New guy ramblings and questions

beaverduck said...

I'm very interested in this pre-biopsy MRI you and other folks have mentioned. Seems to make a lot of sense. We'll see what the Uro says and what my insurance allows...

I'm really only responding to your expressed interests, but this topic warrants further discussion with your urologist at your next visit. Here's a bit of education to carry into that discussion...


Multi-parametric (mp) MRI is capable of detecting clinically significant PC, and generally "overlooks" the more commonly occurring insignificant PC...background info. (For more on this, do your own google research on the term: pi-rads)

"MRI" technology is useful in two completely different capacities.

(1) MRI-guided prostate biopsies. The more traditional biopsy method is the TRUS-guided biopsy--trans-rectal ultra sound-guided biopsy. Ultrasound technology is embedded into the hand-held tool (inserted rectally) used to clearly see the shape & size of the prostate, and then to "fire" the sampling needles "blindly" into a standard array pattern of prostate sectors that are "visible" from a practical manipulation perspective during the procedure. Therein lies some of the problem (addressed in part (2))...portions of the prostate, at the apex, are "out of reach" of the tool and cannot be effectively sampled.

With a MRI-guided biopsy, the urologist will still typically pull samples from the standard pattern of sectors covering (accessible portion of) the prostate similar to the "blind" TRUS biopsy, but will also use the MRI technology to look for likely areas where possible clinically significant PC may exist, and pull additional biopsy samples from that area. This is obviously of great value because insignificant cancers are ignored--as they should be (except for the random encounter)--and false-negatives (which are the bane of TRUS-guided biopsies) are reduced.


(2) mpMRI scans. Despite the personal "opinions" of some HW/PC members who wave-off the risks (based on their own sample size experience of one), urologists generally recognize the significant risks of serious complications from prostate biopsies. Prostate biopsies remain an important tool in the clinical stages and cannot be completely eliminated, but doctors recognize that prostate biopsies have recently been over-prescribed and unnecessary illness and even deaths from complications have resulted. mpMRI scans have been shown to eliminate the need for unnecessary prostate biopsies in greater than 25% of men at risk when no significant cancer is found.

As discussed above, the standard 12-core TRUS-guided biopsy performs poorly both in detecting and ruling-out clinically significant prostate cancer. In addition to avoiding unnecessary primary biopsies in a significant portion of at-risk men, those who have findings with suspicious area(s) can be subsequently targeted in a biopsy--even with the standard TRUS-biopsy, which can come close to the sensitivity level of template mapping/saturation biopsies.

And perhaps most valuable is that the mpMRI scan can "reach" (aka "see") areas in the prostate apex unreachable by the standard needle biopsy...I think there's been men who have commented here in this thread how thankful they were to have their aggressive (rare) PC identified by a MRI scan AFTER their standard TRUS-guided biopsy found nothing.

MRI imaging technology has emerged as an important PC clinical tool in the past decade. I suggest having a discussion with your urologist about which of these MRI modes he/she commonly uses, and why/why not.

You had questions about KP. Had it for a while in So Cal. Worst insurance ever for me. KP keeps switching docs. on you. You have to be your own advocate and tell them what you want done. Had a good friend that they killed at 45 through poor treatment. They kept putting him off till he was dying. Then their support was excellent till he died. Biopsy, There is a MRI guided biopsy that takes the samples at the exact points the mri locates. And again , don't let them rush you into any type of treatment, especially surgery.

When I had my biopsy, Cancer was found in five cores, none of which were from my previous MRI lesion areas, which was guiding the biopsy.

Prostate cancer isn’t a one size fits all disease. Just look at the histories in posts to see the wildly varying Dx, treatment and outcomes, remember that when evaluating advice from forums. Losing your father so young certainly weighs on you, discussing genetic testing might help with that. As far as insurance, You have the advantage of being able to switch at the next open enrollment, unlike employer plans, in this early stage of DX. Dealing with the unknown sucks and honestly will continue throughout the process. Hopefully this is a scare with some knowledge being pickup along the way.

alephnull said...

"prostate cancer is one of the most common, and least lethal of all cancers...period."

This is very true for lower end Gleason scores(G6 and 7 (3+4). ... Us 9 and 10 account for the vast majority of deaths every year.

OK.

Let’s put it this way: survival of those diagnosed with prostate cancer is stunningly different—stunningly better—than survival of many other cancers. Most would contend that this is even true when considering only the high-risk PC cases (ref. alphanull’s self-reflective musing focused on “Us [GS] 9 and 10...”).

