Just wanted to share my experience with contrast pelvic/prostate 3T MRI and prostate 14 core biopsy having recently had both done. After much research and weighing the advantages of both methods for a while I was able to convince my Dr to order the contrast MRI. When I got the results of the MRI they found an area of concern but couldn't be certain what it was so a biopsy was recommended. Another PSA of 5.3 finally convinced me to succumb to the biopsy and I now have a PC diagnosis. Gleason score 6 with only 10% detected in 1 out of 14 cores. So very low grade, but here's the kicker....the cancer was found on the opposite side of the prostate from where the MRI indicated a possible issue. So, no advice to give other than MRs probably shouldnt take the place of a biopsy until the technology gets better. Also, the biopsy wasn't that bad other than the anxiety of it all.
Contrast MRI vs biopsy: Just wanted to... - Active Surveillan...
Contrast MRI vs biopsy
thank you for sharing. And GREAT that you are more than a qualified member of our AS community. May I ask how old you are?
46
Not to sound paternalistic or anything, but, considering your young age, please remember that active surveillance really means "ACTIVE" surveillance. PSA's, etc as often as you and your doctor agree to. You have two new things in your life: a chronic disease and hundreds of new brothers from Malecare.
Yep, current plan is PSA every 3 months and biopsy at least once a year. Just diagnosed yesterday and have known about elevated PSA for almost 2 years. Was dealing with prostatitis like symptoms when the PSA was checked. I plan to put together an action plan so that when we need to move I'll be ready. For now just need to do a lot of research. Everyone has advice :).
Also, thanks for the warm welcome!
Not sure that with Gleason 6 in one of 14 cores an Annual Biopsy is necessary!
hey Chump.... if i didn’t know better, i would say i was looking in the mirror, everything about you has my name all over it, same G6, PSA test every 3 months, biopsy every year, been on AS for about 3 years now, only difference is i get a MRI before my biopsy.... this is a good group, listen to everything you hear, make your own choice, these guys have been thru it all.......
Yeah, I've been lurking for a while just in case, but mostly in the Advanced PC forum. Don't want hang out there for a while, glad I found this one.
My diagnosis in 2010 was the same as yours. A single Gleason 6 in one core of 14. The MRI was new then. But the findings on MRI did not coincide with the biopsy. Back then--those were the old days, really--few had MRIs in general, they were not widely available, and unlike today the biopsies were not targeted. Two suspicious spots were seen. I've had four follow-up biopsies, now spaced three years apart, and the cancer has never again seen in a biopsy. I have had one other MRI. Again, no cancer. I feel a bit pissed off from my last biopsy two years ago. I had an MRI with the intention of having a targeted biopsy. My MRI as I mentioned showed nothing. But my urologist did a blind biopsy anyway and nothing was seen. He wasn't ready to trust MRI as a replacement for biopsy. I was. Biopsies are not as benign as your doctor may suggest. There is a risk for infection, even sepsis. So I am determined not to deal with them as a minor procedure. I have explored a new kind of ultrasound--originally used in prostate studies in mice--that I will have instead of a biopsy if my MD asks for a biopsy. The US is so detailed it can see the track scars from previous biopsies. MRIs have potential issues, too, with gadolinium deposition in brain, bones, kidneys, etc. Chump, good luck. It sounds like you're doing great.
One other thing. I have been to general support groups. There is a tendency to focus on advanced cancers because of the serious issues in treatment choices and coping with the side effects of treatment, Low-risk men on AS can be lost in the crowd.
Thanks for sharing your story with me. I'm new to this whole thing and have only had one biopsy and one MRI in that area, so I don't have a lot of data points to lean on. I originally really pushed for the MRI because of what I had read and thought we would get a good enough image to say with some degree of confidence that there was a problem or not. In this case it turned out to be a huge waste of time and money. I would likely not ask for an MRI again until the technology gets better, or maybe they can zero in a little closer on where the cancer was detected...I don't know.
Do you mind telling me what your psa was when diagnosed and what it is currently. Just wondering if you feel they made a mistake on the biopsy that detected your cancer? Thanks.
Sure. My PSA was 3.95 in June 2010. It had accelerated from about 3. My MD panicked and sent me to a community urologist. He did a biopsy which yielded an ambiguous result. We got a second opinion from the guru, Dr. Jonathan Epstein at Hopkins, who said I should have a follow-up. Which I did in December. This time I had a tiny amount of Gleason 6. I was diagnosed as a prostate cancer patient and ended up switching doctors and going on AS at the University of Chicago.
Was there a mistake, Chump? You are not the first to suggest that. Otis Brawley, MD, former medical director of the American Cancer Society, was the first to suggest that. My records have been switched once at least, but I don't think it was wrong.
I think you are discounting the value of the MRI. I had conflicting results with that, too.
I don't know where you had yours read. But the knowledge of radiologists who read MRIs varies. (The same with pathologists who read the biopsies.) Again, you can get a second opinion and find an expert at reading MRIs like at UCSF.
My PSA has moved around. It once shot up to 9. But my doctor didn't panic. He said he knew my prostate and things would be fine. There are seasonal factors that can impact your PSA score.
My PSA went down. It is now about 4. But I take a new type of PSA test, the PHI test--Prostate Health Index that measures and averages three different types of PSA. Based on this test, I am near normal. My urologist said I have a "lame cancer." I take that as a compliment.
