Hi - I’m hoping for some advice or opinions on anything I can do or ask given I’ve today got a clear transperineal biopsy result but because my MRI in March identified an extremely anomalous area which if cancerous would be rated T4 N1, the junior doctor I saw for my results said he was going to put my case forward for team discussion and consideration of further tests, meaning most likely repeat or more invasive biopsies, as he thought the 2 results were so hugely inconsistent. The doctor clearly expected the biopsy to be positive although the consultant who actually did the biopsy told me he thought it was unlikely cancerous not least because my prostate felt very smooth but also because I’d had a clear transrectal biopsy of the same area in 2019.
It might be worth sharing some of my history. I was referred to urology by my GP in early 2019 due to a high PSA (around 7-8 I think). I had a MRI in 2019 which identified a moderately rated anomalous area which led to a transrectal biopsy which was all clear. I was put on a waiting list for urolift but due to Covid then the hospital ceasing to offer the procedure I was instead left soldiering on with Finasteride and Tamsulisin. Over time I first dropped Tamsulsin then about 9 months ago Finasteride also (due to side effects). Last summer in consultation with my GP and on the basis that my quality of life would improve if I had treatments such as PAE or Rezum, I went back on the urology waiting list and am in fact now on 2 lists at 2 different hospitals – one for Rezum and the other for PAE. It was at my request the MRI was repeated just before I was due to have Rezum earlier this year. The highly anomalous area revealed by the recent MRA meant the Rezum procedure couldn’t go ahead and instead I was listed for transperineal biopsy. Likewise the hospital offering to consider me for PAE is waiting on the transperineal biopsy results before seriously considering me for PAE. I will postpone a CT angiogram which is part of the assessment procedure while the cancer-or-not issue remains in abeyance as it seems consultants are not keen to proceed with either PAE or Rezum unless there is confidence in a negative biopsy, which according to the doctor I saw today there isn’t – as he put it I’m still “under investigation “.
As for my PSA scores, from memory these were hovering around 7-8 before I went on Finasteride, fell to around 3-4 while on it, rose again to around 7 after I came off Finasteride, blipped at around 11 in Dec 2023 but fell to 3.3 in early 2024. I queried the3.3 score early this year but was told it is highly unlikely to be an error and more indicative of my PSA varying day to day.
Urinary symptoms are fairly mild but problematic at times, like when on long journeys. I have a significant but not huge volume of retention. Occasional dashes to the loo and repeat trips. I can no longer pee with the firehouse stream of a teenager. Long drives require planning of toilet breaks. I rarely wake at night even if I drink a beer or hot drink immediately before bed. I’d say things are slowly worsening as I age but are far from dire.
Apparently my prostate is roughly 60cc.
Meds wise since coming off Finasteride I’ve found 5mg of daily cialis helpful. I buy that privately. I don’t always take it regularly. I try not to take more medication than I need, but do load up on herbals and vitamins (saw palmetto, zinc, multivitamins, etc).
I drink a lot of coffee and am trying not to. That certainly doesn’t help with the toilet dashes.
So that’s it. My 2 MRIs, 5years apart, show the same area becoming increasingly suspicious and more recently alikelihood that cancer has spread beyond my prostate. However I’ve now had 2 different biopsies, one rectal and perineal, which are completely negative. The last transperineal (20 samples plus about 6 anaesthetic injections) was incredibly painful and I don’t relish the thought of repeating that in the near future and also am concerned, what with the amount of blood afterwards, that my prostate is going to end up damaged by such butchery. So while I’m waiting on what the team review comes up with, I’d welcome any thoughts from anyone who’s experienced similar history or such near certainly bad MRI results followed by clear biopsies.
Many thanks in advance!!