Biopsy vs MRI Guided Biopsy

Thanks Tudpok18 I believe I have had this cancer for ten years it just that my urologist dropped the ball in Dec 2012 I could barley urinate and it was painful . The DRE exam indicated I have a small prostate so the doc said to himself "small prostate -small urethra " actually he kiddingly said you got a small donut so you have a small hole . He gave me Flomax and it worked!! my PSA was as follows Mind you the last PSA Nov 2020 is when his son took over the practice looked at PSA record( after I told I had to now take a double dose of Flomax ! to be able to pee) he immediately said oh wow you need a MRI ..then the report shows lots issues and he did a Biopsy and said " boy am I glad we did that!!!" So I am explaining that just because I just got diagnosed doesn't mean I "just got it" . The older doctor was really screwing me up . If my prostate wasn't enlarged in 2012 ,then what other reason than an internally growing cancer was squeezing my urine flow? Now it may be my fault for not getting second opinion?? I get that . But I was relying on what I thought was a well established Houston Doctor and I was busy running an auto repair shop didn't dwell on the issue enough !. To make my diagnoses even worst I am small framed 5'8" little guy I weigh 140 to 150 soaking wet maybe that threw him off ?? I work out in a gym 4 times a week , walk/jog 2.0 + miles a day, watch what I eat, do mountain hiking for a hobby, so I am extremely healthy "looking" and maybe that gave him the feeling there could be nothing wrong with me?? At 73 I easily would pass for 60 if I color my hair . I had a doctor a five years ago that didn't know me think I was 48 !! LOL My record in his file indicated that my dad died from prostate cancer at 90 maybe he thought that would be my case and why bother?? But my Dad didn't live the in Houston and run an auto repair shop full of Benzene and other bad things, he was a old German rancher, with clean air in small town and a low stress life!! Anyway I will see a radiation Dr this week as you advise and I also will look into the Signature thing too . Please understand that I am still on schedule for Feb 23 surgery because I found the top urology surgeon in my area and it was either that appointment day they squeezed me in because of a cancelation or wait until early summer that's how booked he is!! And meanwhile I have a 6/12 with a 4+3=7 being worst and two more precancerous and I feel like I almost waited too long now!! Thank you so much for you perspective I hope didn't over explain my situation too much LOL. I appreciate you advice and will continue thank all of you and everyone here. Oh and look at the PSA record below in which I feel i have been neglected by my previous Dr .What do you think?

02/15/2013 2.65
02/25/2014 2.53
03/05/2015 3.18
03/11/2015 3.21
03/11/2016 3.2
11/17/2017 3
05/30/2018 5.21
07/23/2018 5.6
11/21/2018 4.42
11/22/2019 6.15
01/16/2020 4.99
05/08/2020 4.7
11/07/2020 5.4 I was first prescribed a MRI this visit !!!!

Traditionally, normal PSA ranges from 0 to 4, but what is considered "high" within that range increases with age. PSAD (PSA density, or ng of PSA per mL of prostate volume) is a more useful metric. A British study a few years ago suggested that the "normal" general high be lowered from 4 to 3, which speaks to your observation about men on watch. For men with prostates, a high or increasing PSA or PSAD is just one indicator that further investigation is warranted. It's a piece in the puzzle.

A PSAD of 0.08 ng/mL or less is believed to indicate a very low risk of clinically significant PCa.

Djin

Tudpock18 Thanks I already this morn got something going with BRACHY Oncologist . Thanks for Your Nagging it is well accepted (it's for my own Good !!!) Agreed on the 3.0 being the new standard..

Resectfully Jim

Tudpock18 Hope all is well with you as you read this , I went to this RO named Dr. Clive Shkedy , here in Sugarland Tx ..He has very good track record with my healthcare system . He is from Demark but speaks good English. The Staff grilled me about my health and my life history, like they were doing a biography on me LOL. At least 45 minutes just getting to know me. Then the Dr did about another hour showing the me pros and cons of radiation therapy and did a full body exam and DRE. He told me that if he did radiation and it would in fact make it somewhat harder for a surgeon to work in that area later . He said he would put a gel barrier between my colon and prostate to protect it during directed radiation, and he would immediately turn off my testosterone. He said that the outcome could be better for me in the continence department but nerves still may be damaged somewhat in comparison to what can happen during nerve saving proctectomy surgery. He knows I have a skilled nerve saving Surgeon , but if he sees more cancer while doing the operation ,at that point he will not save them, same goes for my bladder control muscles so there's no guarantees that way too and even with the surgery there may be a need for follow up radiation anyway! He said that if the cancer returned in my 80s radiation could still be used a second time in place of the then more difficult surgery because of scarring and my later age .He was very impressed with my overall healthy condition and he said biologically I am 60 years old instead of 73, so what I do need long term consideration in my decision. He said there is no right choice at my juncture. He said he did not do the Brachytherapy, that will be another specialist, ( I am looking for one now) and he warned that may not want to do BRACHY because I am advanced to 4+3=7 ? He I am not sure if this is the truth?? Still nothing from Johns Hopkins. I am so happy you have guided me this far. I sure would appreciate more nagging ..Grinning as I type !!!
Thanks So -So-SOOOOOO MUCH, JimmyM73

