Getting confused and upset

Thank you

BPH diagnosed 11 years ago after urine retention - TURP carried out then and again 5 years ago. Annual PSA - last one was 3.2 low for him then the latest 4.9 resulted in referral, urologist was being cautious did not expect to find cancer. DRE normal (3 exams) GP urine rest suggested microscopic blood but none in 3 tests since, cystoscope showed a little regrowth BPH.

MRI suggested 4 suspect areas but biopsy under TRUS as the new 'Fusion' guided programme was new and wouldn't work.We haven't had PIRAD score. I queried the 3+4 random result and asked if had been x- referenced to MRI but was told probably miniscule and not visible. I also asked about inflammation, the original radiologist had not flagged the LHS for attention but MDT radiologist commented and changed to T2C. I suppose nothing conclusive until histology but this seems puzzling - I know biopsies can 'graze' areas but percentages are small we haven't been told size of areas on MRI. They are confident it is localised and can be removed but I worry given some of the vagueness to date

So, even with regular PSA checks while other stuff going on, an elevated PSA to 4.9(which is not really high..high) And the MRI displaying suspect images, they decided on the TURP biopsy. Good decision. I think they are just covering their backside when they included the left side of the prostate as well. The later pathology will confirm if it was in both side or not. 

As for vagueness, from what I read in these forums, this is a common mallady with some of the 'professionals'. I have been lucky that my urologist is straight up front and very black and white.

Geoff

Yes I think they are covering bases but it's the detail that keeps me awake at the moment 😕 Looking at the British Association Urological surgeons they actually only report under 3 risk profiles - Gleason 3 + 3 and Pathological T2C described as early cancer confined to prostate and T3 locally advanced. I understand the grading but this is how stats are collated maybe the T2C reflects that rather than the specifics of his case..... Original urologist said nothing to worry about and to be honest we have made the decision whether T1c T2 of any demonination it's just the detail that is bothering me less so my husband and I don't want to get him caught up in my worry - thanks

Yes, do not get your husband caught up with yout feelings. Just say yes dear, smile and say everything will be fine. 

Most Australian doctors and 'specialists' are normally pretty open and to the point, without trying to distance themselves from their patients(paying customers). They are only too happy to go into great detail. You, your husband and the doctor make an informed decision, rather than 'we' meaning the doctor, will do this and this... 

I think reporting under three risk profiles when there are many stages and parts of stages, oversimplifies the issue, and causes confusion as to where you are in the staging.

I guess, if you are in the public system(NHS?) then surgeries get put off etc until a doctor can find time. Here in Australia, deferred surgeries are also very common in public hospitals. 

For your husband's sake, keep his confidence up in the knowledge, his cancer is still not at the aggressive stage, and is encapsulated. Putting the surgery off 2 weeks should not change the outcome.

Geoff  

Thanks - it's just the way urological society capture data that's in 3 categories, we have the same staging systems. Time seems to be a factor in U.K. Our last appointment was 1.45 hrs late and a queue of people after us, not a lot of time to go into detail. Thank you for your response - goodnight

My last 2pm appointment with my private specialist was running 2 hours late, with a full waiting room behind me. He ignores time and gets involved with each patient. His last sentence he asks everyone before they leave..." Do you fully understand where we are with everything. if you ask something, another explanation...then...OK, great...If you remember anything else, email or phone me, and I will get back to you". I now ask for very early appointments..this way less people in front to cause delays.. people waiting do not seem to grumble, as they know what the patient before them is going through.

?Geoff

Thank you - I think I am tired and upset today, it's easy to overthink things and originally the op was scheduled for tomorrow, it's now the 20th. We've been through the same process as you and it's forced to take its toll I expect. good luck to you too.

I would like to echo Geoff's comment on PIRADS. This is a tool used in MRIs to diagnose the cancer. It is measured on a scale of 1-5 with  5 being "you can bet your house there is significant cancer there" and it shows what lives are most likely involved.

my PIRADS score was 4, which is lousy but tallied with the following u/s guided MRI biopsy that showed a G9

If possible I would always have a MRI reported on by an expert on prostate image reading and ideally that MRI would mention the PIRADS score.

Why did he choose robotic surgery? Is it because it is believed the cancer is local to the prostate and has not spread?

if so, then good luck with the surgery.

i am 50 and went through the RARP three and a half months ago.

there is some adjustment to one' s new life after that. Even when it goes well as mine did. Or so it is thought.

The doctor said he was a perfect candidate for this type of surgery. Sounded like the best option. Feb 2 2017 is surgery.

Fewer days in hospital, true.

Shorter time with a catheter, true.

Faster recovery, true.

But you should know that  the outcome from surgery is a function of the skill of the surgeon and not of the technique that is used.

There is not one study anywhere that proves that robotic surgery has a better outcome than traditional open surgery when a highly skilled surgeon is operating.

The real benefit of RARP in my opinion is that it makes the work easier on the surgeon and that can only help the outcome. And that's good enough for me.

Regardless of technology used by the surgeon, the number of procedures he has performed is the #1 priority. That is to say a surgeon who has performed 400 open surgeries is to be preferred to someone who has performed 40 RARP.

The best case is RARP performed by a surgeon who has done hundreds of such procedures

Absolutely, surgeon has done over 1000 RARP's. Just like with anything, the more experienced the better!

Geoff