HIFU October 2013

[Currumpaw]

A back injury in 2010 led to 23 lumbar ex-rays. 14 year, stable PSA multiplied 5X. Dg w/G8, T1c. One side of prostate darker-ex-rays? After HIFU PSA dropped from 7.6 to 2.99 in 2 months, stabilized at 3.3 for one year. After 1st post ablation biopsy PSA started moving. Stable in the 9's in early 2017. Three months after the second post ablation biopsy PSA moved from 9.33 to ~14.28. One year after-- PSA in low 20's. The 20 core biopsy had on hg-pin. Bone scan 16 months ago was negative.

[Tall_Allen]

The biopsy may have missed it, or the pathologist reading the biopsy may not be experienced at interpreting tissue that has already been ablated - it's not an easy thing to do. I suggest you have all the biopsy cores sent to Epstein at Johns Hopkins for a second opinion, making sure to let him know that this is on ablated tissue. mpMRI may sometimes find suspicious areas, but again, you need a radiologist with experience on ablated tissue. There are PET scans that may be useful, but because they are only approved or in clinical trials for men with recurrences after surgery or radiation, you will probably have to pay for it out of pocket.

The alternative explanation is that it is already systemic, which would not be surprising with a GS 8. But I think you would want to rule out all possibility of a local recurrence first.