Wow Tudpock18 Johns Hopkins put the whole thing into high gear Instead of my worst of my 6 spot on the prostate being a 4+3=7 and then on down in severity , Johns Hopkins said I have the following scores here is all 12 of them bilateral, the worst two are side by side on the left apex 4+5=9 , 5+3=8 3+4=7, 3+3=6, 3+3=6, 3+3=6, Benign, Benign, Benign, Suspect, Suspect, Suspect... Seeing this makes me think I am gonna keep that surgery appointment and follow up with hormone treatment and preemptive radiation if needed after the surgery. What say you ? I have to re-extend my thanks to you for everything again here as we go. The RO doctor recommended a support local group (which I may join too because of the their knowledge of local resources ) but I told him I already have one GREAT support group right here at HealingWell. JimmyM73

I agree with Tudpock that you should hear out what the best RT/ADT plan for your (now) high-risk PCa would entail. You know that surgery and RT are both options, and for that reason the decision can be difficult and has to be yours -- the "What would you do" question to us shouldn't IMO be looked at as a poll. I can't and wouldn't advise you what you should do. I will say that I would want as good an evaluation as possible, based on your total workup and imaging, as to whether your disease is currently prostate-confined or not.

Surgery can be a good option for high-risk, prostate-confined disease as a number of recent studies have confirmed. From what I have gleaned, about 25% of G9 men who are evaluated as prostate-confined before surgery have a pT2 N0 R0 pathology outcome after surgery. That means they have none of the 4 major adverse features -- positive margin(s), extraprostatic extension, seminal vesicle invasion, or positive lymph nodes -- when the entire prostate and removed nodes are examined.

This outcome means that (assuming an undetectable post-op PSA), you would not need adjuvant ADT or radiation as long as your PSA cooperates, and any salvage RT in the future would likewise be contingent on a rising PSA.

The flip side is that if you are a G9 and have even one of the above four adverse features (or your PSA persists at a detectable level post-op), you would be advised to have RT and/or (probably and) ADT after a period of healing from your surgery. Note that you wouldn't know with certainty your pathology status regarding the need for adjuvant therapy until after surgery.

I chose RP for my G10 (downgraded to G9 after surgery) for a number of reasons. My PSA (correcting for the finasteride I was taking) was under 10, I had had frequent exams and many prior negative biopsies and was reasonably certain my PCa was diagnosed early, and I personally wanted to avoid ADT and RT if at all possible. I avoided adjuvant therapy and have been lucky so far (3.5 years). Like so many men post-treatment, I'm paying the waiting game to see what my PSA does. If I encounter a rise in PSA with no evidence of metastases, the next line of treatment would likely be salvage radiation, but without ADT.

Djin

Well I heard the ADT causes bone loss this may be a consideration for me starting a 73. Is the only alternative is surgical castration correct ? The radiation Doctor I went to see dose IMRT so perhaps I need another type of radiation doctor to talk to ? Dr Epstein personally called me this morning and said for my situation I either need to remove it ( I have very skilled doctor John Boon has done about a 1000 proctectomies with 100s of good reviews except sometimes a rude staff complaint LOL ) or High Dose Radiation . At this point I am not sure what is High dose Radiation entails in my situation, but it seems to me that getting cancer riddled prostate immediately out of my body the quickest surest way to recovery and longevity . We have MD Anderson Cancer center here in Houston about 18 miles away so perhaps I will see what they say about High Dose Radiation Too.
Thanks a lot everyone you guys keep me going !! JimmyM18

By high dose radiation, I suspect that Dr. Epstein was referring to the protocol of IMRT plus a boost from either brachytherapy or SBRT. Often, ADT is used to form a powerful "triple play" to stop the cancer. It has good results, according to studies.

https://www.medpagetoday.com/hematologyoncology/prostatecancer/71560

Thanks Again Appointment has been applied for I live only 3.6 Miles from an MD Anderson satellite location here in Sugar Land The Prolia shot was a smooth move .
JimmyM73

JimmyM73 said...
Have you guys heard of this it has just been approved by FDA in December 2020 has been successful in other countries What is a Prostate-Specific Membrane Antigen (PSMA) study? A PSMA study, also called a ProstaScint® scan, is an imaging test to locate and determine the extent of prostate cancer. PSMA studies are performed on newly diagnosed prostate cancer patients to determine if the disease has spread to pelviclymph nodes.

