MRI Result Meltdown

Margot, how thoughtful and caring of you, to find time to respond to Mike, when you going through difficult times yourself. It's that sort of spirit that makes this place the jewel that it is. 👏

Hello again mate.

I'm sorry that your biopsy results aren't as good as we hoped for. I fully understand how upsetting it is for you and your wife. My heart goes out to you both.

I know how difficult it is to be positive, but it isn't the end of the world mate.  As I said, after my op my Gleason was upgraded to 9 (4+5) and T3a EPE. The surgeon also removed the seminal vesicles, 9 lymph nodes and some other tissue around the EPE, they all came back clear. Nearly 17 months later and my PSA is still undetectable. There are several others who had a similar Gleason and staging to me, who are also now apparently cancer free.

Best of luck with your next consultation.

Edited by member 27 Jun 2024 at 17:07  | Reason: Typo

Hi all. This is my first post. I’m 51 years old, in good health otherwise, but have recently been diagnosed following an elevated PSA result (12.7) at a routine physical exam. I knew that number was bad but I felt that even with the strong likelihood of it being cancer, I thought that the MRI would hopefully show things weren’t too far along.

Well, I just got my MRI results back and I’m now fearing that I am in fact…”that far along”. I’ll spare you from a long dissertation of all the emotions my wife and I are currently experiencing, but to say the least, my head is spinning and is lurking in the darkest of places. I haven’t been biopsied yet, but below is the core excerpt from my MRI report (beneath that is some more ranting by me (sorry) and some questions:

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FINDINGS: 

PROSTATE GLAND: Prostate gland with volume of 20 cc.

There is a large T2 hypointense lesion involving the right posterior base peripheral zone measuring up to 0.7 x 1.8 cm (image 15 of axial T2). The lesion demonstrates prominent focal restricted diffusion with low ADC and early focal enhancement. There are areas of gross extra prostatic extension, most notable along the right posterolateral border.

T2 PI-RADS score: 5
DWI PI-RADS score: 5
DCE PI-RADS score: Positive  

No other suspicious lesion identified. Unremarkable transition zone without appreciable benign prostatic hypertrophy

SEMINAL VESICLES: Unremarkable.

URINARY BLADDER: Unremarkable.

LYMPH NODES: Unremarkable.

VESSELS: Unremarkable.

BOWEL: Unremarkable.

FREE FLUID: None.

SOFT TISSUES: Unremarkable.

BONES:  Unremarkable.

IMPRESSION:
1.  0.7 x 1.8 cm lesion in the right posterior base peripheral zone with extraprostatic extension, suspicious for significant prostate cancer: PI-RADS 5 -  Very high (clinically significant cancer is highly likely to be present).
2.  No seminal vesicle invasion, pelvic lymphadenopathy, or suspicious osseous lesion.

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The things that are really freaking me out big time right now is

• The size of the lesion (1.8cm x 0.7cm – that’s huge, isn’t it?) How big were your lesions??
• and worse…the mention of “areas of gross extra prostatic extension” – To me, that sounds like this thing has already EXPLODED out of the prostate which I feel despite the other tissues currently being labeled as “unremarkable”, metastesis must surely already be taking place, even if it’s at the micro level.
• Also, what does it mean that it’s a “T2” lesion? Does that have anything to do w/ staging at this point?

My biopsy will be in the next 2 – 3 weeks. Then, probably another 2 weeks to get those results (which I’m dreading), then probably bonescan plus whatever other barrage of tests are required. I feel like by the time I do begin treatment however many months from now, more serious spread will have occurred.

Sorry for being so negative. I admit I tend to be a “glass is half empty” kind of guy and right now I’m feeling like the glass is “full of poison”. Is there any positivity here? I could sure use some.

Hi Mike.

I'm sorry that you've had to join us but I'm glad you have. Welcome to the forum. 

As your reports states Pi-Rads 5 means its very likely cancer. However, only a biopsy can confirm that it is, and if so, what Gleason score it is.

There was a chap on here recently who had a similar scan to yours and it transpired that the tumour was benign. 

