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Prostate harder on one side.

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User
Posted 01 Jul 2018 at 03:19

I'm 72 with an enlarged prostate, which I believe is normal for my age, but I'm told it feels harder on one side. Latest PSA three months ago was 6.3 which seems to be Ok for 72. Just. I'm to have another PSA this coming week and of course am getting paranoid. I'm approaching 5 years since emergency surgery for bowel cancer and can't face a new problem. But I'll have to if necessary. Any thoughts? 

User
Posted 20 Jul 2018 at 23:04

Originally Posted by: Online Community Member


Also latest research supports the view that if it's not visible on MpMRI it is not clinically significant disease so you can do without any biopsy.


 


That might be a good generalisation but a) my OH had a completely clear scan even though the cancer was in every section of his prostate and had also moved to the bladder b) CJ has a post op PSA of about 50 so obviously has mets but his scans come back clear. There are just some types that don’t show up. 


Biopsy is not fool-proof but neither is a scan, regardless of whether it is mpMRI or old-style. Put the two together and we are starting to get somewhere near reliable. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 14 Oct 2018 at 23:46
And he will refer me to an Oncolgy radiographer I think it is, for a discussion about what to do next, if anything. There is a 12 week wait here with about 130 men on the list, but as mine is just a consultation I shouldn't have to wait that long. So I was told last week. We shall see! Trying to put it at the back of my mind. The good news is that the 5 year all clear for my bowel cancer is now under a month away, with no concerning colonoscopies, blood tests or checks so far. Best wishes to all. John.
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User
Posted 01 Jul 2018 at 18:15
Dennis, as you know perfectly well, you are a worrier but so far you have nothing to worry about. Nobody has diagnosed PCa and your PSA is not unusual for one with an enlarged prostate. So relax and put ifs and maybes to the back of your mind until you have some facts on which to base your feelings. There may be more diagnostic tests before you have the facts. Relax.

AC
User
Posted 05 Jul 2018 at 03:25
I'm now on 7.4 PSA, which is a rise of 1.1 from 3 months ago. Dr will refer me to a specialist who will no doubt do a DRE and whatever else he thinks necessary. I will have another PSA in a months to look for a trend. He said 7.4 is not a major worry aged 72, it's any upward trend that is interesting. Not the news I wanted, but could have been worse I guess.
User
Posted 18 Jul 2018 at 21:56

Saw a specialist who agreed there was a nodule so now need a biopsy. Possibly in about two weeks. Looking up various sites and getting contradictions, but he said no it doesnt hurt and I believe there will be blood for a while in stools, semen and urine for a while. I'm not going to Google any more. Funny really, I advise others not to but I still do. Hmmm... 

User
Posted 20 Jul 2018 at 08:26
The best practice is to have a multi-parametric MRI scan PRIOR to any biopsy, as the result might render one unnecessary.
User
Posted 20 Jul 2018 at 10:00

Originally Posted by: Online Community Member
The best practice is to have a multi-parametric MRI scan PRIOR to any biopsy, as the result might render one unnecessary.


I wish you were more precise with your assertions. mpMRI should not rule out a biopsy as there are some prostate cancers that do not show on even the most advanced of scans. Template biopsy is not 'best practice' ... it is the best first step for some men in an increasing number of (but not all) regions. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Jul 2018 at 10:50

Originally Posted by: Online Community Member


Originally Posted by: Online Community Member
The best practice is to have a multi-parametric MRI scan PRIOR to any biopsy, as the result might render one unnecessary.


I wish you were more precise with your assertions. mpMRI should not rule out a biopsy as there are some prostate cancers that do not show on even the most advanced of scans. Template biopsy is not 'best practice' ... it is the best first step for some men in an increasing number of (but not all) regions. 



I said an mpMRI “might” render a biopsy unnecessary and moreover would give the surgeon an idea of where to sample during the biopsy. I didn’t mention template biopsy on this occasion, but two friends, one with BUPA insurance and the other with loads of money went privately and had the MRI first and then a template biopsy. That is “best practice” if the NHS is not involved.


I got exactly the same on the NHS by asking nicely.


Cheers, John

User
Posted 20 Jul 2018 at 12:59
Template biopsy carries a higher risk because of the anesthetic and all those punctures. If there is a clear target from an MRI a TRUS will normally suffice.

Also latest research supports the view that if it's not visible on MpMRI it is not clinically significant disease so you can do without any biopsy.
User
Posted 20 Jul 2018 at 13:02
User
Posted 20 Jul 2018 at 13:45

I logged in to the hyper-link to this learned paper eventually, and after reading a load of medical jargon (lucky I studied Latin 50 years ago), the last paragraph contained the most salient point:


“In some countries, such as the UK and Australia, there is widespread use of prebiopsy MRI across different settings. In light of the work by Panebianco et al on intermediate-term outcomes for men with a negative regarding the significance of a negative MRI, in conjunction with PROMIS and PRECISION, the time has come for urologists to strive to make prebiopsy MRI available to all men being assessed for prostate cancer.”


