My latest MRI results

Hey guys,

Here are the results of my latest MRI from yesterday morning.

The last (1st) MRI did not show any lesions. We already had biopsy scheduled for next month.

At the last appointment in April the doc said he would not recommend surgery even if it was free. It was prompted by my stating my deductible will be fully paid by the time of the biopsy and if it would make sense to do the deed now as opposed to waiting when it may cost a lot more than free.

He said the risk of possible side effects outweigh the fact the odds are that I would never need to have and type of treatment, other than AS in the future.

I thought that was a pretty good diagnosis. Hopefully the lesion they found will the nothing but a lesion when we get the biopsy done.

MRI OF THE PELVIS/PROSTATE WITH AND WITHOUT IV CONTRAST

REASON FOR STUDY/CLINICAL HISTORY: 56-year-old male with Gleason 3+3 prostate cancer, on active surveillance. TRUS biopsy 9/23/2019 showed Gleason 3+3 = 6 prostatic adenocarcinoma of the right apex. Most recent PSA = 4.2 ng/ml on 4/5/2021.

COMPARISON: Prostate MRI dated 4/24/2019.

TECHNIQUE: Multiplanar, multisequence MR imaging of the pelvis/prostate was performed without and with IV contrast.

INTRAVENOUS CONTRAST ADMINISTRATION: IV Contrast Dose is documented in the electronic medical record


FINDINGS:

GLAND CHARACTERISTICS:
* Prostate size and volume: 3.2 cm x 5.7 cm x 3.3 cm and 31.5 cc
* PSA density: 0.13 ng/mL/cc
* Hemorrhage: Absent

PROSTATE ZONES:
Transition zone: BPH

Lesion # 1:
* location: Right mid gland and base anterior more so than posterior transition zone
* Size: 1.6 cm
* T2: Heterogenous signal intensity with obscured margins, sequence category 3
* DWI: Focal mild/moderate diffusion restriction, sequence category 3
* DCE:N/A
* Lesion overall PI-RADS Category: 3

Peripheral zone: Normal
No high-risk lesions identified.

CAPSULE AND ADJACENT STRUCTURES:
* Extracapsular extension: None
* Neurovascular bundle: Within normal limits
* Seminal vesicles: Within normal limits

ADDITIONAL FINDINGS:
* Urinary bladder: Diffusely thickened, trabeculated appearance of the urinary bladder wall consistent with chronic outlet obstruction.
* Lymph nodes: Within normal limits.
* Musculoskeletal: Within normal limits
* Other findings: None


IMPRESSION:
1. PR-3 lesion involving the right mid gland and base transition zone measures 1.6 cm
2. No evidence of extracapsular extension or metastatic disease within the pelvis.
3. Findings of BPH with sequelae of chronic bladder outlet obstruction.

Thanks again for all you do. I haven’t been in much. Life takes over and I kind of forget about the issue until time for tests come back around.

Larry

I was saying after a trip to the hospital for something else and the MRI my deductible would be met even before we do the biopsy.

That is why I asked if maybe now would be a good time for surgery since the deductible would be met.

Sorry if I confused anyone.

The lesion is in the same area that had the 3+3 before. It just didn’t show up on the previous MRI.

Personally, if that were my prostate, I would do the same. <ADD>IF the proposed biopsy is transperineal and targeted. I would NOT, PERSONALLY rely on a second TRUS</ADD>

In terms of AS, I sat on far worse for far longer, so maybe you shouldn't listen to me. But I note your BPH symptoms. It was the LUTS that got me in the end: two cases of UAR (really really painful) and I was on that table for what I call a "Radicalised" prostatectomy. You're young and will need to do something sometime so use some of the time research the options (including, based on my experience, surgeons.)

Young and with low grade low involvement PCa with some BPH and a fairly normal size prostate. You appear to qualify for AS, but it includes the ongoing rigors or testing and scans and biopsies. And some 50% of AS men end up treating either because the cancer advances or they get tired of doing the AS.

Personally, I wouldn’t relish the thought of AS activities for the next 30+ years, particularly since there are extremely effective non-surgical treatment options for you. Clearly, surgery on a G6, 2 core, 5% involvement man is the very definition of overtreatment that many have railed against due to the significant incidence and risk of ED and incontinence. Why risk these at age 53?

You appear to be an excellent candidate for High Dose Rate Brachytherapy using a single mono-therapy fraction, or at most 2 fractions, depending on the specialist. Walk in at 10:00 and out by 2:00. No cutting, no catheter left in and no radiation left in the body. All the vital plumbing and nerves left completely intact. Great cancer control with minimal, if any, negative treatment side effects.

HDR-BT is more conformal to the Prostate and cancer than either surgery or any forms of external beam radiation. Presents less side effects than any external beam radiation as the radiation does not pass through healthy tissue to get to the cancer. And it provides the most convenient treatment in terms of time spent, number of procedures, healing, follow-up, etc. Many men on this board have successfully used HDR-BT with great long term results. Any of us would be happy to save=re our specifics and experience with you.

I agree (100%) that radiation therapy should be studied.
In addition to HD-Brachy, there's Stereotactic Body Radiation Therapy (SBRT). Parameters for the latter are based on those for Brachy.
People often refer to SBRT as CyberKnife, but the latter is just one of the possible instruments that can be used. What is most important though is the quality and experience of the radiation oncologist and his/her team.

Shaw, how has surgery recovery gone for you so far? I hope it has been smooth sailing.

Thanks for the words of advice!

BBQ dude,
The trick to understanding Logos is to always ready every word.
Making a choice may have more power/ consequence than anticipated.