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Prostate evaluation 12-1-2016

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Roger2Dodger
Roger2Dodger

Most in here know my story. I have been on Active  surveillance for the past 7 months.

I visited my Urolgist today 12-1-2016 for a re evaluation. I had a PSA test done prior to the visit, and my PSA had increased from 5.83 to 6.87. I was disapointed to say the least of the increase.The last PSA was taken 7 months ago. So that's an increase of 1.04. (not Good)

I discussed my options going forward and I have agreed to have a MRI-guided prostate biopsy After  January 1  2017. My  TRUSS biopsy as I indicated in other threads, and the results were.. 2 cores 4-3=7 and 3 +3 =6

I will meet with my Urologist again after the  results of the  MRI- guided biopsy and discuss my treatment. Whether or not I stay on AS or go for treatment. We did discuss another PSA test after 3 months, but I declined on that plan, My opinion, The MRI would give me a better indication of my PCa, and let me make a sensibile decision.

I would like some opinions from the group, I would be very appreciative!

Emis Moderator comment: I have removed the email address as we do not publish these in the forums. If users wish to exchange contact details please use the Private Message service.

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  • Supertractorman
    Supertractorman Roger2Dodger

    Posted

    I have been on Active Surveillance at PSA levels of 10 for 15 years now, and am more worried about Sepis again after biopsies. Too many possible side effects when they are at your prostate with main risk of nerve damage. You do not mention your age as I am 73 so could die from natural causes before Cancer gets me.  If it gets worse then action needs taken.
    • Roger2Dodger
      Roger2Dodger Supertractorman

      Posted

      Supertractorman,

      I am 76  years old and considered healthy.  What is your Gleason score? I do admire you for chosing Active Surveillance . I wouild like to stay on AS and keep what  I have currently have, erections etc..But I fear my PSa will leave the Prostate and cause me hear ache at a later age.

    • Supertractorman
      Supertractorman Roger2Dodger

      Posted

      Roger,  Gleason 3+4 if I remember correctly. One Professor I have seen says 10 is his boundary position and if their is rapid movement in PSA score then that requires attention. After my   TURP   in December last year my PSA went down to 6 but I lost E/D and still have incontinence plus Prostatitis which I put down to that procedure. Biopsies give you a big risk of Sepsis and anybody having one, please ask after that they have given you A/B's as Sepsis can be a killer and I was an hour away from the next world. He told me nerve damage can be a big risk with removal and that he never wanted to take out a Prostate which can easily be watched. Am seeing him in 2 weeks for next review so will see the position then.    As always it is your choice but for me providing they are watching closely then I will leave it as long as I can.  There is an old Scottish saying which is very apt for all of us " Lang may ye Pump & Pee and never need a Doctor".

    • Roger2Dodger
      Roger2Dodger Supertractorman

      Posted

      Supertractorman...

      Making decisions are difficult with this horrible disease, There are so many opinions out there , including the urologists, doctors, and professionals  on PCa. So, it comes down to the patient to ake the right decision. I truly hope I do. I n your case I would say you made the right one, but you have many years left at age 73, and hopefully your PCa stys the same.

    • Tybeeman
      Tybeeman Roger2Dodger

      Posted

      I am 58 and had mine out 10 months ago, 76? with a Gleason 6. I would let that PSA get to 11 before I removed it. By then something else will have killed you. In 2004 my PSA was 7.2 and it didn’t hit 11 thill last year. I would not have another biopsy till you hit 11.
    • Roger2Dodger
      Roger2Dodger Tybeeman

      Posted

      Tybeeman' I am not even considering removing the prostate. However, I will consider radiation. I am just fearful that my PCa will leave the capsule in later years. I will not panic , I have time to make my decision.

  • greg43014
    greg43014 Roger2Dodger

    Posted

    I had the same thing done with the MRI guided biopsy and my results was 3.3 so I am deciding to have surgery on December 7th good luck I think you're making the right decision whatever that may be

  • greg43014
    greg43014 Roger2Dodger

    Posted

    I had the same thing done with the MRI guided biopsy and my results was 3.3 so I am deciding to have surgery on December 7th good luck I think you're making the right decision whatever that may be

    • greg43014
      greg43014

      Posted

      My Gleason score was 3+3 my PS PS I went from 4.9. To 5.7 to 6.3 and that's why I decide having surgery on December 7th good luck MRI biopsy picked up two legions at my other posts and you'll see why I should logically for good luck

  • geoff90305
    geoff90305 Roger2Dodger

    Posted

    Hi Roger, The biopsy will help to determine if you have a PCa, where it was found and know its Gleason score. The MRI will answer the first two, but not the Gleason. It may help with staging, and the Radioloigist will give you a PIRAD score 1-5..1 being you are a teenager and 5 you got problems.

