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3T MRI Complete, Small PI RADS4 Lesions Found & Dr Does not Recommend Fusion Biopsy

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oldgrape
oldgrape

Results from 3T MRI showed 2 lesions at 8mm and PI RADS 4 and one lesion at 6mm at PI RADS 3. TURP chips showed Gleason 3+4 in about 5%. Two of the lesions were right at the margins of the TURP area removed. Doctor does not feel additional biopsy needed. He feels it will only prove what he already knows. I'm a little concerned that the centers of the lesions could be worse than the edges that were trimmed off in the TURP. So he wants me to come in and discuss with him and the oncologist on if I should treat now or do active surveillance. 

I know the lesions are small but I'm a little concerned that the doctor does not have a concise  picture of the cancer level. Originally my PSA jumped from 1.6 to 3.4 in a year. The number is low but the jump is what originally flagged the original biopsy that came back negative and then the testing of the TURP chips. The doctor was not going to have them tested because the biopsy was negative until I insisted. Am I being over reactive or should I push for the additional MRI.

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5 Replies

  • MK51151
    MK51151 oldgrape

    Posted

    Oldgrape;

    that was exactly how I was diagnosed with prostate cancer. Had TURP in June 2016 and was diagnosed with Gleson 6. Biopsy later, in August, confirmed Ca but with higher Gleson 7 (4+3).

    Had RP in November 2016. Was downgraded to 3+4. My cancer was multi focal on both side of prostate but biopsy missed it.

    MK

  • anthony70342
    anthony70342 oldgrape

    Posted

    If you are that concerned then PLEASE request another MRI or whatever you have to push so you can put your mind at rest.  Leaving ANYTHING up to a doctor is not a good idea.  It's been our experience that we had to push and push and push the doctors because most of them got so "comfortable" in their own skin.  But if you're not comfortable with any of it, then PUSH!  Godspeed!

    • anne05147
      anne05147 anthony70342

      Posted

      Completely agree.  My husband's doctor said he felt my husband should have a biopsy because he was anxious to get a result, this is understandable, but my husband was anxious about having a rectal biopsy as it was a 'stab in the dark', so said he would like another MRI done which was more specific.  So he had this done and it showed no evidence of anything as the previous MRI had been suspicious.  He was then offered an transperineal biopsy instead as part of a research trial and rectal ultrasound.  In the end he had the rectal ultrasound which shows enlarged prostate and declined the trans perineal biopsy and agreed with the consultant to have regular PSA testing and then review.  Unless the patient asks questions, explores alternatives etc., it is likely that the doctor will push also for further investigations to relieve their anxiety also, it is to prevent them also be sued for negligence and is a fine balancing line, but the patient must ultimately make an informed decision once they have explored all the available options.

  • rolf61809
    rolf61809 oldgrape

    Posted

    I don't think one can ever mistake on the side of caution. my local urologist radiologist read my MRI as PI RADS of four and five, while the radiologist at the Cleveland Clinic read them is 2 + 2. Nevertheless I went ahead and had a fusion biopsy. Of course they found nothing. So either my local radiologist didn't know his job or the urologist who did the biopsy didn't know his job or he did know his job and I was one of the lucky few who's cancer gets missed or I am cancer-free. Get the tests done and read through the results of yourself even if you don't understand all the terminology. I found out yesterday that the urologist who did my cystoscopy didn't bother to tell me my prostate was so enlarged that it was compressing my urethra to the point where the walls were 'kissing each other'. After repeated questions another urologist in his group actually read the cystoscopy results to me. So I'm going to go on a couple different drugs to shrink the prostate, what should have happened 6 months ago when I had the cystoscopy. I've had two ultrasounds of the prostate a couple times within the past couple years and it's hard to believe that the urethral narrowing wouldn't have shown up on one of them.

  • oldgrape
    oldgrape

    Posted

    Howdy all. I start my radiation treatment next week. The wife and I decided that watchful waiting was not an acceptable course for us. They never actually did another biopsy. The oncologist decided not much point since I was moving forward with treatment. I decided on having stereotactic body radiation therapy (SBRT) (5 treatments) or Cyber Knife as it is commonly referred to. Since I had the TURP the seeds are not really an option. They will do a PSA test before the 1st treatment to establish a base line. The other radiation option was the low does external beam (43 treatments). I will post as the treatment progresses.
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