Yes, the most common PSMA-PET scan uses a 68Ga radionuclide. Most body tissue produces some PSMA, especially the salivary glands and prostate, and prostate cancer cells produce even more, making this an excellent test and it is now also being used in the initial diagnostic phase and not only for recurrence of PCa. Unfortunately it is not widely available in the States and your insurance may not want to pay for it. But you can look into it.

The problem is that the half-life of this tracer is only about an hour, so an (expensive) generator has to be built at the site of the scan. The impetus for this (FDA approval) has been the bottleneck, and the approval, so far, was limited to UCLA and UCSF. Generally speaking, PSMA-PET performs better than axumin (18F) scans. Since it can detect PCa lesions anywhere, it also replaces the need for bone scans in patients who have had high-Gleason biopsies.

Djin

Jimmy, your upgrade unfortunately places you in a totally different risk category. An immediate consult and reconsideration of your options including those at M.D. Anderson should be a priority. At this point time is not on your side.

FYI ..Did you guys see where they found an ordinary Veterinary drug (don't laugh) fenbendazole is being found successful in fighting cancer I saw it on Longevity website but also at Johns Hopkins is studying it and I understand its being used in foreign countries to some extent. It seems like cheap drug to try compared to the cost and side effects of the ones the medical doctors give . Also another looked at Veterinary drug (don't laugh again)Ivermectin cured three of my friends in Victoria Tx of covid 19... Clinical trials ,gov But back to my situation I go to MD Anderson Tuesday 16th for a third consultation. They also are gonna retest and give their opinion on my slides and MRI and SCANS . Will post results Wednesday . For my 73rd birthday on the 15 th we are gonna receive a polar vortex down here in Houston Area that may see 10 F degrees which is rare for this subtropical zone so I hope that the appointment doesn't get cancelled on the 16th due to ice on freeway bridges. I can send a life story encounters about cancer survivors using fenbendazole I will post the link to the story I hope its okay with the moderator
https://www.mycancerstory.rocks/
Thanks and stay warm JimmyM73
JimmyM73

Post Edited (JimmyM73) : 2/11/2021 8:06:16 PM (GMT-7)

Well Gentlemen I am fresh home from my prostatectomy Done on afternoon of the 23rd . I stayed on mostly water diet the 24 hours prior to the surgery.
( robotic nerve sparring, lymph nodes looked healthy, done by highly reviewed Dr John Boon, Houston Methodist -Sugarland )
Only weird thing that happened was after the surgery my blood sugar shot up from my normal 80s to 175!!! They administered insulin and afterward it even came down on its own. They decided to keep me two nights because of concerns about my insulin returning. I was under some gas pains and felt like I had done 500 sit-ups LOL.. They sent me home yesterday 25th . with a stool softener for ease of Bowell movements I didn't want the hydrocodone because I am on a crusade against Tylenol and also I have Tramadol for when my grade 2 L5-S1 Spondylolthesis acts up. I slept in my recliner last night because it felt better straightening out flat on the bed. I slept good!! My wife is an angel at times like this (...ah actually she's always an angel to me.).. I had some darkening and swelling in my penis and scrotum. I weigh 136-145 pounds so the doctor was probably needing more room in my tiny tight flat abdomen plus I work out very hard and have probably challenging muscles to spread out and my trunk is so short he had to go it almost 2 inches ABOVE my naval and it probably was little more traumatic than a 230 lb man belly I was on the surgery table 3 1/2 hours and it seems like 3 seconds LOL. I am new to surgery and staying in hospitals so this is an adventure to. Boy was I relieved when I passed gas and had two BMs in a row. Now 7 days I will have the catheter removed and then in 3 months I will go to take my first blood labs to see what else has to be done. I will keep you posted and I may post this elsewhere because I am on more than one thread. And Again I can't tell how much I appreciate you Guys for being for me and helping guide myself to my own best choice in this matter
JimmyM73