As far as I'm aware the T2 on the MRI relates to weight of the imaging not to the cancer stage. However, on my MRI report, they did give me a provisional radiological staging.

Is there not one on your report and what's your PSA?

Even if you're like me, and unlucky enough to have a high Gleason score and extra prostatic extension, it's not the end of the world, it's still curable. I had a prostatectomy 16 months ago and there is now no detectable PSA. 

The only advice I can give is take things one step at a time and try not focus on ifs or maybes. As for your head spinning and being in the darkest places, that natural mate, we've all felt that way, but it passes.

Please keep us updated we will do our best to support you.

Edited by member 23 May 2024 at 01:16  | Reason: Typo

At this stage you can't be sure how serious this is but note the UNREMARKABLES. These include the seminal vesicles and lymph nodes and this is good news. Also, as Adrian says, until you've got a definite result from a biopsy there's still a chance it's benign.

If it's cancer, from the news so far any spread is limited so worst case might be locally advanced, which is "curable".

The biopsy will be key here and probably it will lead to you being given an option of treatments, like a prostatectomy or radio therapy [of some sort] maybe with hormone treatment. In more serious gradings you might be limited to RT/HT only whereas if there's a chance you haven't got spread outside the capsule, it could be the prostatectomy path. I think I'm right in saying the biopsy can pick up cancer in the seminal vesicles, though it doesn't extend out to detecting cancer in lymph nodes. A PSMA PET scan is sometimes used if there's a suspicion of spread that far.

At 51 your age will be part of the decision because RT sightly increases the chances of cancer popping up somewhere, later as a result BUT that's always a possibility and the RT doesn't increase the probability by more than a couple of percentage points.

It doesn't matter if you're a glass half full or a glass half empty kind of guy [they'e both the same aren't they 🙂] if you didn't feel some dread about this you wouldn't be human BUT these days a diagnosis of prostate cancer is not a death sentence and from what you've said it's going to be tough but you'll probably get through.

Jules

Edited by member 23 May 2024 at 06:31  | Reason: Not specified

1 - MRI Guided Trans Rectal under local anesthesia in his office

or

2 - MRI Guided TransPerineal under general anesthesia in the hospital

I immediately chose the latter. Only bad part is it will take a bit longer to schedule and I have to go back to my primary care physician for MORE bloodwork (despite having been there for that just a few weeks ago) to get medical clearance for the anesthesia.

I did ask about whether or not any of the surrounding tissues (outside the prostate) are biopsied and he answered with a firm "NO". He said the needle is not supposed to touch any of those areas. He said they will get 2 or 3 cores directly from the tumor and I believe another dozen from other parts of the prostate.

Once I get the biopsy results back then he said I have to go for a (PSMA PET??) scan. Apparently that will give a truer picture of whether all those "unremarkable" tissues are really unremarkable or not. Great. I thought I was somewhat in the clear on the surrounding tissues. Now I feel like I have more to worry about - and even more delays. I am so tense right now. The next several weeks are really going to be a struggle to get through.

So, another update. I received my biopsy results last night. I feel sick to my stomach typing this. A good chunk of my cancer is Gleason 9 (4 + 5) w/ Cribriform. I know that's a really bad combination. Also, while my MRI only showed cancer on the right side of the prostate, the biopsy revealed that the left is cancerous as well (details below). Although the left side doesn’t look horrible, the fact that the MRI showed no cancer there and also showed that the surrounding tissues outside the prostate were clear (despite having “gross EPE”) I now feel certain that there must be cancer in the surrounding tissues and possibly lymph nodes as well.

Here's what the biopsy showed:

DIAGNOSIS:

A.  Prostate, MRI target #1, biopsy: Adenocarcinoma, Gleason score 4 (60%) + 3 = 7, grade group 3 involving 60% of 3 of 3 cores.

B.  Prostate, right mid, biopsy: Adenocarcinoma, Gleason score 4 (80%) + 5 (5%) = 9, grade group 4 involving 75% of 2 of 2 cores. Focal cribriform pattern 4 is present.