 

Edited by member 20 Jul 2018 at 13:46  | Reason: Not specified

User
Posted 20 Jul 2018 at 23:04

Originally Posted by: Online Community Member


Also latest research supports the view that if it's not visible on MpMRI it is not clinically significant disease so you can do without any biopsy.


 


That might be a good generalisation but a) my OH had a completely clear scan even though the cancer was in every section of his prostate and had also moved to the bladder b) CJ has a post op PSA of about 50 so obviously has mets but his scans come back clear. There are just some types that don’t show up. 


Biopsy is not fool-proof but neither is a scan, regardless of whether it is mpMRI or old-style. Put the two together and we are starting to get somewhere near reliable. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 29 Jul 2018 at 10:12

Dr phoned me! And said no MRI but a biopsy on 3 September. Have to go to public hospital as private is $NZ900. It would have been done by now privately, but now I'll try and enjoy August. 

User
Posted 29 Jul 2018 at 11:21
Put it to the back of your mind while you can :-)
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Sep 2018 at 00:38
Well, biopsy is only 27 hours away now! Nervous, of course. But it must be done then the waiting begins for the results. Thousands must be done every year, so it's just a routine procedure. I've been through emergency bowel cancer, a large mesh repaired hernia and gall bladder removal in the last 5 years, so this is nothing. Hmmm. Post surgery infections and cellulitus for extras too. Right, have I convinced myself not to worry?
Sorry, nothing really bothered me health wise until the bowel cancer scare, now I get paranoid over every little twinge.
User
Posted 03 Sep 2018 at 05:30
And all over and not too bad really. The worst bit was a vigorous DRE to begin. Results in 2/3 weeks or so. Thanks all.
User
Posted 05 Sep 2018 at 10:49
Good luck with the results Dunniz
We can't control the winds - but we can adjust our sails
User
Posted 20 Sep 2018 at 00:32
Thanks all. He took 13 samples. 6 on the left were benign, but 2 of the 7 on the right were cancerous. Gleason score 7 (3+4) which could be worse. Grade Group 2, intermediate favourable. It is contained and no perineural invasion or extraprostatic tissue identified. I'm trying to make sense of the terminology but it doesn't sound too threatening. I have to wait for the Urologist to discuss treatment, if any. Maybe watchful waiting or active surveillance? Radiology? We shall see ...
User
Posted 20 Sep 2018 at 00:38
That must be some relief, which seems an odd thing to say to someone that has just had a cancer diagnosis! As you say, an intermediate cancer and from the sound of it, quite small - it will be interesting to know what % of the cores were cancerous; you could ask the urologist when you see him / her.

AS might not be first option with a G7 - some hospitals would only advise it for a G6. They may suggest a bone scan before you decide on treatment, just to ensure they have a full picture.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Sep 2018 at 01:20
I think tissue involved 20% must mean 20% of the two ardenocarcinoma cores? I like the word favourable for the G 7 (3+4) compared with unfavourable for G 7 (4+3.) Latching on to all the positive words I can find! Thanks for your reply.
User
Posted 20 Sep 2018 at 02:31
I would think so - and seems it is well inside the gland rather than being the 20% near the surface :-) - brachytherapy might be a possibility?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Sep 2018 at 06:02
Shame you didn’t have a template biopsy like me where 42 cores were sampled to get a more accurate picture of your situation. I was G4+3=7 and was told in no uncertain terms that AS would not be advisable.

However, my friend is G3+4=7, in his early seventies and he has seen five consultants on two continents. Two advised surgery, two advised AS and one radiotherapy. He has been on AS for some years and is fine. He has an annual MRI and of course regular PSA tests. He pays privately.

Best of luck whatever you decide.

Cheers John.
User
Posted 03 Oct 2018 at 20:06
And was offered a cancellation to see the specialist next Tuesday for follow up appt. Lucky me, would have been a much longer wait. Preparing my list of questions! All suggestions gratefully received.
User
Posted 07 Oct 2018 at 09:50
I've asked this on another site, but - is a G = 3+4=7 group grade 2 intermediate favourable etc suitable for active surveillance? Two out of 7 rhs cores were positive. Just a general enquiry as I'm thinking about my appt on Tuesday. Or wait and see!
User
Posted 07 Oct 2018 at 11:25
Many hospitals would only suggest AS as an option for G6 but there have been a couple of men on here recently with G3+4 where it seemed to have been an option.

Much would depend on
- what % of the cores was 4 rather than 3
- what % of the cores was actually cancerous
- whether the positive cores had found the cancer well contained in the centre of the gland or whether cells had been evident either towards the outer edge or inwards to the urethra
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 07 Oct 2018 at 13:38

If you are considering active surveillance then you really ought to request a template biopsy. I just read that around 20% - 30% of TRUS biopsies result in a subsequent template biopsy.

Edited by member 07 Oct 2018 at 13:42  | Reason: Not specified

User
Posted 07 Oct 2018 at 13:43
Assuming Dunniz can afford the template biopsy privately in NZ :-/
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 07 Oct 2018 at 15:29

Originally Posted by: Online Community Member
Assuming Dunniz can afford the template biopsy privately in NZ :-/


"Hospital and specialist care in New Zealand is totally covered by the government if the patient is referred by a general or family practitioner and this is funded from government expenditure".

