initial results of mpMRI

Hr, sorry that was not the answer we wanted to hear. I was hoping for "can't see a thing!". Anyway, you are proving the value of MP-MRI in real time. Am hoping for the best from your upcoming biopsy.

Jim

H, I'm sorry you are having to deal with this, however you are on the right track having a guided biopsy targeting the suspect area. Far better than the random 12 core "hit or miss" biopsy, which in the not too distant future will be seen as barbaric!

If It turns out that I have SVI, I move from T1C to T3B, have 50% chance of recurrence regardless of treatment, and most certainly will have to have HT for 1-2 years, maybe longer, according to my panic reading tonight. BIG change for me if it's true what I read.

I had a rough night last night. This news is worse somehow than the initial DX of cancer. I feel like the information passed on to me from my urologist after his brief talk with the radiologist is sketchy and therefore I'm all over the place with what if's and treatments.

Basically, here's what the urologist told me: The radiologist said he saw a small tumor that looks positive. He thinks I should have a MRI fusion biopsy to see if there is SVI. I said we already know I have a small tumor near the SV that's positive. That's not news. He said he agreed, that we don't know anymore at this point than we did before the mpMRI. We'll have to wait and see what the biopsy says. At least he didn't see anything else suspicious.

Here's my concern: From everything I read about mpMRI's, the radiologist has better than a 90% chance to identify SVI. Some use the European scale to rate the probability from 1-5, other use a low, moderate, high probability. So what is he really saying when he says I see a small tumor that looks positive? Is he saying he sees the tumor near the SV that I already know about? My tumor was 1mm Gleason 6, which I didn't think the MRI would even show. I read that these tumors need to be at least .5 cm to show. Maybe what he saw was the full extent of a larger tumor and my biopsy only touched the outer edge.

Or is he saying he saw another tumor in/on the SV that looks positive? If that's the case, my urologist really misled me in the conversation. That is not something we already know.

What's such a mystery to me is every article I read describes how the T2 weighted images and some of the other parameters can detect SVI, yet he apparently didn't mention his findings based on these typical mpMRI observations. "Seminal vesicle involvement can be detected from the observation of disruption of the normal architecture of the seminal vesicle, low intensity regions within the seminal vesicle or ejaculatory ducts, obliteration of the angle between the prostate gland and seminal vesicle, or demonstration of direct tumor extension into and around the seminal vesicle."

It's this language in the above that's worrisome: or demonstration of direct tumor extension into and around the seminal vesicle. I feel like I'm not getting the full skinny from the mpMRI, and it's driving me crazy.

Post Edited (hrpufnstuf) : 8/22/2014 7:42:45 AM (GMT-6)

compiler said...
hrp:

The problem is we just don't know the answers to your burning questions.
Very frustrating.

Did you schedule the biopsy?

Mel

Can't schedule it until I meet with the urology doc on Monday.

I see more positive than negative. You have already decided on radiation. Get on with it. Why wait until January? Schedule it now and be done before Christmas.

Proton, EBRT and HDR Brachytherapy all can effectively treat the SVs, mine did. As Allen said, if you are G6 then the radiation alone should keep things at bay without combing HT. You may be one of the guys that radiation and Avodart has great and long lasting positive results.

In the event you have to add ADT, its not the end of the world or really even all that bad, from my experience. My diabetic and arthritic friends have it much worse than I have. You have already strengthened yourself, greatly modified your diet in a way to better control weight gain, and can probably tolerate drugs that minimize the hot flashes, like Megestrol.

As I read your signature and understand the ratings, you appear to be low to barely intermediate risk. This probably would not indicate ADT as part of the initial treatment. I question the real value of further studies at this time. They are going to continue to be physically and mentally annoying and probably won't tell you anything you don't already know or that would significantly alter the treatment course you have already decided.

I say radiate and get on with living a fun positive life.

Hrpuf,
I agree with JNF. If you already decided to have radiation there is no need to have another biopsy. The point of the biopsy is to verify SVI and eliminate surgery from the options. If you have already eliminated it then there is no need for the biopsy unless there is another reason that you or your doctor's have not mentioned.
JT

I have call into the radiologist who read my images yesterday. I'd like to understand what led him to recommend the biopsy and his confidence level.

Radiologist called back. He saw tumor at SV base and it is appears to him to be some invasion. He can't be sure if it's invasion or just my SV anatomy. He did say my positive 1mm is definitely not the entire tumor. He doesn't see anything less than .5cm. Also, thinks it would be very unusual if the tumor is Gleason 3+3 throughout. He rarely sees Gleason 6 spread to SV. He expects to see some 4 on biopsy. He thinks it is good idea to have biopsy to decide about surgery or radiation. When I told him I was going to have proton therapy I could tell he thought the biopsy had less value but said he would not offer and opinion on that.

He said he would rate the chance of SVI as moderate.

Post Edited (hrpufnstuf) : 8/22/2014 2:12:20 PM (GMT-6)