. He said that's not abnormal for a 70 yo man.

I have been monitoring my PSA on my dime once a month and it's been rising so I was preparing myself to have to decide between surgery or radiation, and now this...

What do you guys think?

Update: I had seen an oncologist several weeks ago who treated a friend of mine last year. This friend had almost the exact same numbers I have and he went through the Cyber Knife treatments (5 one hr sessions I believe) with no side effects to date.

I had the MRI results sent to the oncologist and unlike the urologist he recommends treatment as I have greater than a 10 year life expectancy and also that 70% of those on AS eventually have to choose a treatment.

Thoughts? I thought I was good to go for at least 6 months until he made that recommendation!

Yes, good news from the MRI. As to whether or not you treat, that's purely a personal decision. But I'd say that even if 70% of the AS patients eventually needed treatment, it also meant that they were able to delay any potential SEs for that period.

So 30% chance you never need treatment and 70% chance you can delay treatment--personally, I like those odds.

My inclination is to wait and see what the next biopsy in 6 mo says, but now I have a urologist (and surgeon) who says my risk is minimal, stop doing my own PSA's and come back in Jan for the biopsy, and I have an oncologist who says his 'usual' advice is to treat now while I'm young enough (!) to take the treatment well. I guess I'm just worried that it will 'escape' the prostate in that time period and then my options are limited. But I guess that's a very low probability.

I like your idea of waiting till next Biopsy.
Did they say how large your prostrate was and if you had BPH, both of which may result into high PSA numbers.
The third possibility is Prostatitis. My PSA dropped from 4.45 to 3.2 in a 3 week course of cypro. So that something to discuss with your URO.

I would also get a PHI ( prostrate health Index) test done just for the heck of it and I am sure they performed a DRE by now - do share what they reported.

I had a DRE last week and the doc only said it was a small prostate.

I do have another question that I want to throw out. Re: the oncolgist who wants to go forward with the cyber knife RT, is there any advantage or disadvantage to doing it now, as opposed to say, in 5 years if the tumor were to start growing into the danger zone. SE notwithstanding, would doing the RT now give me a longer stretch before the cancer would/could return or could it just as easily return in 5 years, maybe even in a more aggressive form?

Thanks for that Halbert. I actually was diagnosed with high volume, low risk from my 1st biopsy in Feb, if that makes a difference. But I hear you, and I'm trying to get over the 'getitoutitis or 'zapitnowitis'. The fact that the MRI came back as a 1 does give me confidence, so I'm now pretty much convinced that I should just continue to eat healthy and exercise and put it out of my mind for 6 months...

Vic, from recent personal experience (and only that: I'm not trying to be cynical or depressing here!) I can tell you that MRI reading can be very different from one radiologist to the next. In my case the one who first read my images assigned me PI-RADs 5. I then had it read by another doctor at a nationally-ranked hospital; he didn't even assign it a score. Clearly a huge difference - not unlike some stories I've heard (though not in my case as it happens) of biopsy samples being up- or downgraded by Dr. Epstein. Anyway, food for thought.

Here are a few more AS links you might find interesting:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488691/

https://www.ncbi.nlm.nih.gov/pubmed/30552940

https://www.europeanurology.com/article/S0302-2838(18)30813-3/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/29886089

https://www.auajournals.org/article/S0022-5347(17)77714-2/fulltext

and finally, an interesting discussion between a urologist and a medical oncologist:

https://www.urotoday.com/video-lectures/eau-2018-gu-oncology/video/mediaitem/931-embedded-media2018-03-28-13-38-21.html?utm_source=newsletter_5456&utm_medium=email&utm_campaign=eau-2018-notable-videos-in-prostate-cancer

Hi Vic, I'll be able to clarify a few things for you...

A diagnosis with only Gleason 3+3 findings is what the PC medical community calls "indolent" prostate cancer. In fact, there have been heated debated in the medical community as to whether this non-lethal diagnosis should even be called "cancer" because it often triggers unnecessarily aggressive, emotional responses by patients and has led to gross numbers of "overtreatment" for low-risk disease. So, regarding your mpMRI results, this imaging technique largely "skips over" indolent PC, but looks for clinically significant disease...so your PI-RADS score of 1 is outstanding and as low as it goes.

As someone else already alluded, PC is a natural part of aging...in fact THE MOST SIGNIFICANT "RISK FACTOR" FOR BEING DIAGNOSED FOR PC IS AGE...it's natural aging. Studies have shown that most men over age 50 have some sort of detectable PC...mostly indolent PC just like you which will never hurt them. In fact, most of those men have never encountered the set of circumstances which leads to a biopsy and they will never know they are walking around with PC, and will live full, complete lives. (I'm rather surprised, in fact, that--and this point is key--unless you had previous problems with your prostate at a younger age that you even agreed--or that it was suggested to you--to have continued PSA testing, and especially a biopsy...but that's water over the dam at this point.)

That being said, I can see absolutely no good reason for your monthly PSA testing. Frankly, with your "indolent" finding at age 70, what you can comfortably know is that you will NOT die of prostate cancer. The rare lethal kind of PC has a very, very different signature than the common, run-of-the-mill natural aging you have stumbled across. So, not going to die, then one has to question the ethics of any doctor who recommends an aggressive treatment with your findings...with my 10-years of lay experience, I don't get that at all...truly an ethics concern, wondering if the RO is putting his own financial interests in front of the best care options for the patient, but note that there is a big difference between him saying "I recommend treatment for you" and "If you decide to have treatment, I recommend radiation treatment for you." If I was 70 and had just about any type of PC and chose to be treated, I would probably have radiation therapy, too, due largely to age.

If you want to continue to track it through your AS program, the second, confirmatory biopsy 12-18 months after initial diagnosis is typical, and if the results are similar (they usually are) then it gives a very high confidence in the program.

Relax

Post Edited (Blackjack) : 8/15/2019 3:12:21 PM (GMT-6)