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Posted 05 Oct 2018 at 15:17

So after hubby getting a uti and a psa reading of 9.5, followed by another psa reading of 7.3 2 weeks later, he was seen by a specialist nurse today. He said his prostate didn’t feel malignant but did feel a bit firm on one side. He said we have 2 choices, the first being watch and wait with another psa, and the second was to have a mri and a biopsy. He said he’d probably opt for the second choice. So we agreed. However hubby had been reading about the template biopsy, so asked if this was what he was having, the nurse said no it wasn’t, so hubby said he’d like to have the template biopsy as it’s more thorough, anyway the nurse agreed in the end so that’s what he’s having. I asked if the reduction in psa was a good sign and he said it was, made me feel better, also said he’d been doing this job for the last 20 years, so I’m sure he knows what a malignant prostate feels like I’m praying he does. I don’t think he wanted hubby to have the template biopsy first, must cost more money. Are we doing the right thing?

thanks for listening

User

Posted 05 Oct 2018 at 16:01

Hello Mr and Mrs Lewis,

Welcome to the most unwelcome welcoming website in the world!

Mr Lewis should insist on a mpMRI scan FIRST, preferably at 3 Tesla resolution, (but 1.5 T would do at a pinch), and if anything untoward shows on the scan, proceed to a template biopsy.

The cheaper TRUS (up the bum) biopsy is favoured by some hospitals as it is quicker, but much less accurate if there is very little cancer. My big 15mm former buddy, Tommy the Tumour, would have been picked up by whatever biopsy. Some specialists set little store by DRE’s and mpMRI is the way to go.

So, hopefully Mr L’s raised PSA is just a consequence of his urinary tract infection.

Please let us know how you get on.

Cheers, John.

User

Posted 06 Oct 2018 at 20:25

I had a fluctuating psa for around 18 months. They kept an eye on it and after a change in what they could see in an mri compared to a one I had 12 months previously I had a template biopsy which was able to target the problem area specifically. All biopsies have downsides but I was very happy with the template one. I had no bruising or problems after the general anaestheti. You are not under for long.

User

Posted 10 Oct 2018 at 21:20

You will probably have to wait - radiographers are qualified to undertake the imaging; they are not qualified to interpret the results so the images are sent to a radiologist who writes the report. Then in most areas, the biopsy report and radiology report are considered at a multi-disciplinary meeting (usually a weekly event).

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

User

Posted 11 Oct 2018 at 08:55

I had no symptoms at all, nothing evident from DRE. MRI is essential IMHO and dependant on the MRI result a TRUS biopsy will be adequate if there is an obvious target from the MRI.

If the MRI is clear then you should definitely go for a template OR possibly active surviellance if it was a 3T MRI.

I paid 1500 quid for a 3T MRI privately.

User

Posted 11 Oct 2018 at 16:56

Mr & Mrs L, be prepared for a wait for the radiologist''s report. They are in short supply and overworked. It my area it can be three weeks before a report is available to the oncologist. Sometimes the oncologist, who has access to the pictures on his PC, will try to give his own interpretation, but from experience this will usually, if he/she is wise, be couched in pretty general terms. Interpreting the scans is a very skilled job and I've found the full reports worth the wait.

User

Posted 13 Oct 2018 at 11:02

Hi Michaela,

If he is having a template biopsy I think the resolution of the MRI scan is not now too important, as that will give you you both a very accurate picture of what’s happening. Fair play to you for sticking out for a template, and hasn’t it been arranged quickly?

If there is a large tumour like mine was it would be picked up on a TRUS biopsy, but if a TRUS is done before an MRI, they don’t know what they are aiming at. It then takes weeks for the prostate to recover before an MRI can be carried out.

If the TRUS came up with indeterminate results, and if the MRI scan shows something slightly suspicious, then you end up railroaded on a waiting list for a template second biopsy. Two for the price of one and twice the discomfort. Note I didn’t say pain.

So I think you and your clinicians have gone exactly down the right road.

So I wish you the best of luck as ever, and try not to worry too much.

Cheers, John.

User

Posted 13 Oct 2018 at 11:54

I had a template biopsy as part of my diagnosis, I had no Ill effects and felt fine the afternoon after the procedure. Although it’s done under a general you shouldn’t be under long so a minimal hangover.

Once you‘re In the system at the NHS it’s all pretty swift and the resources seem to be good. If at any stage you feel you’re not getting enough info or appointments are slow coming through it’s definitely worth chasing up.

For general info the nurses on the Prostate UK free helpline are fantastic. I found them a great support with unbiased and up to date information.

Wishing you all the best for your next steps.

User

Posted 13 Oct 2018 at 18:30

Originally Posted by: Online Community Member

Dr. Patrick Walsh's Guide to Surviving Prostate Cancer (Fourth Edition)

(I cut and pasted in the name of the book, I’m not sure why it’s come out so big. I’m not on commission!)