C.  Prostate, right posterior lateral, biopsy: Adenocarcinoma, Gleason score 4 (60%) + 3 = 7, grade group 3 involving 45% of 2 of 2 cores. Perineural invasion is present.

D.  Prostate, right anterior lateral, biopsy: Adenocarcinoma, Gleason score number 3 + 4 (10%) = 7, grade group 2 involving 10% of 2 of 2 cores.

E.  Prostate, right anterior mid, biopsy: Benign prostate tissue.

F.  Prostate, left posterior mid, biopsy: Adenocarcinoma, Gleason score 3 + 4 (10%) = 7, grade group 2 involving 5% of 1 of 2 cores.

G.  Prostate, left posterior lateral, biopsy: Adenocarcinoma, Gleason grade 4 + 4 = 8, grade group 4 involving 5% of 1 of 2 cores.

H.  Prostate, left anterior lateral, biopsy: Benign prostate tissue.

I.  Prostate, left anterior mid, biopsy: Benign prostate tissue.

If it wasn’t for section “B”, it wouldn’t be so bad. That’s the pill I’m having a really hard time trying to swallow.

My next step is meeting with a surgeon on July 8th  The point is probably moot as I doubt I’d be a candidate for surgery but he is a highly respected urological oncologist in our area and is affiliated with a hospital that has a very well respected oncology / radiology team. So hopefully, I’ll at least get pointed in the right direction for treatment of some sort. I also still need to get a PSMA PET scan to see if I’m metastatic or not. Can’t wait.

My wife and I had a good cry last night. I only got about 2 hours sleep. When she woke this morning, she started crying again uncontrollably (which got me started as well). Just a few weeks before I was diagnosed, her mother had passed away following a long battle w/ metastatic breast cancer. Now she has to go through this with me.

Hi again 

I know it’s not the result you wanted but I would say that even with the G9 this cancer is still curable. 
I read an article I can’t think of it was this forum or another one I read that is having some debate about the cribform that says there is some doubt about the histology being always negative. I will look for it and post it on here if I can find it. 
I don’t know what the criteria are for surgery is where you are but but my husband has just had RP for his treatment and we await the histology .

I do know however that if you go down the Brachy RT/Hormone route that the stats are still good for a cure with G9 and EC. 

Each of these steps, biopsy, scans, results are horrible and they have to be got through BUT I can honestly say I think when you get on your way with treatment things do feel better. 

People with much more knowledge than me will comment but I wanted to say things won’t always feel this heightened and we are only a few weeks ahead of you so just try an take each day as it comes 

very best wishes 

M 

Thank you Adrian & Margot. I was definitely a bit loopy when I posted Monday. It had only been a few hours post surgery when I wrote it. I'm surprised I did and hardly remember doing it! 

Anyway,, I'm home now resting. To clarify a few things now that I'm more clear headed and have spoken to the surgeon directly. To recap, my RP surgery was early Monday afternoon (the 19th) in a hospital on Long Island (NY). I had Retzius sparing, DaVinci radical prostatectomy.  My left nerve bundle was fully spared but the right side was partially removed. As I said in my prior post, my wife had spoken to the surgeon immediately after the surgery and thought he said they spared a third of the right nerve bundle but when I spoke to the surgeon the following morning he said said they REMOVED about a third of the right side sparing the rest which I was quite surprised about. On one hand I'm happy to have more of the nerves in tact but on the other I'm worried that over sparing on what was the heavily infiltrated side may result in leaving cancer behind. Lymph nodes were also removed on both sides (don't know how many though) as a precautionary measure but the surgeon said none of them appeared questionable.

Also, to clarify a bit about the "clear margins". Again, what was checked during the surgery is not a complete tissue analysis. The surgeon told me they freeze and shave off some of the tissue sample during the procedure and send those bits over to the lab. They did in fact come back clear but he said it's not a full 360 degree sample - just some small areas where the greatest concern was to let him know if he needs to cut wider. The real final results won't be known until the histology report comes back. More waiting!! But hey, at least so far, so good.  Another good little tidbit of info he told me was that usually when there is cancer outside the prostate the tissue becomes "sticky" and is more difficult to remove. He said my tissue not only appeared clear but also removed very smoothly and easily the way normal healthy tissue should indicating there may not have been as much cancer outside the prostate as originally thought, but I'm not getting my hopes up yet.

