MRI 3T results

[Scout4answers]

This looks pretty damn good. Not sure if I am reading this right but it appears they can not find my cancer any more and my Prostate has shrunk from 150cc to 74cc.

"PI-RADS 2 - Low probability of cancer (Clinically significant cancer is unlikely to be present)" My MRI in July 21 was rated PI-RADS -5.

It seems at the very least that the cancer has been dealt a severe set back, but is this normal after 7 months on ADT?

What say you more experienced brothers?

Study Result

Impression

CONCLUSION:

1. The prior noted enhancing lesion with restricted diffusion along the peripheral zone at the apex of the left lobe of the gland is no longer noted.

2. The prior noted adenopathy within the left ischial rectal fossa has resolved. No evidence of adenopathy noted on the current exam.

3. Multiple BPH nodules are seen throughout both lobes of the prostate. No focal regions of restricted diffusion or abnormal enhancement identified. This is considered a PI rads category 2 study.

PI-RADS 1 - Very low probability of cancer (Clinically significant cancer is highly unlikely to be present)

PI-RADS 2 - Low probability of cancer (Clinically significant cancer is unlikely to be present)

PI-RADS 3 - Intermediate probability of cancer (The presence of clinically significant cancer is equivocal)

PI-RADS 4 - High probability of cancer (Clinically significant cancer is likely to be present)

PI-RADS 5 - Very high probability of cancer (Clinically significant cancer is highly likely to be present)

Cancer Imaging: 2016.

Dictated by (CST): Malik, Amaar, DO on 4/20/2022 at 1:41 PM

Finalized by (CST): Malik, Amaar, DO on 4/20/2022 at 1:56 PM

Narrative

PROCEDURE: MRI PROSTATE (W+WO)(CPT=72197)

INDICATIONS: 73-year-old male with history of biopsy proven prostate cancer

COMPARISON: EDWARD , MR, MRI PROSTATE (W+WO)(CPT=72197), 7/27/2021, 2:03 PM.

TECHNIQUE: 3T. Body coil. Multiplanar T1, T2 weighted, 3D T2 weighted imaging sequences. Multi b value Diffusion weighted sequences. Dynamic post infusion sequences after the administration of 16 cc IV gadolinium based contrast.

PATIENT STATED HISTORY:(As transcribed by Technologist)

CONTRAST USED: 16 cc of Dotarem, IV.

PSA HISTORY: Biopsy proven prostate cancer, with biopsy being performed in 2021.

FINDINGS:

PSA VALUE: 0.03 ng/mL obtained on 4/15/2022

PROSTATE VOLUME: 74 cc

(L x W x AP) x 0.52

RIGHT LOBE: There are multiple BPH nodules seen throughout the transitional zone. No peripheral zone lesions noted. No foci of restricted diffusion or abnormal enhancement.

LEFT LOBE: Multiple BPH nodules are seen throughout the transitional zone. The prior noted enhancing lesion with restricted diffusion along the apex of the gland posteriorly involving the peripheral zone is not discretely seen on

the current study. No foci of restricted diffusion or abnormal enhancement noted.

SEMINAL VESICLES: Symmetric and unremarkable.

ADENOPATHY: The prior noted adenopathy within the left ischial rectal fossa has resolved. No foci of adenopathy noted.

VISUALIZED PELVIC BONE MARROW: Prior noted nonspecific ovoid foci of decreased T2 bone marrow signal involving the right proximal femoral metaphysis and left femoral head are stable/unchanged.

Component Results

There is no component information for this result.

General Information

Ordered by PHYSICIAN NONSTAFF

Collected on 04/20/2022 1:56 PM

Resulted on 04/20/2022 1:56 PM

Result Status: Final result

This test result has been released by an automatic process.

[cesces]

Get some second opinions.

Maybe you continue your current therapy for a while.

Then suspend it.

And see what happens.

Use Google docs to maintain your own spreadsheet of PSA test results.

Maybe there is no reason to hurry pulling the trigger on your one time bullet of Sbrt just quite yet.

With each month you are collecting more data on yourself and learning more.

Hey, when you are a trader and you have an unsettled market you don't understand, do you rush in to trade with all your resources????

[Justfor_]

There is a discrete, regardless how slim may be, probability for anything to happen, including you dropping from PIRADS 5 to PIRADS 2.

"NEW YORK, April 20 (Reuters) - The Japanese yen bounced from a fresh two-decade low on Wednesday after the Bank of Japan stepped into the market again to defend its ultra-low interest...."

Twenty years, times approx. 260 trading days per year makes it to 5.200 trading days.

If there were 5.200 patients with your profile and current treatment, do you thing that you would be the sole one to re-stage to PIRADS 2?

[Scout4answers in reply to Justfor_]

not sure what you are saying?

[Justfor_ in reply to Scout4answers]

I am rephrasing:

There is a finite, regardless how slim may be, probability for anything to happen.

[Scout4answers]

So you think I may have 5200 more trading days in my future?

[Justfor_ in reply to Scout4answers]

Why not? We are the same age, born Sept 1949 and I bet you more than one among 5.200 men of our age will celebrate their 93rd birthday.

