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User
Posted 15 Jan 2025 at 22:11

Hi all, hope this is in the right section! Hope one of you experts may be able to help with this: first biopsy in 2018 revealed very low grade 3+3 and only one core out of 30 pos.


Just had repeat at 5 yearly (although this time with local) and results have all come back negative. (30 cores I think) 


Good news I hear you all say, but where has the cancer gone? 


I'll still be under AS so still in a good position, and I realise seems pretty insignificant compared to what some are going through- almost feel like a fraud!


Be grateful of any feedback, many thanks 😊 

User
Posted 16 Jan 2025 at 15:30

I'd guess that a small bit of low-grade cancer was caught in 1 'core' (sample)  the first time.  The next time, all 30 cores missed it. 


It evidently hasn't multiplied or grown significantly in 5 years so not a problem. 

User
Posted 16 Jan 2025 at 17:19
It was clearly stated (multiple times) to me that any biopsy can easily miss the PC as they are only tiny samples relatively speaking compared to the whole prostate. Although they make an effort to target any suspicious areas highlighted by the MRI.

But still I'd say thats good news and a good indication to continue AS.

In my example they found T2 in the 1st biopsy, but only T1 in the 2nd.
User
Posted 16 Jan 2025 at 19:08

They may have just missed it when they undertook MRI and biopsy. My husband had a RP as a consequence of a lesion detected by MPMRI and biopsy however a further three tumours were not identified either by the MPMRI or by biopsy and were only discovered when the whole prostate was subject to pathology following surgery. All sections of the prostate were subject to a biopsy. The tumours were small but one was Gleason 4:3


 


I am not saying for one moment this is the case for you but most definitely MPMRI and biopsies miss cancers. This is why there should be an emphasis on “ Active” when on surveillance.

Edited by member 16 Jan 2025 at 19:10  | Reason: Not specified

User
Posted 16 Jan 2025 at 19:11

Thanks for reply owow, I don't think it was made that clear to me but yes your right it don't take much figuring out. I'm guessing they have targeted my tumour too as it's fairly "accessible" interesting how your 2 were different. 30 cores does sound a lot as prostate is only small,  but I guess the needle is relatively small. (Although it doesn't look it head on! )


Onwards and upwards ☺️ 

Edited by member 16 Jan 2025 at 19:16  | Reason: Not specified

User
Posted 16 Jan 2025 at 19:23

Thanks IDK2.,


your right it is a minefield, and AS does need to be active- thankfully my nurse is very proactive, it's a shame she's ready to retire...


Let's hope things stay as they are. 


Hope yours is all OK too,


Thanks for your help. 

User
Posted 16 Jan 2025 at 19:26
I think my 2nd biopsy had 30 cores also, I did ask whilst they were actually carrying out the procedure. But the nurse was keeping me busy trying to take my mind off it at the time. The template was too small for my small-ish prostate, so a bit of manual aiming was done.

At the review they did say it was a little unusual getting T1 this time, and only at 5%.
But I believe the previous T2 area wasn't targetted.

For a 5 year review you are in great shape, PCa aside. I wonder how many men walk around with low grade for the rest of their lives never knowing it was even there.
User
Posted 16 Jan 2025 at 20:22

Fortunately MPMri’s are extremely accurate (I believe over 90%) for identifying Gleason 7, 8, 9 and 10’s. The false negatives percentage’s are primarily in the Gleason 6’s, after analyzing results of MpMRI results to the core biopsy readings of prostates in a study. That still misses though.

User
Posted 16 Jan 2025 at 20:28

Hi Ned,


Pretty sure I've not had an mpmri, are they specific to prostate? Think mine have just been standard mri....

User
Posted 16 Jan 2025 at 20:32

Owow, 


I guess it must be like looking for a needle in a haystack, especially low grade. Probably like a small teabag after 30 cores πŸ˜„. 


Yes I'm in a good position really, 1 step in front. 


As you say,  most would never know....

User
Posted 16 Jan 2025 at 21:07

Yes the MpMRI is specific to the prostate. A regular MRI would not pick up the same the prostate. It’s always good to confirm its a MpMRI you are getting. 

User
Posted 16 Jan 2025 at 23:12
Neither of my 2 prostate MRIs involved contrast, so I conclude from that, mine were not mpMRI.

I wonder what defines the MDT to decide on a mpMRI, and if its down to resources, staff and training.
The article on here https://prostatecanceruk.org/about-us/projects/mpmri suggests it is available at my local hospital, so I'm tempted to ask why it wasn't used.

Has anyone pushed that question to their own teams?
User
Posted 17 Jan 2025 at 08:43
Yes I've pushed a few times about contrast, and they have said not needed, so am presuming I've had normal mri.
Something I will enquire about.
 
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