    I am not sure about the MRI/biopsy, unless you know you have a lesion to see to biopsy.

    My choice was to have the MRI first, then I went to the urologist, we looked at the images and radiologist report and my PSA history to decide if a biopsy was warranted. In my case it was not warranted. If it was warranted, then I would chose a perineal biopsy, which has virtually no infection risk, compared to a rectal version.

    When you know you have a PCa, and you have its gleason, size, stage..you can make a better decision about AS or....

    Geoff 

    • Roger2Dodger
      Roger2Dodger geoff90305

      Posted

      Geoff,

      I have already had a MRI, Pirad score etc; and. A TRUS biopsy. My biopsy remains were sent for Genetic testing and the results proved my PCA in the non aggressive range.That is why I chose AS. Now my PSA has elevated , I want to know exactly what my cancel is.. ie aggressiveness etc. So a guided biopsy perhaps will tell me. Your thoughts?

    • geoff90305
      geoff90305 Roger2Dodger

      Posted

      Roger, my thoughts

      What size did your original MRI report the lesion(s) to be and their proximity to the walls? Did they give you any staging? It is good you had your biopsy genetic tested for aggressiveness and it came back in the non aggressive range. To me, this means the lesion(s) will still grow, but slowly.  The PSA increase shows the PCa is still growing, as to be expected, but, it will also be your BPH, and a bit of prostatitus adding to the PSA score. What size is your prostate?

      The number of needle samples with a MRI guided biopsy will only require a few samples due to the targeted plan. This should help reduce the problem of infections. I guess you are you looking to see if the Gleason score has increased?  You will then get it Genetic tested to see if is still in the non aggressive range?

      Roger, on this and other forums, I have seen reports of guys in their 70's and 80's still AS with PSA at 70+. Sure, their PCa is growing slowly, but it was not aggressive, meaning, it is in no hurry to leave the prostate capsule and create havoc. At 76, I would not contemplate interventional treatment unless the PCa has turned aggressive. You might be in pretty good health now, but even robotic surgery will take its toll on you. Us oldies do not heal as well as the 'young' guys in their 50's. 

      If YOU decide to consider remedial action, consider all of them, but the less damaging types like radiation may better fit your age. Apparently, radiation with or without seeds are getting better and more targeted. While radiation may presently have 20 year later complications, you may not be here, and so not be a problem for you. 

      It is all about quality of remaining life.    

    • Roger2Dodger
      Roger2Dodger geoff90305

      Posted

      geoff90305,

      I like your thoughts and advice you have given me. What you have said makes sense.

      I will get back to you on the questions you presented.

      Robotic surgery is definitely not a treatment I will choose

      I called prolaris and told them their nonaggresive range in the genetic testing , I thought was not a valid score because of my Gleason 7. They disagreed and told me the rise in my PSA was just a tool not a diagnosis of cancer

      A rise in one's PSA is certainly a red flag that PCA is growing.

      I am going to get that MRI- guided biopdy and let that determine my course of action. I am done with AS...

      Roger

    • geoff90305
      geoff90305 Roger2Dodger

      Posted

      Roger, I sort of agree with prolaris. The PSA test just says the prostate aint happy. The cause of higher PSA is usually, prostatitus, BPH or PCa or a combination of all three. From what i read, the prolaris people actually look at your tumour in great detail and do their magic. From what I read about Gleason results, they are usually reported upwards rather than downwards.. So, I suppose, the Gleason 7 result while sounding moderately aggressive, the prolaris method may disagree with the Gleason 7 score.

      Do they have a follow up procedure where you can send them another sample? and see if they still agree it is not aggressive and the rise in PSA is for some other reason. I suppose the PCa grows and puts out more PSA.

      I like your last para. No more excuses not to do anything....take action. BTW, when you get a MRI guided biopsy, do they do a new MRI, or use the last one to needle guiding? The reason I ask is if they did a new MRI, they could compare both sets of images and advise of the lesions growth. I will pm you something.

    • Roger2Dodger
      Roger2Dodger geoff90305

      Posted

      Geoff,

      I talked to Prolaris just after I got my text results, They told me my Prolaris score did nor reflect my Gleason score. They described it this way. The prolaris score could be compared to a car, how fast it is running. In other words a 7 could run fast, but my score (car) was not running fast.

      The National Comprehensive Cancer Network has 3 conditions of PCa considered for treatment.1. Stage, 2. PSA over 10, 3. Gleason 7. And I have Gleason 7.

      I ask Prolaris yesterday if I could send my MRI- guided biopsy remains in for testing, they said I could , but discussed with my Urologist. I don't think that will be necessary, because the guided MRI will tell me what I need to know.

      All I know about the MRI-GUIDED biopsy is it is different than the TRUS one I had. They only go to the cancer it self.

      Where do I go to get the PM?

      Thank you so much for your guidance and support

      Roger

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