First time post , needing a little help !

The question of how long to results rather depends on which area of the country you live in - it is extremely variable.

When you say there is a family history of PCa, what do you mean? Is there a family history of close male relatives being diagnosed under the age of 60 and / or close relatives diagnosed young with breast or ovarian cancer? If not, the single biggest risk to him is not some male relative having PCa but the fact that he is a man. The vast majority of men have some cancer cells in their prostate - 60% of men in their 60s and 70% of men in their 70s - and we are certainly seeing more men diagnosed in their 30s and 40s.

MRI’s are useful but unfortunately produce indeterminate results in 40% of cases (or miss altogether) - that info comes from UCLH where they are probably performing the most advanced imaging techniques. From my experience they rate risk of PCa after MRI on a scale of 1 to 5. 5 being the urgent risk category and almost mandatory to have biopsy. It’s interesting that even levels 2 to 4 are all referrals or highly recommended referrrals for biopsy.

What is the use of MRI you might ask. Well from my point of view it’s value is only for targeting visible lesions. if you are able you could ask for a referral to the INNOVATE trial at UCLH where the new bio marker/VERDICT scan protocol is being trialled. Funded by Prostate Cancer UK

Short answered though is get the biopsy. And make it a saturation biopsy.

Fresh

Edited by member 13 Aug 2018 at 01:34  | Reason: Not specified

By the way my second MRI shows the Pca very well, not sure why, maybe a better technique?

Now awaiting my Brachytherapy treatment.

John

- If the mri shows clear areas of concern, he doesn't need a template biopsy as they know where to target

- if he is offered template biopsy ask whether it is possible to do it with a spinal block rather than general anaesthetic. Some hospitals do and some don't.

- if you live in an area where template biopsy is not allowed unless there has been a TRUS biopsy first, you would have to go out of area

- if you push for template biopsy that was not otherwise going to be offered to you, the hospital target for diagnosing and starting treatment no longer applies ie the clock stops ticking

- in some areas the wait for a template biopsy can be a few months unless you have cover or can afford to pay

Wishing you all the best with your treatment John 

Thanks Lynn, I really appreciate the info you are providing; I have a million questions  however it seems futile in asking them until we have the facts 

Hannah xx 

No point freaking out - a pirad score of 3 should be rather consoling in the circumstances. I can see why the nurse would freak you out but it could be a miscommunication - perhaps they had a cancellation and saw an opportunity to slot you in?

Edited by member 09 Oct 2018 at 21:02  | Reason: Typo

Hi, 

So Tim had a Gleason score of 3 and 3 on the trus biopsy , at first we were told it was negative and to have psa levels checked 3 monthly, and basically back to gp care. Then we got a letter asking Tim back to see the consultant who told us his notes have been amended following the mtd , he had his flow rate checked , which was very poor and given medication for this. We also found out that his prostate was originally measured at 20cc by consultants dre, it's actually 47cc from mri measurements. He has just had another psa that has risen to 4.69 . I really don't understand What's going on!  

As I said back in August, cases like Tim’s really deserve a template biopsy. I just read this week that between 20-30% of TRUS biopsies are succeeded by template biopsies to get a better picture of the state of the tumour.

I think that would be his best bet going forward, and then take it from there.

There is a school of thought now that says Gleason 3+3=6 should not be referred to as “cancer”, and should be referred to as “a little difficulty down below” or some more medically correct term.

I hope I have reassured you a little bit.

Cheers, John.

Thank you both so much , yes I thought Gleeson 3 and 3 was a great result! But  the psa has jumped in such a short time. I made your point about the template , but they said as they could see some thing on mri a target approach would suffice. We will be really determined for the template biopsy now. 

Really appreciate your time and kind words xxx

Hi Lynn , thanks for the response , yes they said if this one is higher , they will repeat in a week , and then another biopsy , gp has written a letter to the consultant today. Yes that makes perfect sense about the upgrading, and reassuring to know your thoughts about the enlarged prostrate to the psa levels , he has been given tamsulosin, which seems to be working. 

An increase in Prostate size which happens to men to varying degrees as they grow older can account for some increase in PSA but this is usually a slow process but may be accelerated by growing tumours. There are so many variables and consultants with the tools that are available to them plus histology are best placed to give an opinion on a specific case . That being so, perhaps is is best not to speculate but seek more precise opinions from consultants, particularly when what they say may appear to be contradictory.

hi guys , we still here lurking in the background, hope you amazing people are all well .

So from psa 2.9 in August we now find ourselves at 5.2, psa tests every 6 weeks have seen slight increases  every time, we have said we really want the template biopsy now , although still low in psa terms , are we right to be concerned that a Gleeson score of 6 previously, that some further action is warranted? 

Feeling deflated , probably phycological as hitting a whole new number 😥😥 advice would be very much appreciated xx

It is not common for a Gleason to change from one thing to another (ie G3+3 becoming a G4+4) but it is possible that the G3+3 is very active and / or that there are other clusters elsewhere in his prostate that are a higher grade. 

I stick with my previous comment though. If he is not yet ready to have radical treatment then it seems pointless having a template biopsy. If on the other hand, he is thinking "I am only 43, this cancer needs to be dealt with now" then he can go straight for the radical surgery / radical RT option. I am not sure what a template biopsy adds either way. 

Anecdotally, it often seems the very young men diagnosed end up having a more aggressive, more determined cancer. I think if this was my brother or friend, I would be pushing for more detailed scans and radical treatment.

I can't remember whether you have completed your family yet? If not, time to deal with that aspect might be the only really persuasive argument for delaying treatment now?