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MRI shows PIRADS 5 Lesion

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User
Posted 01 Aug 2018 at 15:11

Had an rectal biopsy and no cancerous cells found but PSA up from 4.4 to 7.1 in 3 months, so MRI performed. Strangely, PSA back to 4.1 after quarterly blood test after the MRI. 

Just had my MRI results and shows PIRADS 5 lesion on the anterior left apex of the prostate gland. There is broad contact with the capsule suggesting radiological staged T3a disease; furthermore, there is a borderline right external ililcc node. 

All very scary sounding stuff and now waiting an appointment for a transperineal template biopsy of the prostate under short general ananstheic as a day case.

My Dad, at 81, was diagnosed 6 months ago with prostate cancer (although he also had a bone scan and nothing wrong there) and has just undergone 20 days of radiotherapy so awaiting the results of his blood tests one month after treatment completed.

Presume if they find malignant cancer cells I will then be given options for treatment? Lets hope its not outside the prostate or in the bones. Scary times...

 

User
Posted 01 Aug 2018 at 16:24
Ray, I presume your rectal "biopsy" was actually a digital rectal examination! The highly suspicious rating for the lesion suggests that the template biopsy will be positive for PCa, but you will know then the grade of the cancer and perhaps have confirmation of its spread within the prostate. That will lead to suggestions for treatment options. Let us know the findings and you will get plenty of help with advice, should you need it.

Good Luck

AC

User
Posted 08 Oct 2018 at 20:47

Ray

I was PIRAD 5 and then had a biopsy.  Initially, I was T3aN0MX, Gleason 7.  As I was 48, surgery was recommended.  Pathology upgraded me to pT3bN0MX and Gleason 9, so I'm glad we got it out of me.

I've no regrets about going down the prostatectomy route, even though I have since needed salvage radiotherapy.

Good luck with your decision making.

Ulsterman

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User
Posted 01 Aug 2018 at 16:24
Ray, I presume your rectal "biopsy" was actually a digital rectal examination! The highly suspicious rating for the lesion suggests that the template biopsy will be positive for PCa, but you will know then the grade of the cancer and perhaps have confirmation of its spread within the prostate. That will lead to suggestions for treatment options. Let us know the findings and you will get plenty of help with advice, should you need it.

Good Luck

AC

User
Posted 01 Aug 2018 at 16:35

Thanks for your reply.

Rectal digital prostate exams have always been negative so I actually had a trans rectal ultrasound scan and biopsy done (known as blind biopsies?) where they took 12 biopsies which came back negative in November 2016. The ultrasound did show a 15% enlargement of the prostate though.

I am now awaiting an appointment probably in September 2018, according to the Urology Appointment schedule.

Edited by member 01 Aug 2018 at 16:40  | Reason: forgot to add info

User
Posted 08 Oct 2018 at 19:58

Targeted biopsies taken and 19 of 64 came back cancerous with 3+4 (7) on the Gleason scale. Bone scan was also recommended and that has shown no cancer in the bones, which is a major relief. I am now meeting my Urology Consultant on Wednesday. My Urology Nurse called me this evening and said my consultant would be discussing my treatment options of Prostatecomy or Radiotherapy. My scary thoughts have disappeared, especially after the bone scan so now I just need to listen to what the consultant has to  say and weigh up my options I suppose. 

I am leaning towards prostatectomy as that should ensure all the cancer is removed, although I want to know my surgeons success rate with either option but the thought of a catheter and bag for a week really doesn’t make me feel comfortable at all. 

Does anyone know how quickly I have to make my decision on what treatment to take? 

Edited by member 08 Oct 2018 at 20:03  | Reason: Added targeted biopsy results

User
Posted 08 Oct 2018 at 20:47

Ray

I was PIRAD 5 and then had a biopsy.  Initially, I was T3aN0MX, Gleason 7.  As I was 48, surgery was recommended.  Pathology upgraded me to pT3bN0MX and Gleason 9, so I'm glad we got it out of me.

I've no regrets about going down the prostatectomy route, even though I have since needed salvage radiotherapy.

Good luck with your decision making.

Ulsterman

User
Posted 09 Oct 2018 at 07:18

John,

Thanks for the advice. I will definitely talk about this as an option, although at the Monday consultant meeting the nurse told me it was discussed and the surgery/radiotherapy options were agreed as best next steps. Will ask him how many operations he does a year, good tip 😀

User
Posted 09 Oct 2018 at 11:49
With 19 cores out of 64 you are unlikely to be suitable for AS :-(

If you are interested in that stuff, don't just ask about the number of ops; also ask what % of his patients are still using at least one pad per day at 12 months post-op and what % can get an erection sufficient for penetrative sex at 12 months without the use of a pump or injections. You should also ask what % of his patients had positive surgical margins and / or needed salvage RT.

Some surgeons have fantastic results in terms of margins / recurrence because they cherry-pick only the most straightforward cases. Some look on paper to be not so successful because they are brave and operate on men that other surgeons would consider risky.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 01 Nov 2018 at 06:53

Met my Urologist and my Oncologist. Recommended treatment is 3 years of hormone treatment, started 19/11/2018, with 4 weeks of tablets and 3 month injection on 05/11/2018. This will be followed by 37 sessions of 10 minutes a session, Monday to Friday, targeted radiotherapy to start on 05/02/2019.

No real side effects from the hormone tablets yet apart from I seem to be ejaculating less and less sperm even though I am having a full orgasm. Is this normal?

User
Posted 01 Nov 2018 at 08:13
Hi Ray,

Not surprised you have not had any side effects from the HT as you are not starting it for three weeks! 😉

Best of luck anyway.

Cheers, John.

User
Posted 01 Nov 2018 at 08:16

John,

 

I have been on hormone tablets for 2 weeks of 4 weeks On Monday I have the first of my 3 year’s worth of 3 monthly hormone injections. 😳🧐

Edited by member 01 Nov 2018 at 08:18  | Reason: Spelling

User
Posted 01 Nov 2018 at 11:19

Hi Ray,

Just joking as the date you wrote is in a few weeks time!

Cheers, John.

 

User
Posted 01 Nov 2018 at 12:29

No problem. Should have read 19/10/2018 😀👍🏼

Edited by member 01 Nov 2018 at 12:31  | Reason: Not specified

 
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