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Good bye AS?

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Posted 5/27/2017 10:03 AM (GMT -5)
Hello wise men and women of HW,

I had my 2nd MRI recently. The first 1.5T MRI was done only 3 weeks after my first biopsy so the results were inconclusive but did show a 9 x 14mm Pirads 3 lesion in the transition zone. The 2nd 1.5T MRI used an endorectal coil and showed a 14 x 24mm Pirads 5 lesion in the anterior mid TZ bulging into the anterior fibromuscular stroma. It also showed a 14mm Pirads 4 lesion in the mid and apical PZ as well as areas of Pirads 2 and 3 throughout the gland. The RO ordered a biopsy and a bone scan based on these results.
I had the biopsy (not MRI fusion) and the radiologist could see the Pirads 5 on ultrasound so two cores were taken there as well as the standard 12 core sextant biopsy.

It seems my time on AS will be brief. I will not be surprised to see my original G6 up(down?)graded.

My PSA has been fluctuating slightly but has been generally stable. I had convinced myself that it would take some gleason 4 results to convince me to go to treatment but would it be reasonable to continue monitoring if the biopsy does show only gleason 6?
Posted 5/27/2017 11:02 AM (GMT -5)
At this point, you have several suspicious areas. That's all that you or anyone else knows.

I have read posts from men with PIRADS 5 lesions, and fusion biopsies were unable to find any cancer there. I had one lesion that was downgraded from PIRADS 4 to 3 when they upgraded to the PIRADS version 2.0. So, the MRI's are not determining.

So, while there is certainly cause for concern, the facts will be in the biopsy pathology report. Let us know when you have it.

For me to go off AS, it would take a dominant pattern 4, or more than one 3+4 core with more than 10 percent involvement. Good Luck.
Posted 5/27/2017 1:38 PM (GMT -5)
Decide when you got the biopsy pathology report. The decision to start active treatment should be based on a change in the biopsy results (Gleason score, number of positive cores, length in the core involvement), or T-stage progression.
Posted 5/28/2017 2:58 PM (GMT -5)
Astronut

I've been on AS for 4 years with my stats for that in signature below. Last month I had an MpMRI identify a Pirads 4 lesion in the transition zone and now waiting for results from the fusion biopsy that I just had done.

Ill wait to see what the report shows and uro recommends before deciding on next steps but similar to you, my mind set right now is that if any gleason pattern 4 shows up, I'm inclined to come off AS. My primary rationale for that is my age. At 56 I hopefully have a good long run left so that eventually I'll need treatment for the PC. The best odds for results and recovery would by treating while I'm younger.

That said, let's hope both us have good results which allows us to keep going on AS. Good luck
Posted 5/28/2017 3:01 PM (GMT -5)
Signature included this time
Posted 5/28/2017 5:00 PM (GMT -5)
Thanks, RickTrin, good luck to you also. It looks like you are being well monitored on a good AS program.
Posted 6/6/2017 4:16 PM (GMT -5)
My updated signature includes the results of my second biopsy... 6 of 14 cores positive in 3 of 7 areas tested, gleason 6 and 7,(3+4 and 4+3). The 3 + 4 cores were almost 50/50% . The two targeted cores in the large PiRads 5 TZ lesion were negative and the PiRads 4 in the TZ was 4+3. Core involvement was about 15-20% .
So now it's time to leave AS and move on to treatment. I appear to be borderline low/high intermediate risk and the options (for me in Canada) are surgery, LDR or HDR brachytherapy (monotherapy) , or LDR or HDR-BT +23 sessions EBRT. I've decided that surgery is not for me and am leaning towards HDR-BT + EBRT.

Any thoughts on whether BT as a monotherapy might be a better choice?
Posted 6/6/2017 4:26 PM (GMT -5)
BT monotherapy is a good option and likely the first one I'd research. EBRT would be effective too. Close call.

Andrew
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