Brilliant book. We had the earlier copy first so this one slightly updated. Dr Walsh I do believe is the gentleman who first discovered then developed the first nerve sparing prostatectomy so he is indeed regarded as THE GOD of prostate surgery in America. Retired from surgery himself now but still very active in the prostate world.

User

Posted 19 Oct 2018 at 10:44

I‘m very sorry to hear they’ve found something on the scan. I suggest you give the Prostate UK free helpline a call, the Nurses are very knowledgeable and should be able to answer most of your questions.

Once you get the biopsy result the next steps will be advised. If it is cancer and you go with surgery or radiation/hormone treatment the odds are very much in favour of getting rid of it.

It‘s much easier said than done but try not to worry too much and take it one step at a time.

User

Posted 19 Oct 2018 at 15:38

Originally Posted by: Online Community Member

Is it right that the staging TNM is different depending on which cancer it is?

from what I understand T3a means it’s could just be spreading out if the prostate, meaning it’s still relatively early?

The ability to confirm cancer based on MRI depends on the type of MRI - the more detailed ones will give a score out of 5 for how likely it is - a 1 means it is almost certainly not cancer and a 5 means it almost certainly is cancer. But without a biopsy they cannot confirm the diagnosis. The biopsy will also tell them which of the 27 different kinds of prostate cancer it is, which is important because some rare types need a specific treatment. Adenocarcinoma is the most common by far.

The TNM has nothing to do with different types of cancer, it is a way of describing the full diagnosis.

T is the staging - T1 means the tumour is small and in only one part of the prostate, it can't be felt in DRE and often can't be seen on scans. T2 means the cancer can be seen and may be felt. T3 indicates that it is at or close to the edge of the gland or has broken out but only in a limited way - to the closest lymph nodes perhaps. T4 means it has broken out and invaded local tissue such as the bladder.

N is about the further afield lymph nodes - if it has gone to the lymphatic system it is considered incurable but can be controlled

M is for metastases / spread - usually to the bones but might be lung, liver, etc.

It is possible to be T1 or T2 but still have mets to bone or organ although this is more rare. T3 is not considered to be relatively early.

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

User

Posted 19 Oct 2018 at 16:29

Interestingly T3a is "locally advanced" so is not as early as you would like it to be, however it is rare in the UK to catch Pc really early because there is no effective screening and PC rarely produces side effects until it's been there a while (years!).

Now you have your staging the G score is important and it could still be a benign leision hence the need for biopsy.

At this stage you will have just about all forms of treatment available so now would be a good time to research these so you can ask informed questions when you get the definitive result from the biopsy.

User

Posted 19 Oct 2018 at 16:34

Originally Posted by: Online Community Member

N is about the further afield lymph nodes - if it has gone to the lymphatic system it is considered incurable but can be controlled....

My post operative histology came back as T3aN1M0 after two out of fourteen lymph nodes removed proved cancerous on biopsy.

My hopelessly optimistic oncologist told me I am cured despite those results, so I am off to see a Harley Street oncologist soon to see how cured he thinks I am....

Anyway, I am enjoying being cured....for now...

Cheers, John.

User

Posted 21 Oct 2018 at 09:27

The treatment offered may depend on your local team to a certain extent. I’ve just had my prostate removed even through they knew it was starting to spread (Gleason 9). It turned out to be T3b but they think they got it all. My lymph nodes were found to be clear.

By way of contrast I have a friend who was Gleason 10 who was down to have the procedure in Belgium. Once they had him on the table and actually saw it had spread, confirming it had spread to lymph nodes by biopsy while he was still under. They then closed him up and he went straight into HT and RT. He is now clear and although told he would be on HT for 2-3 years they took him off at around 18 months.

The stats are pretty positive whichever route you decide to take.

User

Posted 21 Oct 2018 at 10:48

If the scan was not an mpMRI hi-res, hi-def, scan at 3 Tesla resolution, how can they tell the full extent of the cancer (if any)? The only way to tell is to look inside, which in a way the biopsy does, but that is no indicator of spread.

My tumour was 15mm and turned out to have spread, despite the scan indicating it had not.

Anyway, the biopsy result will be another piece in the jigsaw, so try not to worry too much about it till then.

Cheers, John

Edited by member 21 Oct 2018 at 12:10 | Reason: typo

User

Posted 21 Oct 2018 at 12:29

Even with a 3T they can't tell for sure, a 1.5 t will still show tumours. All require skilled human interpretation unless the cancer is so advanced it has destroyed all the normal structures.

If the cancer has broken out surgery is still an option it all depends how far it has gone. At some point it becomes more effective to use radiotherapy as the curative option.