I was supposed to be discharged from the hospital Tuesday morning but ended up having a setback which kept me there an extra day. I was feeling well Tuesday morning and was eager to get out of bed and walk around. I asked my nurse if I could so he helped me out of bed and we started walking around the hospital hallways. I felt great while walking. In fact, when we got back to my room I asked to go for a second lap which we did. When we got back to the room again I was still doing very well so while I was still standing he decided to show me how to properly empty my catheter bag. While I was standing there watching him I suddenly started feeling dizzy and said that I needed to sit down. As I was walking back to the bed I began sweating profusely, became very nauseous, vision began to fade...and bam! Next thing I know I'm flat on the floor with an emergency team of 10 people scrambling over me. The short of it was, I just passed out. But when that happens in a hospital after surgery they make you go through a litany of tests including bloodwork, full exam, EKG, even an echo-cardiogram. The worst part of it for me was it was Tuesday morning and I hadn't had any solid food since the prior Saturday evening (no food Sunday and full colon prep). I was STARVING and wanted to eat soooo bad. You would think they would want you to eat after a fainting episode but nope! They told me no solid for another day and...I'd just earned another night stay! I walked again that night and Wednesday morning without issue so they fed me and tossed me to the curb. So I'm home now.

As far as pain goes, my issues have been  I am extremely bloated (gas pain from anesthesia induced constipation) and surgical pain (internal) on the right side of my abdomin and some catheter discomfort ( more on that subject in a bit). I cannot lay down flat yet because when flat, the stretching of my abdomin while breathing really triggers the right side abdomin pain badly. It feels like muscle pain - almost a knotting sensation. Fortunately I have a comfortable lounge chair which I used last night which wasn't too bad.

Finally, there's the catheter. I HATE IT!! I'm counting down the minutes to removal - 8,640 to go give or take a few. It's not so much pain though I do keep getting the pinching twinges at the tip of my penis despite using the cleaning wipes regularly - ouch. I'm also having consistent issues with the long tube not quite draining properly into the bag. I have to keep maniupulating the tube to get the urine to flow properly. Did anybody else out there experience this? When it backs up it creates pressure in my bladder and makes me feel like I have to pee - but obviously can't. When it's flowing properly I feel fine and there is no urge to pee but the issue is persistent and has been so since Monday. None of the docs or nurses seemed concerned though as long as the urine is making it's way out of me. Oi. 8638 minutes and counting...

So that's my status in case anyone is curious. Thanks again everyone and I will continue to update regularly. I'm also happy to answer any questions for anyone gearing up for RP while I'm in the midst of it all. All in all, despite my moaning and wining, it really hasn't been too bad though. 

Yes that’s what we’re hoping. We went through a really difficult time when Rob was first diagnosed like yourselves. I think it’s the not knowing that causes us to have so much fear and anxiety, but now things are very different and we’re pretty positive and enjoying life. I hope that you have found things easier now you’re on the road to recovery. There’s no point in worrying about something that probably won’t ever happen. 

With regards to the catheter, no that wasn’t what he experienced. The only issue that he had was one day it got a bit blocked because of small blood clots and debris….it did eventually sort itself though. Also one time he forgot to close the tap after emptying….while we were in a restaurant 🤦🏻‍♀️🤣 luckily it was a friends restaurant! When he went to have his catheter removed they actually scanned his bladder, I believe this isn’t always common practice though, they weren’t particularly too concerned with the tiny leak (I think the surgeon did a bladder neck reconstruction during surgery) but just kept it in as a precaution.

The negative PSMA pet…..they radiated the whole pelvic area. We went in pretty early with a low PSA so we keep everything crossed that it was successful but could be a couple of years before we know.