MRI results

I posted last week about my Dad's rising PSA. It went up about 3 points in a year while on Finasteride for BPH. As a concerned daughter, I have been educating myself regarding PC. I appreciate the information and support here on this Forum.

Last Friday, my dad had the MRI of his prostate region. Yesterday, the doctor reported the MRI showed a 1cm area that was of "slight concern". In speaking to the doctor, he was very reassuring, telling my dad that the "area" was contained within the prostate and that the next step will be for a fusion biopsy.

I suppose it's too early to be optimistic but I am relying on the doctor's seeming optimistic report that even if it IS found that the biopsy shows PC, that the MRI looks as though everything is contained.

Based on what I've learned here, that is at least good news.

To recap - my dad is a healthy 71 years young and has a history of BPH with rising PSA but no previous DX of PC. Two weeks ago his PSA was reported up about 3 points from last year and was 6.9.

Thanks again for any support, advice, education!!!

Thanks island time- I appreciate the positive input. I certainly hope you're right. I think he's prepared even if they find a few cells....but hopefully it won't be anything that requires intense treatment.

Mermaid, it's easy to get anxious about an MRI, a biopsy, or any test that could bring a diagnosis of cancer. Probably everyone on this forum knows that feeling. But, the odds are in his favor to have a good result.

Try to chill, and let us know what the MRI report finds.

I wouldn't sweat it at this point. By age 70, the majority of men have some PCa in their prostate gland statistically, however the vast majority of it is indolent by that age. The biopsy will provide more substantive data of course. Do you happen to know if the MRI was scored via the PIRADs system for PCa? Here's the scoring system:

radiopaedia.org/articles/prostate-imaging-reporting-and-data-system-pi-rads

Your dad is 71 years of age, and the average life expectancy for men in the U.S. is 76 years of age. Generally, prostate surgery is contraindicated for anyone with an average life expectancy of less than 10 years. So, if anything, at most, your father would be looking at some type of RT in the unlikely event that treatment is necessary. I also wouldn't sweat the biopsy being scheduled five weeks out, if the MRI results indicated a higher risk category, he would have scheduled the biopsy more aggressively. If anything, the five week scheduling makes his situation look favorable.

Even for high risk PC, 5 weeks is not likely to make any difference. Even high risk PC tends to grow slowly at first. There are many things that show up on MRIs that are not cancer. Conversely, many cancers do not show up on an MRI.

Be sure to ask the urologist for a "pelvic plexus block" or a "periprostatic nerve block." I think it's barbaric when they don't do that. It's not a bad idea to take some extra precautions against sepsis, either. Resistant infections are on the rise.

They always give antibiotics, but if you have a resistant strain that won't help. If he hasn't taken fluoroquinolones before, he's probably OK. Minimally, they can pre-treat the area where the needle is inserted with povidone iodine or chlorhexidine. If he's used antibiotics before, they can swab and culture for resistant e coli. And if the risk is very high, they can biopsy transperineally instead of transrectally. These are all things that are worth discussing with his doctor.

As you say, never assume. It's always better to ask. Some tertiary care institutions do some of these things as a matter of standard practice, while community care often lags far behind. To put this in perspective, sepsis only occurs in about 7% of cases in the US, so it is small, but rising.

I always start with general questions when I talk to doctors, and follow up with more specific questions. So, for example with anesthesia, I ask:

1. What kind of anesthesia do you usually use?
1a. If he says "general," i'd say: "Well my dad is 70 and I'm concerned about that."
1b. If he says "local," I'd ask " Do you mean topical, or a single injection? I've heard that a pelvic nerve block or periprostatic nerve block can completely prevent pain with minimal side effects. Can we do one of those?

For infection prevention, I'd ask:

2. What kind of infection prophylaxis do you typically use? (You should tell him about your father's history of antibiotic use, if any)
2a. If he says that the patient does an enema beforehand, takes a pill the day before, the day of, and the day after (this is the standard of care), and your father has a history of antibiotic use, you can say, "given my father's antibiotic history, I'm concerned about resistant infections, can we consider some additional precautions, maybe ... x, y or z" (Note: if your father doesn't have a history of antibiotic use, it's highly unlikely that there are resistant strains in there.)

The needle is sterile until it's used. What is treated with an antiseptic is the lining of the rectum where the needle will pierce it.