[GS, btw beaverduck, stands for Gleason Score, which is the primary measurement (with a confusing, unbalanced scale) of aggressiveness coming from a prostate biopsy. GS 9 & 10 are high-risk cases; GS 10 is the highest possible. Oddly, GS 6 is the lowest possible score.]

Start with a very broad perspective. In the US, in the most recent period reported by the American Cancer Society, here’s a few selected 5-year survival rates (all cases):
-Pancreatic cancer = 9% survival; pancreatic cancer is, however, relatively rare
-Lung cancer = 20% survival; lung cancer rates of diagnosis are similar to prostate cancer
-Prostate cancer = 99%

Drilling-down, alphanull reports that survival is lower amongst the advanced PC cases. This is technically true (and obvious), but advanced PC cases are not common…and are rare amongst those under age 60. Numerous studies have reported Gleason Score stratification according to age at diagnosis. Here’s the survival rate results of one recent report (LINK):
-Age LE 60: 96.7% GS <8…so, only 3.2% of all new PC cases for those under age 60 are diagnosed GS 8, 9 or 10. Here’s the rest of the data:
-Age 61-70: 88.1% GS <8
-Age 71-75: 82.2% GS <8
-Age 76-80: 62.5% GS <8

Drilling-down even further into the mortality of high-risk cases only (which is the very limited subset that alphanull is talking about), again numerous studies are available with roughly similar (not identical) reported results. Outcomes can vary widely as a result of MANY FACTORS BESIDES GLEASON SCORE (such as clinical stage, initial PSA, etc., and to a minor extent (probably surprising, to some) treatment mode). But looking at the Gleason 9 & 10 cases as a whole, 10-year cancer-specific mortality rates (in this recent report, LINK) varied only between 4.4% and 8.8%...in other words, 10-year PC survival for the high-risk GS 9 & 10 cases was greater than 90%. That doesn’t mean nobody dies of PC, but at 90% in 10-years, even high-risk PC stacks up very favorably against just about any other cancer survival rate.

So alphanull’s comments quoted above may be technically and narrowly correct, but it obfuscates the meaningful big picture for the original poster…a newcomer in his 40s (not even diagnosed, yet) who is just trying to learn/understand the big picture. This site is at its best when we put ourselves in the shoes of the newcomers.

Based on data, I stand firmly behind the original big picture rule of thumb for our new friend beaverduck: prostate cancer is one of the most common, and least lethal of all cancers...period.

Post Edited (Blackjack) : 1/14/2019 3:32:49 PM (GMT-7)

Mumbo said...
BJ - However, the macro statistics are fine until it is you visiting this forum which means your odds have just changed considerably from the national statistics.

Your statement is roughly the same as a caution I have issued many times to those who use statistics less frequently (and perhaps should have included here)

Statistics are estimates that describe trends in large numbers of people. Statistics cannot predict what will actually happen to any one individual.

Thanks for your reminder. This additional note, however, may be relevant to the long-term “veteran” members of HW/PC, but wrt newcomers it is only relevant in the way it may color their interpretations of “vet” replies which may not have been made from—as I previously mused—from the newcomer’s perspective...which I guess was the whole point of calling-out alphanull’s narrow comment.

You are welcome! Pleased to help you along. The basics of prostate cancer, the pointers & the "rules of thumb" that I provided were things I wish I new when first diagnosed 10-years ago (also in my 40s)...so I'm very glad to help jump-start you with the important knowledge & information every newcomer should have.

Many of these points are also in the "sticky thread" (top of the thread list) in the posting titled: "Newly diagnosed with PC? – read this thread first"

Best wishes...

Yes, a long history of condescending and pedantic behavior through a half-dozen different identities. It’s become so annoying that I’m thinking of using the ignore function for the first time.

This is supposed to be a Support site.

Alephnull, you forgot his infamous moniker Casey59. His core messages might have merit but all is lost in his condescending tone and insults. A real shame.

I apologize for going off. He and I have not been pleasant to each other for quite awhile.

I also apologize to all the other posters for steering this thread where it shouldn't have gone.

Tudpock18 said...


Gary, unfortunately there is no specific rule against using multiple identities or being condescending......

It appears that the OP on this thread was not offended and that is good. For others that were my best advice is to use the ignore function...

Sounds reasonable to me. Thanks, Jim