User
Posted 07 Oct 2018 at 15:52

Originally Posted by: Online Community Member


Dr phoned me! And said no MRI but a biopsy on 3 September. Have to go to public hospital as private is $NZ900. It would have been done by now privately, but now I'll try and enjoy August. 


"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 07 Oct 2018 at 16:25
NZ $900 = £442.

I believe NZ has a public / private healthcare system where many citizens pay a bit extra for health insurance, like a lot of people here.

Anyway, the words: “the TRUS biopsy is as bad as we thought it was” and “Don’t let them palm you off with a TRUS biopsy” and “20% of TRUS biopsies result in subsequent template biopsies” keep ringing in my ears whenever I hear it mentioned.

In fact my tumour would have been detected with a TRUS. And I would still have cancer.

Cheers, John.
User
Posted 07 Oct 2018 at 19:43
Yes I did have health insurance for many years but the premiums shot up as I got older. I kept paying them when I was in England and couldn't use it anyway but now I'm an ailing pensioner ... I'll mention the template biopsy tomorrow. Thanks all. It's good to know that you're 'there.'
User
Posted 14 Oct 2018 at 23:46
And he will refer me to an Oncolgy radiographer I think it is, for a discussion about what to do next, if anything. There is a 12 week wait here with about 130 men on the list, but as mine is just a consultation I shouldn't have to wait that long. So I was told last week. We shall see! Trying to put it at the back of my mind. The good news is that the 5 year all clear for my bowel cancer is now under a month away, with no concerning colonoscopies, blood tests or checks so far. Best wishes to all. John.
User
Posted 01 Nov 2018 at 18:59
And now a lump on my right testicle! Dr says it's probably an epididdymal cyst I believe, but a scan in 4 hours to make sure. Then on 10 Nov the face to face talk with the oncology radiologist for the prostate cancer. It's all go. The good news is 15 days until the 5 year all clear for bowel cancer. Almost too afraid to have the final blood test, which I can do any time now. Maybe next week....
User
Posted 06 Nov 2018 at 08:29
Yes it was a unilateral epididymal cyst which is benign. And the CEA blood test for bowel cancer was normal. So, roll on Saturday ...
User
Posted 06 Nov 2018 at 11:38
Great news - 2 down, one to go.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Nov 2018 at 21:02

Radiation! Starting 5 December and 20 zaps. Happy Christmas. 

User
Posted 06 Dec 2018 at 18:55
Radiation put off to January at my request as I developed shingles! Also my last appt with colorectal nurse put off to January for the same reason. Happy New Year then! Sigh...
User
Posted 07 Dec 2018 at 17:03
Dunniz, how I sympathize! I recall getting shingles in my first year at university and being stuck in unsuitable digs with a landlady who really didn't want to be a nurse. It was at Christmas, too! I can't remember the treatment, but do recall being bedridden for a couple of weeks. It was in the early sixties, so I hope your experience reflects some progress in the intervening half century!

AC
User
Posted 07 Dec 2018 at 19:51
I think things may be a bit better now! I escaped the tingling then burning feeling but the rash is still there after two weeks. More of an ache which is worse at night. 35 large tablets over a week. Funny, nobody wants to look at the rash when I ask. I've taken photos though so might put it on Facebook.
Hope you have a good December and enjoy Christmas. I much prefer the cold dark ones I had when living in England. Who wants to eat a Christmas feast on the beach anyway? Cheers.
User
Posted 12 Jan 2019 at 23:04
Update time. Have had five out of twenty radiotherapy sessions so far with no noticeable side effects. Yet. Maybe there won't be any?60 Gy in 20 fractions external beam radiation. The only problem is getting my bladder full or empty enough for the zapping. The shingles rash has just about disappeared and I see my colorectal nurse tomorrow for the last appt now I've passed the 5 year mark for the bowel cancer. Quite a day coming up. Such fun.
User
Posted 13 Jan 2019 at 17:45

The bladder filling is challenging but getting it in the zone will make the treatment more effective and reduce side effects. Best wishes for the rest of the treatment.


 


 

User
Posted 22 Jan 2019 at 18:49
So far so good. Day 13 today and no nasty side effects yet. Apart from 4 or 5 bowel movements in the morning but I can cope with that. R Therapist said the success rates for this treatment for localised Intermediate Favourable are very good.
User
Posted 22 Jan 2019 at 18:58

You're getting there, Glad to hear its going reasonably well.


The important thing is those little s**t*y cells are getting blasted to bits.


 

Edited by member 22 Jan 2019 at 19:02  | Reason: adding a line

User
Posted 04 Feb 2019 at 08:05
And that's over. 20 fractions and 60 Gy. Side effects are still little and often BM's, except for today when I produced a lot at once and noticed it was darker than usual. I'm hoping it's too much dark chocolate I've eaten in the last two days. Not hydrating enough either. Peeing is quite frequent but not much each time. A bit painful at times as is ejaculating but I've stopped that until things are back to normal. Early days, only the third day since the last radiation. Patience!
 
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