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Biopsy coming up- looking for some info

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Prostate Cancer
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Posted 4/1/2023 4:33 AM (GMT 0)
Hey everyone. Quick synopsis. I’m 57. Initial PSA in 2019 was a 1.8 following regular bloodwork. In 2020 it was 2.1 followed by 3.57 in 2021 and then 5.91 in December of 2022. My urologist (due to history of kidney stones) suggested an MRI due to the PSA trend. MRI was done on 3/16. Results showed a PI RADS 5 leaion, 19 mm x 10mm in the left anterior of the transition zone, mid gland, extending into the fibromuscular stroma. Additionally some mild bph was noted with additional PI RADS 2 areas in the peripheral zone. An additional PSA test was done on 3/27 when the biopsy was scheduled. Biopsy is scheduled for 4/18. New PSA is 6.7. Doc said it’s a decent size lesion but I was in a good place if biopsy reveals cancer from a treatment standpoint. He was confident he could reach it during the random core/ targeted TRUS biopsy. Anyone have some insight on the PI RADS 5 lesion in the transition zone/ stroma. Obviously concerned but feel it can be dealt with effectively if biopsy shows I’ve joined the group. Thanks in advance
Posted 4/1/2023 12:24 PM (GMT 0)
Welcome, and hopefully you won’t need to revisit this site after your biopsy. I don’t have answers to your questions, but I’m sure someone else will chime-in soon. Question for you: Curious as to why your doctor didn’t biopsy in 2021 when your PSA was 3.57. I experienced something similar: My PCP didn’t flag my PSA for a couple of years as it was steadily climbing until after it passed 4 and hit 6. When I later asked him why, he explained that the lab didn’t flag it until after it passed 4. I learned after that to closely monitor all blood lab work and look for trends that doctors will sometimes overlook. I wish you all the best for your biopsy. I was knocked-out for mine and it was a breeze.
Posted 4/1/2023 12:58 PM (GMT 0)
I’ll just say that it is better to have it in the middle of the prostate (transition zone) than near the outside (peripheral zone). Less worry about extra-prostatic extension (EPE). Using the MRI-guided biopsy, they should be able to dart that PIRADS 5 sucker easily.

How big is your prostate?
Posted 4/1/2023 2:11 PM (GMT 0)
MotownPaul, thanks for response. I think it didn’t get flagged as well because it didn’t hit the 4.0 mark. Plus we had just moved out of state and had to find another GP. Essentially no one including myself was paying attention to the PSA trend.
Posted 4/1/2023 2:22 PM (GMT 0)
CentralPAdude, thanks for responding. My prostate volume is 46cc. PSA density is 0.15. Also no extraprostratic extension was noted. I have read that tz lesions typically move into the stoma because the bph in the tz acts as a barrier and so it goes into the stroma.
Posted 4/1/2023 10:08 PM (GMT 0)
No regrets nor looking backward about PSA, it is what it is and time to look ahead. Get past the biopsy and see where you are at then plan accordingly. It is not a good time between now and biopsy results as the mind races ahead with doomsday scenarios. Do what you can to stop thinking about it and find other things to do until you get some results. Hang in there…
Posted 4/2/2023 12:39 AM (GMT 0)
Thanks, Mumbo. Looks like you’ve been thru an ordeal but doing great now.
Posted 4/2/2023 12:13 PM (GMT 0)
My ordeal is minimal compared to many here. Last time I was feeling great was in my 50’s. This old age stuff is not for the weak. PCa is at least a treatable disease so one does not need to flip out about lack of options and just being sent back home. I feel so smart and calm now looking back on things but there seemed to be no end to the journey when it started, just one thing after another with little good news along the way until the end.

You just have to pace yourself, it is a long process regardless of what happens.
Posted 4/22/2023 12:17 AM (GMT 0)
I had my fusion guided biopsy on 4/18 with no resulting complications thankfully. Got the phone call this morning that I have cancer. Results from the biopsy shows Gleason 7 (3+4) in each of the two targeted cores ( pi rads 5 lesion; Doc was able to get both ends). Next step is setting up an appt with my urologist to begin discussing treatment options. As a new member of this esteemed group of men I want to particularly advocate for mri’s prior to biopsy. Doc said if I hadn’t had the mri he wouldn’t have found the cancer as it was in the transition zone extending into the anterior fibromuscular stroma. A difficult location to biopsy because of its anterior location. If at all possible get the mri before biopsy! My cancer could have been a different story if it was found a couple years later.
Posted 4/22/2023 12:58 AM (GMT 0)

Fightingfalcons said...
I had my fusion guided biopsy on 4/18 with no resulting complications thankfully. Got the phone call this morning that I have cancer. Results from the biopsy shows Gleason 7 (3+4) in each of the two targeted cores ( pi rads 5 lesion; Doc was able to get both ends). Next step is setting up an appt with my urologist to begin discussing treatment options. As a new member of this esteemed group of men I want to particularly advocate for mri’s prior to biopsy. Doc said if I hadn’t had the mri he wouldn’t have found the cancer as it was in the transition zone extending into the anterior fibromuscular stroma. A difficult location to biopsy because of its anterior location. If at all possible get the mri before biopsy! My cancer could have been a different story if it was found a couple years later.

well shoot. i was also 3+4 with a PSA of 6.8. good luck to you man. you got this!
Posted 4/22/2023 2:42 AM (GMT 0)
The next steps are the difficult part, lots of options for treatment and all should work equally well. Do you get a second opinion on the biopsy pathology to be sure about results? Do you get genomic testing on a biopsy cancer sample to further assess cancer risk? Your follow up meeting with the urologist is just the first step in this process. You will get worn out mentally until such a time as you reach a final decision and move on to treatment. Then you will worry about treatment related issues until that is over. Then you will become the experienced veteran that speaks from experience on HW.

You are doing fine so far, no surprises and your attitude is good. Hang in there…
Posted 4/22/2023 4:22 PM (GMT 0)
I had an MRI before my biopsy in 2017.

It was a good thing because the MRI guided biopsy found only one positive core with GS8. The other 13 cores had no cancer.

I chose brachy boost with no ADT. I had two big bounces that triggered a PSMA PET-CT that found nothing.

My last PAS was 0.18.
Posted 4/22/2023 4:55 PM (GMT 0)

MacroMan said...
...biopsy found only one positive core with GS8. The other 13 cores had no cancer.


Macroman,
Man, that was a good aim. Glad they found it and it appears you are doing quite well.
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