In the midst of this, I was diagnosed with type-2 diabetes. I changed my diet for a while--I am slipping--to a keto approach. My PSA dropped. Also, for diabetes, I take metformin, which has been shown to reduce blood sugars but also PSAs plus it has a longevity effect, in mice anyway.
Chump, I think you are doing great and shouldn't be discouraged.
You mentioned a new kind of ultrasound. I can't have an MRI because I have a defibrillator. I have Gleason 6 prostate cancer and I'm on AS - PSA's every 6 months and biopsies every 2-3 years. Do you have any more information on this new ultrasound. There's a new Precision Point Biopsy that has replaced TRUS biopsies. I understand that John Hopkins is now using this for all prostate biopsies.
Sure. Your doctor probably hasn't heard of this. It is more commonly available in Canada, but some facilities in the US have this device. I plan to go to Cleveland Clinic if it comes to that. I know University of Virginia offers it. I understand that Medicare covers this like any other US--not sure about traditional insurance. You can find info at exactimaging.com/united-states Let us know what you find out. Good luck.
Hi AS2010 - I am also in Canada, and was wondering how you got the PHI test in Canada through Cleveland Clinic - could you let me know?
I had a 3T mpMRI in April that didnt show anything, but my PSA is still at 4.5, and I h have increasing bone pain in my pelvis. I want to consider retesting through another means, but am unsure what is available in Canada.
Thanks for any help.
David
My history: 2017 PSA 2.5, 2018: 4. 2019: 6 (Feb), 5.7 (March), and now 4.5 (July) after 1 month of Cipro.
Free PSA March .56 and Free/total .10 (44-56% of PC)
Free PSA July .52 and Free/total .12
March ultrasound showed normal size but recommended biopsy due to small nodule.
April mpMRI 3.0T with T2 images, good quality, found central gland unremarkable, however Peripheral Zone indicated Diffuse intermediate T2 signal in the peripheral zone without restricted diffusion (?). Interpretation was that this might be related to previous prostatitis. They noted that there is no restricted diffusion which was reassuring but that the extensive changes decrease diagnostic quality somewhat. Suggested repeated MRI in 1 year. PIRADS 2 Low.
Only pain is pelvic bone ache and upper inside of leg. Urologist diagnosed prostatitis.
Hi Chumpsteak!
I want to second Darryl's caution of Active Surveillance. What AS means especially, in your case, age 46 is Active. I'm 69, diagnosed at about age 68 last year, Gleason 6 in 3 areas. The cancer is contained within the prostate and is said to be non-aggressive (Gleason = 3+3). The prostate was sampled 12 times and showed both lobes with cancer: one lobe had tumors of 0.3 mm (1% involved), 0.6 mm (2% involvement), and the other lobe had tumor of 3 mm (8%). So, your diagnosis is similar to mine with the exception of a 23 age difference between us. That's why Darryl is concerned but I see that you and your doctor have a good plan in place.
After going through many forums, this one I like. Much info from here! Do not be surprised if some on here disagrees with your AS decision. Personally, I wholehearted agree with it.
Welcome
jerry (jack's my dog)
3 month PSA 2.94 .... i have 2 cores gleason 6 .08mm less than <5
Hello Chump. You're in a good place. As someone else said, your AS needs to stay active. Also, AS guidelines seem to have gotten more relaxed even in the 2 years that I've been on this. Its going to be a combination of biopsies, MRI's and PSA draws. In my 2 years since diagnosis,, I've had a repeat biopsy, (2) 3TmpMRI's and quarterly PSA draws. I get to skip a biopsy this year, as long as PSA stays low, and have another MRI scheduled in January 2020. My PSA 3 months ago was 3.5. AS isn't a cakewalk either. It's a process.
For me the "Active" part of Active Surveillance includes: improved diet, nutrition, fitness and detoxifying my surroundings. All of this is built on great support from my family, faith in God and a good relationship with a doc who I trust.
I was diagnosed with PCa in June. Started with a PSA of 9.75 which lead to a digital exam then a biopsy. Biopsy revealed PCa with a Gleason score of 6 (3+3) / Grade group 1 on the right side and 7 (3 +4) / Grade group 2 on the left. First doc recommended removal, second was OK with Active Surveillance. Did an MRI in Sept and again in Feb. Feb results revealed stability in one tumor and possible reduction in the other.
PSA tested in Sept revealed a 9.1 which was encouraging. Later in December it went down to 8.17. Feb's PSA went up to 8.4 which served as a wake-up.
Overall my perspective is to use a logical combination of PSA tests, biopsies and MRI's until I am comfortable with my status.
To improve my chances for success I follow an organic anti cancer protocol and have done so since Sept. It's called Square One (google it).
Now at the age of 56, I feel better today than I have in the last 20 years. Super healthy, shedding weight, eating great and exercising more. My wife is on board with this too and it has made a big difference for both of us.
Like the others who have commented, I find this group to be helpful and therapeutic (thank you brothers!).
In summary, I'd encourage you to bring the "active" part of AS to life in every possible way.
Did you specifically request that Gadolinium be used in your MRI? I've had three MRIs. The last one in August 2019 showed No Cancer! Many are concerned about Gadolinium Retention Disease. I read the risk is 1:2000. Nevertheless Sloan Kettering is no longer using it in their Prostate MRI
Perineal biopsy with local anesthetic
