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Posted 7/28/2015 2:53 PM (GMT -5)
Hi,

I'm 44 and just received the results of an abnormal abdominal prostate ultrasound ordered by my primary care physician. Since my urology appointment is 10 days away, and I'm in freak out mode, I'm hoping to get some information about what to expect going forward. Do these findings warrant an immediate biopsy or is this something that will be watched closely first? I've been googling every possible phrase from the report's findings and impression, and not coming up with much useful information.

No Signs/Symptoms
PSAs: 0.6 12/2010, 0.4 12/2012, 0.4 12/2014

FINDINGS:
The prostate gland measures 4.2 x 3.4 x 4.2 cm. There is hypoechoic nodules seen within the ventral peripheral prostate gland abutting the floor of the urinary bladder. Mild extrinsic defect is seen in the floor of the peripheral prostate gland abutting the floor of the urinary bladder. It mesaures 1.7 x 1.2 x 1.2 cm. It does not demonstrate increased vascularity.

IMPRESSION:
Hypoechoic peripheral nodules seen along the ventral aspect of the prostate gland with mild extrinsic defect seen within the floor of the urinary bladder. Transrectal prostate ultrasound can be performed to further delineate this finding.

Post Edited (rja1797) : 7/28/2015 2:06:42 PM (GMT-6)

Posted 7/28/2015 4:09 PM (GMT -5)
It's always disturbing to be told that something requires further examination. All kinds of possibilities race through one's head, I know.

Here are a few of reasons not to freak out:
(1) Your PSA is super low. There are only some extremely rare forms of prostate cancer that would have PSA as low as that.
(2) Prostate nodules are common. Most often they are not cancerous.
(3) You are only 44. Prostate cancer is extremely uncommon in a man that young.
(4) The doctor recommended a transrectal US rather than a biopsy at this time.

Even if it's just a benign growth, its location at the bladder neck may be causing obstruction. Are you having trouble peeing? While your prostate is normal in size (31.5 cc), bladder neck outlet obstruction may have to be dealt with even if there is no cancer.

- Allen
Posted 7/28/2015 4:51 PM (GMT -5)
Allen,

Thank you for your response.

I do not have any of the typical Urinary symptoms.

Are all transrectal US done using color doppler these days, if not, it is wise to request that further imaging of my prostate be done using color doppler?

- John
Posted 7/28/2015 4:56 PM (GMT -5)
Hi John,

Color Doppler US is a very highly specialized technique that only a few doctors in the US are proficient at. It is considered experimental by insurance companies and probably will not be covered. I'd suggest you go ahead with the TRUS first and see what that tells you.

- Allen
Posted 7/28/2015 9:38 PM (GMT -5)
You can also request a T-3 MRI scan if a Tesla Three machine is available in your area...This scan can locate and pin-point abnormalities better than ultrasound and most other imaging techniques..But in the end, the only 100% sure and accurate technique is the biopsy which in your case may be overkill.....
Posted 8/4/2015 7:46 PM (GMT -5)
At my urology appointment today the Dr. informed me that after looking at my scan images, the 1.7 x 1.2 x 1.2 cm nodule identified by the radiologist was just a cyst. This was exactly the news I was hoping to hear, and although I had several questions, I did not want to challenge this Dr with 35 years of experience about his findings. He proceeded with a DRE and said everything felt normal and to come back in a year.

Is it possible to identify a cyst vs something more concerning simply by looking at abdominal prostate ultrasound images, or is the Dr. using my age (44) and low PSA (.4) to determine the probability of what it could be? Should I seek a second opinion on this?

With all the prostate research I've done in the past week, it will be hard not to think about this mass inside my prostate on a daily basis.
Posted 8/4/2015 8:14 PM (GMT -5)
Rja, while I cannot directly answer your question, this might ease your mind.....

I know for sure that U.S. Is often used after a questionable mammography, to differentiate between a breast cyst and a breast tumor, and it has a high degree of reliability (over 90%). I would think that this might translate to the prostate as well. There is nothing wring with asking the Dr that question to ease your mind .

Congratulations on what certainly seems like a great outcome
Posted 8/4/2015 8:25 PM (GMT -5)
Cysts are hollow sacs filled with fluid, so they look very different from cancers. You can relax.

- Allen
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