Active Survelliance at the moment

Diagnosed in April 2017 at 55 yo. Negative DRE. PSA 4.4, Bx 3/12 GS 3+3+6 low involvement all <20% confirmed by Johns Hopkins. mpMRI in July 2017, Pi-Rad 2 and 3. Confirmatory bx April 2018. 4/12 GS 3=3+6. All involvement <30%. Follow up PSA June 2018 was 12.8 then 9.8 on recheck in August 2018. Possible prostatitis as I ran fever after bx. Following active surveillance currently at Emory/St. Joseph's in Atlanta. This may change depending on next PSA number in November. Scheduled for mpMRI in January 2019.

[Fox2018]

Hello,

Can you tell me what Pi-Rad 2 and 3 means?

Thanks!

Mike

[Hidden in reply to Fox2018]

The MRI looks for any lesions and if any are seen, are given a PiRad score of 1 to 5. Basically a 1 is most probable benign. 2 is probable benign. 3 is unequivocal. 4 is probable malignant. 5 is most probable malignant. My uro’s were concerned if any 4 or 5’s. The MRI was to see if I would be a good candidate for AS. If any 4 or 5, they would possibly consider treatment. Just additional data to make a decision.

[Fox2018 in reply to Hidden]

Thank you. I am scheduled for a mpMRI with an endorectal coil with and without contrast in 10 days. Your response will help me understand better the results.

[Hidden in reply to Fox2018]

That's good. It's the recommended next step to see what you're dealing with. I'm not sure what your bx showed, but this MRI is just to get another view and more information. I just read your data. One positive GS 6 at 11%? That's really good. I am curious about your PSA. .6 and .7? Is that a typo or recurrence?

[Fox2018 in reply to Hidden]

Not a typo - was 0.5 or 0.6 for 7 years prior to 2017. In 2017 it increased to .0.7. Moved up to 0.8 in May of 2018. DRE for last 8 years was all clear. In May of 2018 a small nodule was felt in left apex (I think that is the right terminology)...

Yes, one of 12 cores positive GC 6 at 11%. Full body bone scan showed one small spot of radiotracer pickup in left iliac bone. I am having an MRI done on this area next Tuesday to get more information.

[Hidden in reply to Fox2018]

So the DRE prompted the body scan. I’m wishing you good luck.

[Umpire20]

Keep up the good work. I've been on AS since diagnosis in Nov06 at age 59.

[Hidden in reply to Umpire20]

I didn't think they did AS that far back. If my PSA doesn't continue to fall back to the 4 range, I may be getting booted from AS.

[Hidden]

PSA result from 11/27/18 is 5.13. My two Uro's' suspicion of infection from my last biopsy seemed to hold up. The journey continues.

[kayak212 in reply to Hidden]

Thanks for your earlier message that you have Dr.Sanda...my last PSA in December went up from 9.30 the prior December to 11.36 last month. I have been on AS for 3 1/2 years. I am meeting with him next week for annual case evaluation and he is bringing a Rad Oncol along too. Dont know how old you are, but at almost 79 whether to begin any treatment is a very tough decision for me...and for Sanda I suspect.Hope our meeting goes well...his style and mine arent always compatible. I hope we will work out a mutually agreeable plan. Are you a member of the Emory PC support group?Good luck to you .

[Hidden in reply to kayak212]

I’m 57. I would like being on the their support group but it’s during the day and I can’t make it during the day because I have to work. Emory’s multidisciplinary approach includes a meeting with a radiation oncologist. I saw Dr. Hershatter.

Sanda is pretty intense, but I did see his softer side when he saw I was a bit worried when my PSA spiked after my second bx and tried to reassure me with a plan.

[kayak212]

Glad to hear he has one. I have never seen it. He doesnt seem to like being questioned much in my experience, but i know he is a real pro Urol and im in good hands.

[kayak212]

ejc61...Well i met with Dr.Sanda and Dr Hershetter yesterday. Sanda recommended i start treatment based solely on the increase in my PSA to over 10. Wouldnt really discuss any alternative views or issues...same as usual in my experience...fortunately Hershetter spent about an hour with me going over my last 3 MRIs in detail...did a DRE..normal again..talked about the various types of rad therapy...recommended Ext Beam Rad Ther...28 sessions, but also said he thought i could continue on AS for a couple of more rounds. Anyway when Sanda came back in to wrap up we agreed there is no reason for me to see him anymore and that it would better for me to see Dr.Hershetter because any radiation therapy i decide to do would involve him, no Sanda and surgery that Sanda does has never been an option in my case.Im going to get a second opinion from Johns Hopkins and am having a Fusion targeted MRI biopsy on 4-17-19 since last biopsy was blind type and back in May,2016. Sanda doesnt even do the biopsies! Says he has people who do those. Should be able to finalize treat vs no treat decision by June. I feel good about where i am heading now.

[Hidden in reply to kayak212]

I was figuring that you would get an more current biopsy/MRI before anything is done. That would make me comfortable. I don't think surgery is suggested after 70 or so so I wouldn't be surprised I suppose. Yeah Sanda pretty much does surgery only which gets back to why I have two Uro's. Somewhere in my notes I remember being told that a urologist assists with one of the radiation choices. Maybe not.

[kayak212]

Yesterday was a good day for me. Sanda may be a great Urologist/surgeon...frankly i think he is a better researcher...but what he does wont help me a bit so parting ways made total sense. I am looking into SBRT as a treatment method even though Hershetter said he didnt recommend it over EBRT....either way i wont be driving 100 miles a day for a month to get radiation therapy. Too many other good people around and im already looking for them. Sanda claims he has nothing to do with the radiation choice selection....he is a Urologist...The RadOnc is the guy who drives the therapy selection process.

[Hidden in reply to kayak212]

Always good when you feel accomplishment and making progress.