Our saga continues....unbelievable!

Hubby had his MRI at MD Anderson on Sunday. It was a 3t but also with an endorectal coil.
This morning we were in the car driving to the hospital for his pre-op appt ahead of his biopsy on Thursday when we received a phone call saying all appointments and surgeries were cancelled due to the coronavirus scare. We turned around and went back to the hotel, packed up our stuff and made the six hour drive home.
we received a phone call about an hour ago saying they still want to do the biopsy on Thursday as the MRI results weren’t very good.
now we have to drive all the way back there on Wednesday.
We just received this message from the Dr.

“I recognize the mixed messages you have received today regarding the status of your planned prostate biopsy for this Thursday. I appreciate your patient with us as we is an institution try to sort through the current coronavirus pandemic and our balancing our patient's need for cancer care with the needs of the community for Covid-19 care and our attempts to quell this emerging healthcare crisis.

Late last night I was instructed to cancel all fusion biopsies. This instruction was subsequently confirmed on a conference call this morning. Following that conference call I received the results of your MRI performed earlier today. The findings on the MRI surprised me and caused me to petition on your behalf to be allowed to proceed with the biopsy this Thursday. I've now been given permission to proceed. This is the reason you received a second call now rescheduling your biopsy for this Thursday.

The MRI findings suggest a much higher volume and grade cancer than was identified
on your initial biopsy. I think it important to proceed with fusion biopsy on Thursday to better characterize your prostate cancer.

On Thursday we will have to complete the consenting process in the preoperative holding area. He will be receiving a telephone call from our anesthesia Department to receive clearance for anesthesia on Thursday.

The results of the biopsy will take approximately a week to receive and I will follow-up on the results of these biopsy through this my chart system.

If you have any questions, please feel free to address them to me and my team through this MyMDAnderson portal.

Result Date: 3/16/2020
Highly suspicious cancer foci noted in the peripheral zones bilaterally, with possible extracapsular extension and neurovascular bundle invasion on the left as well as possible extracapsular extension on the right.

I’m very thankful he petitioned to be able to go ahead and do it!

Dang, Star, that stinks! But, in this PC + Covid-19 word, what are you going to do? As Djin said(and as you are of course doing), soldier on!

Well that stinks out loud. Things are so scattered right now. I hope you get better than expected results. Be safe. Donna.

Star, tough news, but obviously yhou've now got reason to feel like your with a Dr that really cares and is advocating on your behalf. Hang in there, trite as it sounds, is all i can offer.

Agree with all, and especially Djin's comment about the dual biopsy, if possible.

Maybe finally you'll get the quality experience that MDA is famous for. It would be interesting to hear what this new doctor has to say about your biopsy reports.

Hi Star, EPE (extraprostatic extension) and ECE (extracapsular extension) are two terms for the same thing. I think it just varies path lab to path lab which one they use.

Seminal vesicle invasion is separate from EPE. You might think SVI is a form of EPE ("outside the prostate), but EPE is used like ECE to mean that growth has come through the capsule. The degree of EPE is usually indicated with a description, e.g. focal, multifocal, non-focal, extensive, and may have the number of focuses, a measurement, etc.

As you probably know, while EPE and/or SVI increase the risk of BCR down the line, their presence does not mean that primary treatment won't be curative.

Djin

Post Edited (DjinTonic) : 3/18/2020 8:04:39 AM (GMT-6)

star0210 said...

His MRI report uses both terms which is why I’m asking.
For one lesion it says EPE and on the other one it says ECE.

I'm not sure. Perhaps, e.g. if there is evidence of growth into the seminal ducts or bladder neck, one might use EPE, since there is no capsule to grow through in those cases (?)

I don't know if the capsule is present at the base of the prostate. If growth extends outward there (e.g. the nerve bundles), perhaps one would use EPE (?). I checked one study that looked at EPE and then had the percentage of those men who also had SVI, which is why I believe these two are non-overlapping terms. Perhaps the location of these lesions can give you a clue as to why they used both terms.

As far as post-RP path reports, they all seem to state either EPE or ECE was identified or not identified; I've never come across one that has both terms. Perhaps MRI reports make a distinction.

Djin

Hubby had his fusion biopsy this morning. They took 15 samples...7 targeted from the 3 separate areas of concern and 8 random from other areas.
Of the three areas of concern, one was high risk, one was medium, and one was low. The MRI identified only two areas of concern both pi-rads 4. I’m not sure if the third area was one he identified today via the ultrasound or if he took that from the original biopsy results.
It will be at least a week before we get results.
We’re taking it easy today and will drive home tomorrow.

From the summary....
1. ROI #1 0.14 ml, left lateral base, medium risk
2. ROI #2 0.55 ml, right lateral mid, high risk, central zone was associated with a hypoechoic region
3. ROI #3 0.1 ml, right medial apex, low risk