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PI-RADS 5, Likert 5 and PSMA positive

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User
Posted 23 Apr 2022 at 13:37

I’ve posted before being worried about a steep rise in PSA. Now I’ve had an mpMRI and PSMA PET/CT and the results are “highly suspicious for prostate malignancy” on both scan reports. The P5 lesion on MRI lights up in the same place on PSMA PET. 

My PSA isn’t that high (5.9) but PSA density is 0.20 as my prostate is normal size for a 50 yr old (30 cc).

The reports mention possible EPE, extension across the midline and equivocal seminal vesicle involvement, which scares me and seems very imprecise but I understand it could mean T3 (if it’s cancer)?

My question is - if it is cancer - how do they confirm staging as this would be relevant for treatment options?

I’m having MRI targeted fusion biopsies in the next few weeks. Will the biopsies be able to confirm staging? 

Many thanks for any input. 

User
Posted 23 Apr 2022 at 15:25

The bone scan finds whether it's T4 (spread outside the prostate), but assuming it's not, the biopsy will take multiple samples from different parts of the prostate. If the samples test positive for cancer in those areas right on the outer edge, then it's T3. If the outermost samples are clear but the inner ones show cancer, it's T2.

Best wishes,

Chris

 

Edited by member 23 Apr 2022 at 16:52  | Reason: Typo

User
Posted 24 Apr 2022 at 08:39
Your PSMA PET is now the gold standard for staging combined with needle biopsy will give you an estimated stage. Sounds like you don't need to worry about distant metastases and equivocal on the seminal vesicles is better than unequivocal!

Just need to wait now and perhaps research the options for curative treatment so you know what questions to ask when you get your staging and Gleason score.

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User
Posted 23 Apr 2022 at 15:25

The bone scan finds whether it's T4 (spread outside the prostate), but assuming it's not, the biopsy will take multiple samples from different parts of the prostate. If the samples test positive for cancer in those areas right on the outer edge, then it's T3. If the outermost samples are clear but the inner ones show cancer, it's T2.

Best wishes,

Chris

 

Edited by member 23 Apr 2022 at 16:52  | Reason: Typo

User
Posted 23 Apr 2022 at 15:43

Thank you Chris. So the biopsies should confirm staging as well as whether it’s actually cancer. That’s really helpful as it’s a question I couldn’t find the answer to anywhere else!

User
Posted 24 Apr 2022 at 08:39
Your PSMA PET is now the gold standard for staging combined with needle biopsy will give you an estimated stage. Sounds like you don't need to worry about distant metastases and equivocal on the seminal vesicles is better than unequivocal!

Just need to wait now and perhaps research the options for curative treatment so you know what questions to ask when you get your staging and Gleason score.

User
Posted 28 Apr 2022 at 15:14

Thank you francij1. I only just saw your reply. That’s helpful and reassuring. I have biopsies next week so quicker than I’d expected so that’s a relief - I’m having a few sleepless nights! 

 
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