Hypoechoic Lesions

Hi all, had a prostate biopsy today and they did see hypo-echoic lesions, no nodules. Sounds worrisome. My PSA is right around 4 give or take. I have included the visit note from today below. No biopsy results yet, but I am a little bit scared. Would appreciate your comments. Thanks in advance, Craig

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Digital Rectal Exam: normal anal sphincter tone without rectal masses. Prostate free of nodules

Transrectal Ultrasound Exam: Prostate was viewed in transverse and sagittal planes. Hypoechoic lesions- r base and mid, left base. Prostate and seminal vesicles appeared to be symmetric.

A total of 10 cc 1% lidocaine was injected at the prostate-seminal vesical junction on both sides, and at the apices.

Using Ultrasound guidance, using imaging from both axial and longitudinal planes. prostate biopsy was carried out. A 12-core biopsy was performed, 2 biopsies in the base, mid, and apical regions of the prostate on both sides.

No significant bleeding noted. Patient tolerated the procedure and was instructed to rest for next 24-48 hours and to call with any fevers, chills, significant hematuria or difficulty urinating.

Follow-up within a week or two to discuss findings and management options.

Hello - Anxiety is expected and normal. Best thing to do is to just patiently wait for biopsy results and see where you stand. Keep in mind that the standard 12 sample biopsy only covers a small volume percentage of the prostate so a negative result does not mean you are all done, never to worry again.

I am a little surprised that a MRI was not done as that is becoming a standard evaluation tool. You may want to discuss with urologist when discussing results. Urologist takes their best shot with ultrasound imaging but it is quite limited compared to modern MRI imaging. Hang in there, could be nothing, could be something, nothing that can not be addressed and treated if necessary.

Will be the longest 3 weeks based on my experience. My urologist called me the next week after biopsy and gave me the bad news in general and said we would discuss the details at the 3 week meeting with spouse. He scheduled the meeting late in the afternoon so there would be plenty of time to discuss and answer questions. It was like waiting to get by a bus.

Some folks get their biopsy results posted in their medical records system nowadays so you may want check for results. Usually about a week later. Sorry to hear about the BB accident, a MRI could take care of those pretty quick then you would not have to worry about them.

Thanks so much for the replies. It is a comfort to talk with you guys. I think my results will come through the records system at some point and will post them here for anyone who wishes to comment. Thanks and regards, Craig

Hi Craig. Here's my understanding of hypoechoic lesions. Almost any change from normal whether benign or malignant makes the tissue less compact, so more sound energy passes through, and the area shows up darker on the ultrasound screen (less reflection back to the probe = "hypoechoic"). If you uro isn't aiming for specific MRI-identified lesions, then you probably had a random core taken in that prostate zone. If your doc sees a darker area in that zone, they will aim for it, so "random cores" aren't always strictly random. These areas are "suspicious" for cancer. As yet, no imaging method, whether MRI, CT, or US can diagnose cancer, which requires microscopic examination and, as mentioned, hypoechoic lesions can result from benign conditions.

I asked my uro for the percentage of patients for whom he sees at least one hypoechoic lesion somewhere in the prostate, and he estimated it at about 50% of biopsies.

Post your complete results when you have them, and we'll try to give you some info and, more importantly, some questions/topics to discuss with your uro should it turn out that there is cancer. The name of the game here is One Day at a Time ;)

Djin

Yeah, I think many of us have BB gun stories. I wonder if kids still shoot BB guns. Oh l forgot, kids don't go outside anymore. 😀

Craig, I wish you the best results going forward. This forum will always be here to support you through any decisions you make.
OT, As far as BB guns. A group of 14 kids all in the six grade including me, split up into two teams. Some had BB guns the most of us had home made sling shots. The rules were no large? rocks would be used in the sling shots. If you got hit you were out. One team went into a three story abandoned business with the windows missing. The other team was on the ground seeking shelter behind trees and bushes. My best friend was hit under the eye and the BB stuck there. I was hit in the head with a large pebble. My best friends mom forbade me to see him again. That was the last time we played Army. Oh and we also used an abandoned wet down slab of cement to play slip and slide on. I still wonder today how I lived to be be 70 years old.
Again Craig, my best wishes.
Jack