New here, looking for some positive reinforcement

[Rondief]

I am a 59 year old male. I have been monitoring my PSA annually for the past 7 years. It went from 2.5 to 4 to 6.5 and stayed there. I had 2 biopsy and both were negative. Then in February my PSA jumped 11. I just got the results of my MRI (my 3rd biopsy is tomorrow).

I'm not sure how to interpret the numbers, although I do know PIRADS 5 - "Very high and significant cancer is highly likely to be present". I goggled the rest of it but its all in medical terms that a regular guy like me does not understand.

The doc and I are going to have some serious discussions tomorrow about metastasizing and treatments. Although I do believe it is contained to the prostate.

I'm trying to educate myself, I am curious what other have done with similar number (see below). Any insight would be greatly appreciated.

Thanks in advance.

Study Result

Impression: 1.9 cm PI-RADS 5 lesion in the RIGHT posterior lateral peripheral zone, mid gland to base. (PZpl).

PI-RADS v2 score: PIRADS 5 - Very high (clinically significant cancer is highly likely to be present)

History: Increasing PSA, most recently 11.09. History of negative biopsies in 2013 and 2016.

Technique: High-resolution T2-weighted images in 3 orthogonal planes, diffusion weighted images and dynamic contrast-enhanced images.

Contrast: 17 mL Dotarem intravenously.

Peripheral zone: 1.9 cm focus of signal abnormality in the RIGHT posterior lateral peripheral zone, mid to base. This demonstrates marked ADC hypointensity, moderate to DWI hyperintensity, and abnormal postcontrast enhancement kinetics. This would be compatible with a PI-RADS 5 lesion.

There are other scattered small and linear areas of T2 hypointensity in the peripheral zone, possibly representing sequela of prior prostatitis.

Transition zone: The central gland is enlarged and shows a heterogenous swirled and whorled appearance with well defined nodules, indicative of BPH.

Volume: The prostate gland measures 5.4 x 3.8 x 4.8 cm for a volume of 51 cc.

Other: Seminal vesicles show normal bright signal on T2 weighted images. No extracapsular involvement identified. The visualized portions of the urinary bladder are unremarkable. No adenopathy or osseous lesions.

PSA density: 0.217

[Tall_Allen]

High PIRADS scores denote areas of suspicion. They are not cancer. That has to be confirmed by a biopsy. Now that they know where to look, they can target the biopsy to the PIRADS 5 area. The biopsy cores will be inspected by a pathologist who will confirm or deny prostate cancer, and assign a Gleason score to it. The Gleason score is a measure of how virulent it is. Gleason score of 6 (Grade Group 1) indicates a cancer that may be safely watched. Higher grades will probably need treatment. Good luck on the biopsy - let us know how it goes.

[Rondief in reply to Tall_Allen]

That's great info, thanks!

[Hidden in reply to Rondief]

You don’t need google . You found HU . No better source .

[GP24]

I hope your doc follows Allen's recommendation. Maybe you ask him if he will be able to put the needles into the suspicious area indicated by the MRI.

I am always afraid things may go wrong.

[Rondief]

Good afternoon guys, the biopsy went well, if you don’t mind a broom handle stuck up your butt.

The doc took 12 samples in a grid pattern, plus 2 additional directly in the suspected area. I have an appt on the 9th to review what he found.

Here’s hoping for the best. I’ll update as thing progresses.

[monte1111 in reply to Rondief]

I remember that broom handle. And 14 samples. Counted them. Damned perfectionist.

[Shooter1]

We'll be waiting for results. Good luck, waiting can be hard.

[Hidden]

How many sticks in the biopsy? Sometimes, cancer cells are just missed..... as far as metastasis and your feeling...... you can’t possibly know without a nuclear bone scan and soft tissue CT scan as a baseline for future scans.

Have you had any of the following drugs: 21 days of Cipro, 60 days of Bactrim, 120 days of Indocin, and 30 days of Urimax to counter PSA rise? In my book, if not infection or inflammation, then the obvious answer is PCa. One just have to find it....

If I were you, I’d have the scans and then repeat the biopsy in six months. Yet, there are some who would do otherwise........

GD

[Rondief in reply to Hidden]

The first two biopsy had 12 sticks each, all with negative results. This one had 14, with the extra two being in the suspected area. I will know the results of this biopsy next week.

I have not been put on any drugs to date since my PSA was hanging around 6.5, it jump to 11.2 in 10 months which warranted the 3rd biopsy.

I'm sorry, I may be a bit naïve, but what is PCa?

Thanks, Ron

[Garbonzeaux in reply to Rondief]

PCa=Prostate Cancer

[524nurse]

I’m new to this so if o typed before please excuse. I was a hospice nurse way back when. Now have husband with aggressive PC. About bone pain. Best thing we ever used was diclofenic patch or flexor patch. It’s like a strong ibuprofen patch with minimal side effects and great result. May be old school now but o was considered a angel by my patients. Ask your doctor. Oh and bone is kinda like a burn you can point to specifically.

[j-o-h-n in reply to 524nurse]

Greeting 524nurse,

It's great to have a hospice nurse join the crowd here. We need your input. Can you tell more about your husband? age? location? treatment center? doctor's name(s)?, PSA and Gleason scores? Type of treatment(s)? All info is strictly voluntary but it helps us help you and helps us too. If you respond please do so in a future post and not directed to me. Thank you.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/30/2019 9:53 PM DST

[j-o-h-n]

May the force be with you....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/30/2019 9:48 PM DST

[monte1111 in reply to j-o-h-n]

Chewbacca has left the stage. There is a disturbance in the force.

[j-o-h-n in reply to monte1111]

They're gonna have to fold him in half to fit him in the box.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 05/03/2019 5:30 PM DST

[Rondief]

UPDATE

So here’s the biopsy in in a nutshell.

Gleason score of 8, doc has ordered a CAT Scan and a bone scan, then based on those results we will discuss treatments.

Any thoughts on if the new tests come back negative? Surgery vs about 6-8 other options he listed (I don’t remember off hand).

if it shows that it has moved to other areas, it’s a whole new ballgame.

Thanks, Ron

[Hidden]

Get the best scans you can afford. Pet scan or at least mri. While your psa is high enough to show issues