MRI Scan & Fluctusting PSA - Biopsy. What does it mean?

Posted , 7 users are following.

My urologist is recommending I have a biopsy. I’m considering trans perineal biopsy. 

My PSA results have fluctuated: 4.9 (3Mar18), 4.6 (20Mar18), 6.8 (8May18), 5.5 (6Jun18), 5.3 (2Aug16). 

I had MRI on 29May18 which showed “tumor 0.33 cc stranded wedge shaped area of lower T2, moderate restriction, in right posterior peripheral zone. Looks moderately suspicious with overall score 4/5. No visible extra capsular tumor or bulge. Significant tumor >0.2cc or Gleeson 3+4 or higher.”

Am considering trans perineal biopsy end September 2018 (first I could get) by Professor Emberton of Princess Grace Hospital with view to High Frequency Ultrasound (HIFU) Treatment if required. I live outside UK so am not covered by NHS. Private treatment is extenely expensive but I fear my health and life is at stake. Any comments and thoughts most welcome. 

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12 Replies

  • Posted

    Hi.

    I had HIFU under Prof. Emberton, but at the university college hospital in London. The procedure can be done as a day patient and not evasive.

    I would suggest with your PSA not being that high and a gleeson score showing the cancer is not overly aggressive. that you dont need to panic and get a biopsy done to get a better idea where you are.

    After that to get as much advice as you can and see what options you have. HIFU treatment can be available in other countries around Europe so maybe also consider that.

    Good luck

    Brian.

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    • Posted

      Thanks Brian. I am trying to keep calm and am investigating the watch and wait approach. Having a biopsy is my first hurdle as I am wary of the risks of having a biopsy. Although I realise delaying a biopsy might have risks too.

      I heard that HIFU is available in USA and Germany but have not researched beyond that as my family home is south east London, The private costs are shockingly high but I want the most skilled doctors to keep the risks at the lowest possible.

      What was your experience of HIFU and was the outcome successful?

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    • Posted

      Hi again. I went in at 07.30 and back out by 14.30 and on the train home. With my procedure I had no incontinence after the catheter was removed locally. Also no major problems with erectile function. I am 63.

      Other people may of had a different experience, but I decided that hifu appeared the less evasive and that would appear to of been the case with me.

      Good luck Mike.

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  • Posted

    I'd like to see what the Gleason scores are after your biopsy. If it's G7's or higher, I would stay clear of HIFU treatment. Yes, I had HIFU with G7's & G8's. Then everything got worse 3 years later and I had to have my prostate removed.

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    • Posted

      Thanks Davey22.

      I do not want a biopsy because of the risk of seeding any cancerous cells to other parts of my body and of infection from the needle biopsy. However my urologist tell me the MRI report results show that I should have a biopsy to know if the lesion is cancerous. 

      Sorry to hear about your HIFU problems. I thought HIFU was safest with fewer problems.

      Are you clear of all problems following removal of your prostate?

       

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    • Posted

      Hi Mike Tango,

      So far so good about 5 months after RP. No incontinence issues. Only when I sneeze very hard I get a little leakage. It's probably too early to tell, but I do have a severe case of ED. I'll get my next PSA in a month from now. Another thing to mention. The doctor said that removal of the prostate was tough. The HIFU treatment sort of made the prostate adhere to the colon. But a skilled surgeon was able to  seperate the gland with no damage to the colon.

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    • Posted

      Thanks for info davey22. I hadn’t heard of prostate sticking to colon after HIFU. I learn that lesions don’t disappear on their own so it’s either benign or I need treatment (HIFU or other). Glad to hear Prostate safely removed. I read that 5 months is early for outcome of ED problems. Here's hoping for good recovery . 

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  • Posted

    My husband's PSA was12, no symptoms, just picked up on routine blood tests. MRI was said to be clear by doctor performing first biopsy, which was a Trans Periannal one. We were told cancer was in a small area and would probably be watch and wait, however, surgeon from another hospital within the team upgraded the MRI and he then had a targeted biopsy. Which showed more cancer in the right side still but in a difficult to treat area, he was a Gleason 7 and tumour classed as T2A, then T2B. Only option available was to have prostate removed. Prostate removed and they found cancer in the whole of it and final outcome was it was a T3C. We were glad no further treatment required and felt lucky that it had been picked up so quickly. If it had not been for the other surgeon upping his MRI result, he could have still had the cancer in his body and it would have spread. Go with your gut feeling re what you want to do. Is there no option of treatment where you are living? 

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  • Posted

    Your age and sexual activity are relevant. Also how you want to spend the rest of your life is a consideration. PCa takes a long time to be fatal, surgery doesn’t get the results advised and they tell you afterwards you still have to assume you have cancer cells in the body waiting to declare themselves even with the gland and the bits you loose with it gone. Biopsies may be worth some scrutiny. You bleed a lot after them and while they say biopsies do not cause the Cancer to spread the only reasoning for this I found was based on another organ and its post-biopsy survival rate. I had a 6 hit negative biopsy some years ahead of a 10 hit one following MRI detection of 2 areas of 3+4 PCa. The other 8 U/S guided only were all negative. It takes a lot of U/S guided hits to find PCa.

    An approaching 90 year old friend had what he called a “scraping” 15 years ago with pathology reporting 5% of the removed tissue as PCa. No action was taken on age basis and he is still going strong without any urination problems!!

    I was treated for BPH since 1990 and only discovered PCa in October 2015. My PSA never went above 3.8 with final reading 2.62. I was treated with 5ARI drugs from March 2013 to March 2014. I had Open Radical Prostatectomy 5 November 2015 and suffered almost 3 years of pretty severe incontinence, untreatable fungal infection, rashes, mistreated bladder neck blockage and now PMR which may be related to PCa or surgery.  Several months of self catheteration was a problem as I needed to use more force than I was supposed to causing some concern. I believe Robot assisted surgery would have been worth the substantial extra cost.

    I needed to do much more research during BPH and PCa stages. Urologists are usually surgeons and will want to cut. Oncologists may prefer radiation when maybe wait and see is perhaps the best option. This forum and the internet will give you all the help you need to ask your urologist the right questions. This site seems to link Urologists along with Lawyers and Politicians.  Barrie Heslop

     

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  • Posted

    There is a HIFU thread in the forums.  I have never heard about this before, so thanks for mentioning.  I will also look it up.  Btw, there's a guy who said his PSA scores went down from Wim Hof breathing method.  He bought the Carney book and I found his post about his blood work in that big online bookstore.  I have also recently (just four days now) been breathing with Hof's and Stig's technique and my Systolic has gone down from 150's to 130's - 140's. 

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  • Posted

    You mention fluctuating PSA numbers.

    My question is: did you use the same pathology lab every time?

    As to biopsy: ideally you have it AFTER a MRI is reported on by an expert in

    prostate reporting. You don't want a generalist radiologist reporting. You must

    have an expert.

    As to biopsies: I had a transpereneal biopsy by the guy I wanted to operate on me.

    Bear that in mind as many surgeons will not trust a biopsy conducted by another surgeon.

    Transpereneal is the safest apprach with much less risk of infection.

    Good luck.

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