User

Posted 21 Oct 2018 at 14:16

Some surgeons will operate even if it has just broken out; others would refuse. Some would refuse if it looked close to breaking out. Part of the problem is that they have to report their stats and so it is a bit risky for them to take on patients that could make their results look bad. Unfortunately, a couple of the supposedly top surgeons with amazing results are known for cherry picking only the safest patients. Others may look like they make more errors but are actually the brave ones who put patients before league tables.

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

User

Posted 25 Oct 2018 at 23:28

If you know the name of the planned surgeon you can google their published outcomes data. All uro-surgeons have to publish this (although some ignore it). If you can't find it that way, ask the surgeon when you see him/her. The standard data they are supposed to collect is:

- % positive margins

- % biochemical recurrence

- % using one pad per day or less at the 12 month mark

- % able to get an erection either naturally or using mechanical / chemical assistance at the 12 month mark

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

User

Posted 09 Nov 2018 at 11:37

Thank you for your reply, it sounds horrible and as much as I’m dreading it, I just want it over with. I’m praying it’s not a ”tiger”, I’m just struggling to get my head around it all. Pete has been putting it to the back of his mind and is trying to carry on as normal.

Thank you for thinking of us.

Show Most Thanked Posts

User

Posted 05 Oct 2018 at 15:48

It isn't just the cost - it also means a delay and in many areas is done by general anaesthetic which has its own risks.

The value of a template biopsy is rather dependent on what the MRI showed.

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

User

Posted 05 Oct 2018 at 15:58

Hi Lyn

what do you mean a delay? Does it take longer for the template biopsy?

User

Posted 05 Oct 2018 at 16:01

Hello Mr and Mrs Lewis,

Welcome to the most unwelcome welcoming website in the world!

Mr Lewis should insist on a mpMRI scan FIRST, preferably at 3 Tesla resolution, (but 1.5 T would do at a pinch), and if anything untoward shows on the scan, proceed to a template biopsy.

So, hopefully Mr L’s raised PSA is just a consequence of his urinary tract infection.

Please let us know how you get on.

Cheers, John.

User

Posted 05 Oct 2018 at 16:17

Thank you for your reply John. how do we know which type of mri machine they use? is this something we should have insisted upon today?

I’m sorry to hear tommy is so big, I hope he has been brought down a peg or two?

its also good to hear that some specialists dont depend too much on the DRE, it has been niggling at me.

Were really hoping it’s the uti that has caused all this worry, and things will be ok.

thsnjs again

Michaela

User

Posted 05 Oct 2018 at 16:38

Hi Michaela L,

He could ask the radiologist as he enters the tube, but I seem to recall a “General Electric 3T” logo on the scanner I went through. Any resolution will be fine if anything substantial is there to be found.

Tommy the Tumour is long gone four months ago, but watching the news today, I wonder if he’s in a big pile of medical waste somewhere waiting for disposal. I thought they might have given the b****** a decent burial, as we were so close!

We here are very focussed and possibly obsessive about PCa (our quaint name for the Big C!), but my surgeon, one of the best in Britain, says the DRE is not at all reliable, but a lump or hardness is not as good as smooth.

And my new oncologist, again a top man, says following a surgical trial, “the TRUS biopsy is as bad as we thought it was”.

So Mr L. is making all the moves in the right direction, and we all hope it comes to naught.

You didn’t say how old Mr Lewis is and whether he had any symptoms.

Cheers, John

Edited by member 05 Oct 2018 at 16:49 | Reason: Not specified

User

Posted 05 Oct 2018 at 17:19

Not all hospitals have the 3 Tesla machines and some will not allocate one to you. Of course, if you go private you are in a better position to select a hospital where, you have more say on when you would like the scan to be done, and can specify a 3 Tesla machine only. (For John, as regard the make, possibly the most advanced and widely used brand in the UK is Siemens with Philips, the next used but a new model by one may outshine the other. GE is more common in the USA but they all produce models in common classes of power so the brand is not so important. The 3 Tesla model has only been used for under about 10 years, whereas some of the 1.5 Tesla models can be quite old although hospitals are still buying them. to serve a purpose. You will see from this link that we in the UK are well down the league when it comes to scanners per million of population :- https://www.rcr.ac.uk/sites/default/files/cib_mri_equipment_report.pdf

However, it is interesting that a 7 Tesla scanner has been delivered in Scotland but probably more for research at this stage. There are even more powerful MRI scanners in the USA but with the increase in power other problems increase. :- https://www.bbc.co.uk/news/uk-scotland-glasgow-west-38123803

Speaking on behalf of fellow urologists, a leading surgeon has stated that it is best to do the MRI first and then the biopsy. Apart from other considerations it takes time for a Prostate to heal before a good MRI scan can be done.

Edited by member 05 Oct 2018 at 18:22 | Reason: Not specified

Barry

User

Posted 06 Oct 2018 at 03:00

Shocking to read that paper, Barry, and to find that Finland and Korea have over five times more MRI scanners per head of population than Britain. And we keep being told “The NHS is the best in the world”.

