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Just seen urologist.

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User
Posted 23 Jul 2018 at 18:37

So my story is that a work check flagged my PSA at 3.8 and my GP did a re-test and it's 3.9.


I'm 53 years old and had noticed a bit more wee'ing but nothing else so my GP referred me since apparently down here in Kent, they fast track appointments once you go over the threshold.


Have just seen the urologist today and flow test was good and he said my prostate was enlarged to the touch but not hard or bumpy. Oddly he then proceeded to give me leaflets on biopsies etc. but said he felt that was probably 'just' the common enlargement issue.


Anyway he said he'd send me for mpMRI as standard and keep me on the 'cancer fast track path' but I said to him I didn't particularly want biopsies done if the MRI was negative and also based on a pretty low PSA reading.


I just said can I not have the MRI and only biopsy if it spots something and he shrugged and said, you can do it that way if you want. He's also booked me in for bladder/kidney ultrasound since he said his machine was not very good plus a barrage of blood tests.


So I feel he's being thorough however was interested in people's thoughts on me saying no to biopsy unless MRI picks up anything? He said MRI 'can miss 40% of cancers' but I said that random biopsy can miss as well! Odd.


MRI can miss 40% seems a very odd thing to say unless he meant 40% of very small cancer cells?


Cheers,


Steve.

User
Posted 23 Jul 2018 at 21:28

If the mpMRI is unequivocal re suspect areas there is usually no need for a template biopsy, the faster TRUS biopsy should be more than adequate.


Never seen the statistic 40% before and it seems a bit high but yes, sometimes the cancer clusters are too small to see. There are also some prostate cancers that simply don’t show up on scans. My husband’s scan was clear - fortunately he had the biopsy first so they already knew there was a cancer in there and the op was arranged. Only when they got in did it become apparent that the cancer was throughout his prostate and also in the bladder. ChrisJ has mets but even the most up to date scans and tracers have not been able to find anything.


Have the mpMRI and then reassess rather than make an absolute decision now perhaps?

Edited by member 24 Jul 2018 at 00:20  | Reason: typo

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 23 Jul 2018 at 19:50

My PSA was 8, the MRI showed very little to worry about, but it was decided to do a biopsy, just in case because there was a faint shadow. It was used to target the biopsies properly, rather than dig around and relying on luck.


That showed cancer with a Gleason of 7!


Biopsies aren't a big deal, but it is the only way to be sure what is the best thing to do.

User
Posted 23 Jul 2018 at 20:18
Hi Steve,

Just go for the mpMRI, around 40 minutes of lying still listening to loud annoying ‘Techno’ type noise.

If anything untoward shows up, request a target or template biopsy as they are far more accurate than the cheaper rectal TRUS biopsy.

Let’s hope it doesn’t come to that.

Cheers, John.
User
Posted 23 Jul 2018 at 21:04

I had to contest with the urologist at my local hospital to get a mpMRI scan conducted first as apparently 'I didnt meet their criteria' (a psa of less than 20 required). Upon advising the urologist I had asked my local GP to refer me to another hospital, they suddenly relented and I got the scan.


I'm glad I did as the scan indicated a PIRADs 4 lesion with a predicted T staging of T3a. Again all this was in the mpMRI report which the urologist never told me about (I later obtained a copy of the report from my oncologist) and he wanted to conduct a saturation TPM biopsy. I requested a targeted fusion biopsy and we eventually compromised  with a fusion biopsy plus some samples from other areas of the prostate.


Outcome of the biopsy was a gleason score of 4/5 only in the targeted area (3 cores out of 4 positive from this area) with the other 8 samples from other non suspicious areas coming back as negative.


So I would say yes go ahead with mpMRI first and targeted TPM biopsy thereafter if any suspicious lesions seen, plus a few samples from other areas of the prostate to be on the safe side. 


 

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User
Posted 23 Jul 2018 at 19:50

My PSA was 8, the MRI showed very little to worry about, but it was decided to do a biopsy, just in case because there was a faint shadow. It was used to target the biopsies properly, rather than dig around and relying on luck.


That showed cancer with a Gleason of 7!


Biopsies aren't a big deal, but it is the only way to be sure what is the best thing to do.

User
Posted 23 Jul 2018 at 20:18
Hi Steve,

Just go for the mpMRI, around 40 minutes of lying still listening to loud annoying ‘Techno’ type noise.

If anything untoward shows up, request a target or template biopsy as they are far more accurate than the cheaper rectal TRUS biopsy.

Let’s hope it doesn’t come to that.

Cheers, John.
User
Posted 23 Jul 2018 at 21:04

I had to contest with the urologist at my local hospital to get a mpMRI scan conducted first as apparently 'I didnt meet their criteria' (a psa of less than 20 required). Upon advising the urologist I had asked my local GP to refer me to another hospital, they suddenly relented and I got the scan.


I'm glad I did as the scan indicated a PIRADs 4 lesion with a predicted T staging of T3a. Again all this was in the mpMRI report which the urologist never told me about (I later obtained a copy of the report from my oncologist) and he wanted to conduct a saturation TPM biopsy. I requested a targeted fusion biopsy and we eventually compromised  with a fusion biopsy plus some samples from other areas of the prostate.


Outcome of the biopsy was a gleason score of 4/5 only in the targeted area (3 cores out of 4 positive from this area) with the other 8 samples from other non suspicious areas coming back as negative.


So I would say yes go ahead with mpMRI first and targeted TPM biopsy thereafter if any suspicious lesions seen, plus a few samples from other areas of the prostate to be on the safe side. 


 

User
Posted 23 Jul 2018 at 21:28

If the mpMRI is unequivocal re suspect areas there is usually no need for a template biopsy, the faster TRUS biopsy should be more than adequate.


Never seen the statistic 40% before and it seems a bit high but yes, sometimes the cancer clusters are too small to see. There are also some prostate cancers that simply don’t show up on scans. My husband’s scan was clear - fortunately he had the biopsy first so they already knew there was a cancer in there and the op was arranged. Only when they got in did it become apparent that the cancer was throughout his prostate and also in the bladder. ChrisJ has mets but even the most up to date scans and tracers have not been able to find anything.


Have the mpMRI and then reassess rather than make an absolute decision now perhaps?

Edited by member 24 Jul 2018 at 00:20  | Reason: typo

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 23 Jul 2018 at 23:08
Think you meant the faster 'TRUS' should be more than adequate Lyn, the template one being transperineal.
Barry
User
Posted 24 Jul 2018 at 00:19
Ha! Yes, thanks Barry. Corrected :-/
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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