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Lump found from DRE - worried daughter

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User
Posted 13 Nov 2019 at 19:22

Hello all,


First of all I would like to thank everyone on this forum - I have found this website so useful thus far although we have literally just been introduced to the world of PCa (or not!)


My father has been having more frequent urination at night for a few months to a point he decided he had to visit the GP. Blood test came back with PSA of 5, which from what I gather from this forum is not rocket high. He was then given a DRE, and GP found a small lump. 


I know a high PSA may not mean PCa but it's the lump that concerns me. How accurate is DRE? And if it's not PCa what could it be?


My father is now given a urology appointment next week - what should we expect? MRI? Biopsy?


Many thanks


Melma


 


 

User
Posted 13 Nov 2019 at 20:15
A hard or lumpy prostate needs to be checked out so it is right that he has been referred- no point guessing what the outcome might be.

In most areas of the country now, they would suggest an mpMRI first, probably followed by a biopsy a couple of weeks later. An mpMRI is different to a normal MRI in that it uses two or three different kinds of image and lays them over each other - if they suggest an MRI scan, do ask them to confirm whether it is multiparametric. In a few areas, they still do the biopsy first, particularly if the specialist thinks he can feel a tumour. I expect the first thing that will happen next week is that the urologist will do another DRE to see whether s/he can feel anything.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 14 Nov 2019 at 03:14
Keep calm and carry on!

There are men here who have had similar symptoms as your Dad’s, and following tests - MRI and biopsy -have been found to have Benign Prostate Hyperplasia or prostatitis, not cancer.

Just wait for the results of his tests. You may like to order the free “Toolkit” comprehensive information folder from the “Publications” section of this website.

Best of luck.

Cheers, John.
User
Posted 14 Nov 2019 at 03:14
Diagnosis won't be months away - the MHS has a target of 31 days from referral
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 19 Nov 2019 at 01:17

Which hospital is your dad under?


You can use the PCUK interactive map to see what your hospital and others in the locality offer.


https://prostatecanceruk.org/about-us/projects-and-policies/mpmri 


You will see that the vast majority of NHS hospitals do offer mpMRI now but not always to the correct standard and not necessarily to all patients. If you were to ask for a referral to another hospital that does offer mpMRI to PROMIS standard, you will need to accept that the clock for 31 day target (referral to diagnosis) will stop ticking. Perhaps best to see what the MRI with contrast shows and then consider referral for mpMRI elsewhere if there is a discrepancy between the scan and the biopsy results.


Not sure why you would be wanting free PSA to be measured - it isn't particularly important to your dad's situation

Edited by member 19 Nov 2019 at 01:22  | Reason: to activate the hyperlink

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 19 Nov 2019 at 17:31
Any scan can give a false negative or a false negative, including MRI with contrast and full mpMRI. As I said above, a new member here was recently told on the strength of their mpMRI that they had a high grade cancer but the biopsy showed no cancer at all in the targeted area.

As much as you want to, it will be very wearing trying to predict all possible outcomes and then plan your next steps for each. If Dad gets a PIRADS 1, you would want to question whether it is appropriate to expose him to the risk of biopsy. If he gets a 2, then I would be more inclined to ask for a biopsy targeted to the area that could be felt in the DRE, just to be sure. However, if the uro shares the GP’s concern about that ridge / lump, he will perhaps suggest a biopsy regardless of the scan results.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
Show Most Thanked Posts
User
Posted 13 Nov 2019 at 20:15
A hard or lumpy prostate needs to be checked out so it is right that he has been referred- no point guessing what the outcome might be.

In most areas of the country now, they would suggest an mpMRI first, probably followed by a biopsy a couple of weeks later. An mpMRI is different to a normal MRI in that it uses two or three different kinds of image and lays them over each other - if they suggest an MRI scan, do ask them to confirm whether it is multiparametric. In a few areas, they still do the biopsy first, particularly if the specialist thinks he can feel a tumour. I expect the first thing that will happen next week is that the urologist will do another DRE to see whether s/he can feel anything.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 13 Nov 2019 at 23:33

Thanks .It's so hard not to jump ahead of myself. It's so hard to digest all the information thrown at me right now. And diagnosis may be months away. Any suggestions on how to cope?


Thanks

User
Posted 14 Nov 2019 at 03:14
Keep calm and carry on!

There are men here who have had similar symptoms as your Dad’s, and following tests - MRI and biopsy -have been found to have Benign Prostate Hyperplasia or prostatitis, not cancer.

Just wait for the results of his tests. You may like to order the free “Toolkit” comprehensive information folder from the “Publications” section of this website.

Best of luck.

Cheers, John.
User
Posted 14 Nov 2019 at 03:14
Diagnosis won't be months away - the MHS has a target of 31 days from referral
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 18 Nov 2019 at 22:53

So we finally had our initial consultation. In all fairness it has only been 6 days since we have been referred by the gp but it felt like ages.


The consultant said he felt a ridge - whatever that means - rather than a nodule, which is somewhat good news?


So MRI ordered for tomorrow (good lord how amazing is the NHS) BUT apparently the hospital doesn't offer mpMRI. I asked why but he said an MRI with contrast (what is that please) is just as good, and most hospitals under the NHS doesn't do that (really?) 


I have also asked for the free PSA to be tested but consultant says NHS doesn't do it...


How could I get a mpMRI under the NHS if at all? 


Thanks all

User
Posted 19 Nov 2019 at 01:17

Which hospital is your dad under?


You can use the PCUK interactive map to see what your hospital and others in the locality offer.


https://prostatecanceruk.org/about-us/projects-and-policies/mpmri 


You will see that the vast majority of NHS hospitals do offer mpMRI now but not always to the correct standard and not necessarily to all patients. If you were to ask for a referral to another hospital that does offer mpMRI to PROMIS standard, you will need to accept that the clock for 31 day target (referral to diagnosis) will stop ticking. Perhaps best to see what the MRI with contrast shows and then consider referral for mpMRI elsewhere if there is a discrepancy between the scan and the biopsy results.


Not sure why you would be wanting free PSA to be measured - it isn't particularly important to your dad's situation

Edited by member 19 Nov 2019 at 01:22  | Reason: to activate the hyperlink

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 19 Nov 2019 at 16:32

Thank you. It doesn't look like our hospital offers mpMRI to PROMIS record. The consultant has said that if pi-rads score comes out to be 1 or 2 then biopsy is not needed. Would the contrast MRI give any false negative? Should I push for a biopsy regardless of the results?


Thanks 

User
Posted 19 Nov 2019 at 17:31
Any scan can give a false negative or a false negative, including MRI with contrast and full mpMRI. As I said above, a new member here was recently told on the strength of their mpMRI that they had a high grade cancer but the biopsy showed no cancer at all in the targeted area.

As much as you want to, it will be very wearing trying to predict all possible outcomes and then plan your next steps for each. If Dad gets a PIRADS 1, you would want to question whether it is appropriate to expose him to the risk of biopsy. If he gets a 2, then I would be more inclined to ask for a biopsy targeted to the area that could be felt in the DRE, just to be sure. However, if the uro shares the GP’s concern about that ridge / lump, he will perhaps suggest a biopsy regardless of the scan results.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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