Need Help Understanding MRI Findings

My husband had an MRI this morning followed by his 2nd biopsy which was 16 needles. The doctor that did this biopsy was not our usual doctor.

Post Edited (Jack & Diane) : 4/18/2017 4:08:24 PM (GMT-6)

Remember that mpMRIs identify suspicious areas, not cancer. You'll know a lot more from the biopsy. Whatever it is, it is in an unusual place - the transition zone - and has bulged through the urethra. I would guess that this is probably interfering with his peeing. Often this occurs because of BPH - you'll have to wait for the biopsy. He doesn't mention anything in the anterior, so it may be the bulge that he's calling ECE is from the TZ disfigurement pushing forward, or there may be some other lesion in the anterior zone that doesn't show up on mpMRI. I assume they biopsied in both places, so you'll know more soon.

If it's BPH in the TZ (which is common), Jack may need a TURP. If it's PC in the TZ, he may be better off with surgery than radiation - radiation might cause inflammation and urinary retention at first (before it reduced), whereas surgery would relieve the obstruction immediately.

I suspect he didn't want to answer your questions because your usual doctor should be answering them, and he didn't want to step on any toes.

It's easy to get confused by all the scans and other diagnostic tools we all discuss on this site. They all have their uses in different situations. For right now, Jack has had exactly what he needs in terms of scans. You'll know more after you see the biopsy report. Try to stay focussed on the present, if you can.

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Your husband has many options ... and you both, fortunately (i.e., 3+4!), have plenty of time to sort through them. I had *very* similar biopsy results and decided to go to a major research center rather than continue working with the appealing and presumably competent surgeon to whom my family practitioner referred me and who performed my biopsy. My first urologist did a prostatectomy every week or two but, if I was headed down that road, I wanted a surgeon who was doing one or two a day and had thousands of prostatectomies under his belt.

Although it was not as convenient, I think it was the right decision to "escalate" my case from a "community" urological practitioner to a top-tier university team. In my case, my surgeon advised that radiation was also a reasonable choice and the radiation oncologist I saw advised that surgery was also a reasonable choice. Because of the similarity of our biopsy results, I would not be surprised if your husband got similar advice. In fact, if either the surgeon or the RO felt very strongly that you should rule out the other's therapy, that would be worth probing quite deeply. Given your husband's age, I suspect the usual calculus may tip more in favor of surgery than in my case where the odds of a cure were very close. But the fact that he will likely live much longer with the side effects of any treatment may give radiation the edge. You and your husband will get amazing help on this board in sorting that out.

T

I'm jealous. I had to wait 12 days (!) to get my catheter out. Glad Jack can now focus on mending without having to mind the bag. And, for sure, there is a lot of good news in the pathology report.

To your question about the surgical margins, you'll probably get some very knowledgeable responses soon. My surgical margins were negative so I did not go down this path myself, but I imagine the question will be whether it makes sense to proceed with adjuvant radiotherapy after your husband has healed from his surgery. His first meaningful PSA test will probably be 6-8 weeks post-surgery and that will provide some important input to help guide next steps.

You might find it helpful to read this discussion of surgical margins by three Harvard physicians, but note that their exchange took place in 2009 and was last reviewed for accuracy in 2011. This field moves fast so there is a lot of information these doctors didn't have when they recorded their chat.

Finally, it's not always easy, but it's important to take vacations from worrying about all of this. This is a good time to focus on health--eating well, exercising, enjoying life, etc. For me, getting back on my bicycle was critical. My surgeon gave me the go-ahead for 30 miles rides in the hills about 8 weeks after surgery. After the first post-op PSA test will be soon enough to consider what comes next. We'll be here.

Absolutely good that it was 3 rather than 4 at the margin. Absolutely good that is was only 5% 4. You have good reason to take a breather from worry. I heartily second TA's advice to focus on the present. Also, you don't need to worry about high-grade prostatic epithelial neoplasia. I saw HGPIN on my path report and got all bent out of shape until I found out what it was. Despite the ominous name, it's generally understood to be a precursor to prostate cancer and is found in the majority (in some studies 100%) of post-surgical pathology exams. Once you've been diagnosed with PCa, the presence of a precursor for PCa is more or less irrelevant.