Having said that, the hospital side of the NHS have been brilliant for me.

User

Posted 06 Oct 2018 at 08:44

Is it very expensive to have a mpmri done privately? Not that we’ve got the money but if the NHS isnt good enough?

Its sad as a patient that we’ve got to worry about if we’re being given the best treatmen, there’s already enough to think about with a pca diagnosis.

User

Posted 06 Oct 2018 at 09:54

Dear Mrs L,

The mpMRI Mr L will be having will be fine, and there is no need for you to worry about the minutiae of Tesla resolutions, as he has wisely opted for a comprehensive template biopsy, which will give you and your doctors a very good idea of what’s going on.

I had 42 cores sampled in my template, of where they knew the tumour to be from the MRI imaging (left lobe) whereas with a TRUS biopsy before MRI they might take between 6 and 12 core samples from where they THINK a tumour might be.

Your husband is doing all the right things, so don’t worry too much. Strangely enough, I have never been worried about my diagnosis and subsequent treatment, especially as my Nomogram forecasts I have a 96% chance of not dying of PCa in 15 years. If I had something like lung or pancreatic cancers it would probably be around 1%.

To answer your question, I think MRIs are around a grand (for forty minutes in an electro-magnet). The hospital side of the NHS have been fantastic for me, and I would have paid around £25,000 for exactly the same thing private, as a friend has just done. But I think he had a better wine list than the Royal Surrey Hospital offers!

Roll on his scan and biopsy, and I wish you both the best of luck. Please let us know the outcome.

Cheers, John.

User

Posted 06 Oct 2018 at 11:05

Hiya John,

thank you so much for your reassuring reply, all these new words are like a foreign language I don’t really want to learn!!

its good to hear you don’t worry about your diagnosis, and if it comes to it, I hope we can adopt that attitude as well.

Wow! It’s pretty pricey for a private Mri then!! I’d expect wine for life if paying that! Guess we’ll be staying with the NHS, which we certainly can’t complain about at the moment!

Not sure if it was you who asked earlier? But Mr L is 63, had no real symptoms as such, maybe a few extra trips to the loo and a bit of hesitanc, this is usually relieved after passing wind 💨😱

I will definitely get back to you to let you know what’s happening, hopefully with good news.

you take care, and enjoy your weekend

Michaela 😊

User

Posted 06 Oct 2018 at 11:22

Hi again Michaela, the twenty five grand that my friend from South Africa paid was about £1000 for MRI, around £1500 for template biopsy, so much for bone scan and around £20,000 for robotic laparoscopic surgery. He flew here to have one of the best surgeons carry out the op.

Unfortunately his cancer has spread outside the prostate and now he has hormone and radiotherapy to look forward to. Don’t know if he will have the adjuvant (another new word!) treatment here or in South Africa.

Chin up!

Cheers, John.

User

Posted 06 Oct 2018 at 20:25

User

Posted 10 Oct 2018 at 21:14

Quick update, Mr L has got his appointment for his MRI, it’s this Friday. Just wonderI got if there’s anything we should be asking at this appointment? Will the radiologist discuss what he sees or will we have to wait?

Thank you

User

Posted 10 Oct 2018 at 21:20

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

User

Posted 11 Oct 2018 at 08:55

I had no symptoms at all, nothing evident from DRE. MRI is essential IMHO and dependant on the MRI result a TRUS biopsy will be adequate if there is an obvious target from the MRI.

If the MRI is clear then you should definitely go for a template OR possibly active surviellance if it was a 3T MRI.

I paid 1500 quid for a 3T MRI privately.

User

Posted 11 Oct 2018 at 16:56

User

Posted 13 Oct 2018 at 09:19

Hi all,

you were right, nothing was discussed with Mr L yesterday, so will have to wait until they have the results of the biopsy. The biopsy is next Thursday, so not too long to wait. I am impressed at the speed of everything in the NHS. MR L did ask if he was having a mpMRI, but was told it wasn’t necessary? So just waiting in limbo land for his template biopsy next week. I am surprised they haven’t repeated his Psa test due to the fall after having the uti. Sometimes I’m sure everyth is going to be ok, then other times I’m sure our lives are about to change. How dI you cope living in limbo land?

User

Posted 13 Oct 2018 at 11:02

Hi Michaela,

So I think you and your clinicians have gone exactly down the right road.

So I wish you the best of luck as ever, and try not to worry too much.

Cheers, John.

User

Posted 13 Oct 2018 at 11:54

For general info the nurses on the Prostate UK free helpline are fantastic. I found them a great support with unbiased and up to date information.

Wishing you all the best for your next steps.

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Been to see the specialist today

Dr. Patrick Walsh's Guide to Surviving Prostate Cancer (Fourth Edition)

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