[treedown]

I hope that it means what you are asking. However, with a PSA at .03 I have to wonder if any scan would pu something. Also can you confirm your present treatment is considered curative? Or would the assumption mean there was a mistake in your dx? I can see that this might make you rethink RT though. What did your Dr say?

[Scout4answers]

MO has not yet replied ROs have not seen scan.I was told by MRI operator that cancer will show up regardless of Lupron.

I do not think there was a mistake, both Biopsy and past Mri and Pet scans showed aggressive cancer.

Until I hear from MO and RO it is merely an interesting report. MRI was ordered by RO to map out targets for RT so I assume cancer would show up.

[Justfor_ in reply to Scout4answers]

Hey, hey, hey, slow down here. ROs usually order a "plain" MRI for their planning. A mpMRI (multiparametric) will get you a PIRADS rating. Which one of the two did you get?

[Scout4answers]

RO from UCLA ordered this one for targeting

[Justfor_ in reply to Scout4answers]

PSMA PET CT may prove useful for lesion targeting. MRI is mandatory for the planning stage of a blind irradiation. It's purpose is to provide the topology of the organs to be spared. An ordinary (non multiparametric) MRI is adequate for uploading to the computer the images that will be used during the planning stage.

[Scout4answers]

Because I am in Chicagoland and RO is at UCLA. this was done to determine whether I might still be a candidate for SBRT.

[Justfor_ in reply to Scout4answers]

The RO would have asked for it even if you were next door neighbours. It is a part of the SoC protocol and on top of that a Doc's sales pitch. He/she will pass you the idea that the irradiation plan is the most important element in all this. He is selling him/herself and not the technical infrastructure or the operating manpower. The truth is that the planning software performs simulations of machine setups re the delivered irradiation onto the targeted field and it is up to the professionalism of the planning group how much time they will spend for optimising it.

[reconjj in reply to Scout4answers]

Hello Scout , 6 yrs ago I had SBRT to prostate 5 sessions at Illinois Cyberknife , Dr. Arica Hirsch came highly recommended . During those 6 yrs my PSA was steady in the 1s . This past Dec routine PSA was at 4 . Red Flag . After consult with Dr. Hirsch she ordered a PSMA-Pet , Pylarify . I went to V.A. for that . It showed oligometatastic , 1 lymph node in pelvic area . V.A. gave me a 6 month shot of Eligard . I went back to Dr. Hirsch for 3 sessions of SBRT to the lymph node . Then I went to U of C for consult with Dr. Szmulewitz where he started me on 250 mgZytiga , and 5mg prednisone. I returned to Dr. Hirsch for 25 sessions of IMRT , tomotherapy to the entire pelvic area . I experienced very little side effects . So far 6 months into this all labs are good , and I will continue to see Dr.S and the V.A MO until something progresses where I have to make a decision on who to stay with for further treatment .

[Scout4answers in reply to reconjj]

Thanks Reconjj, so glad to hear your therapy is working well. How long do they plan to keep you on ADT? what is your latest PSA?

[reconjj in reply to Scout4answers]

My PSA as of 02/17 was .22 . Testosterone was at 9 ng/dl . Dr. S said 2 yrs on ADT , Eligard and 2 yrs on Zytiga and prednisone . I really dont have side effects except for occasional fatigue . I might get a hot flash very rarely . Im so surprised at the lack of side effects that sometimes I wonder if the drugs are working . But they are . Dr.S wants a visit every 6 weeks with labs up till 6 months . V.A. wants visits and labs every 3 months .

[MateoBeach in reply to Scout4answers]

Yes and it confirms you are still a candidate for SBRT since no still no mets outside the pelvis. Don’t wait just because you have a fine ADT response now. It is not curative and eventually will fail. Hard fact.

[Scout4answers]

Understood, and that is why I have met with 6 ROs and picked him for the job. His specialty is prostate cancer , he is head of that dept. at UCLA . He does 200/year on the most advanced machine I could find; Veiw Ray by Meridian, MRI guided with auto stop if target moves.

[Justfor_ in reply to Scout4answers]

No PSMA PET though. Deal breaker for me.

[Scout4answers in reply to Justfor_]

Have been told that it would not pick up anything below 0 .25 PSA. I had one scheduled locally and they canceled it.

[Justfor_ in reply to Scout4answers]

Yes, did someone else tell you that JPY will not print the 12x to the USD?

[MateoBeach in reply to Scout4answers]

Indeed it is the best system available. 👍👍

[anonymoose2]

Same boat as you. I’m on drug vacation and I feel great both physically and especially mentally. TA is a realistic and I understand the facts. But for now I live to live. I cant be negative at this point in my life. I totally understand that this PC isn’t a grizzly bear and the doctors just put a bullet in its head to finish it off. I understand that this cancer is like a zombie and just around the corner a zombie is sleeping and if and when it awakes it might kill me. For now the zombie is so weak and at a disadvantage but it’s still there. For now I’m aware it can pop up at anytime around any corner. But right now no one can find that zombie. We rejoice and live another day. We must keep our eyes and ears open. But for now it’s sleeping and we rejoice.Cheers 🍻