Help?

[Headstrongpratz]

Asking for my dad aged 55

Mild urinary symptoms

Recently had a PSA test showing 14.4

Urologist ordered an mpMRI

MRI FINDINGS :

PIRADS 3 in the transitional zone with no capsular bulge, no involvement of peripheral zone seminal vesicles or bladder

No pelvic lymphadenopathy as well

PMSA pet scan however showed a lesion involving both lobes of prostate (SUVmax 7.8) also involving base of bladder and no seminal vesicle involvement

Also 3 PMSA avid subcentimeter pelvic lymph nodes (SUVmax 2.9)

No PMSA avid skeletal lesions

Biopsy scheduled for monday

What is the next step?

And why such discrepancy between the two scans?

And is it a cause for concern?

Update:

Biopsy was done.

Initially planned on doing MRI fusion biopsy

But they couldn’t find any lesion on the mri so went with TRUS

26 cores were taken

Reports due Thursday. (3/10/22)

[Hidden]

Well the definitive test is the biopsy, but at that age his psa is pretty high. The biopsy will tell you the aggressiveness of any cancer they may find.

The psma pet is designed to specifically hone in on prostate cancer lesions, or more accurately, cells that express psma, and prostate cancer cells famously do. The fact that he received a psma pet indicates his dr is on top of things. If there is suspected spread to nearby lymph nodes it will make the decision on how to treat easy (likely radiation of some type along with something called hormone therapy/ADT).

[Headstrongpratz in reply to Hidden]

Thank you for the reply

Yes I’m hoping for the biopsy results to be favourable if at all

Is it still curable at this stage.

Since the SUVmax of the lymph nodes are very less?

[Hidden in reply to Headstrongpratz]

I cannot definitively answer any questions about suvmax or the interpretation of the psma pet. The fact that a trained reader thought to mention the small spots is all I would care about and I would make sure to ask my dr about it to make sure he/she saw the note. They are busy people and miss details sometimes.

If the only area of known spread are lymph nodes near the prostate he is potentially curable, but he should not be complacent.

[Spyder54]

Headstrongpratz, first, I am not a Dr. For 2 yrs since my Dx I have read a lot, and this site has been invaluable. SSZYS is correct, a Gleeson Score from Biopsy will tell of the aggressiveness. A Genetic test will tell of any genetic risk factors.

So far, you seem to be in good hands with a multi parametric MRI. GET YOURSELF TO A MAJOR CANCER FACILITY. There you will get the best and latest. If the lymph nodes are contained in the pelvic region, your Father may still be curable (from what I hv read). There seems to be something going on that needs addressing. One step at a time. Do not let him think on this for months. PCa is, or often is, slow moving, but once the spread/metastisis is outside of the pelvic region, it becomes theroretically incurable.

So dont freak, but get to the bottom of this. If removal of prostate is needed, or allowed, there is a very very strong division on what is best. Robotic Prostetechtomy, or Radiation. Good to have choices. Advantages to both.

Best of luck, Mike

[Headstrongpratz in reply to Spyder54]

Thank you so much for the reply. Yes the biopsy is scheduled at one of the best cancer institutes of the country. So further management and all would continue over there only. Hoping for the best

[HopingForTheBest1 in reply to Headstrongpratz]

If radiation is done first, it typically makes subsequent surgery more of a challenge.

[Spyder54]

best of luck. Keep us posted. One step at a time

[Tall_Allen]

Good news that there is no cancer outside the prostate.

What is the next step? biopsy, with extra cores from suspicious areas.

And why such discrepancy between the two scans? The pelvic lymph nodes are probably not cancer - the SUVmax is too low. PSMA is not good for finding cancer in the prostate because it is urinarily excreted. I'm surprised he got a PSMA PET scan.

[Headstrongpratz in reply to Tall_Allen]

Thank you so much for the reply. The PSMA PET scan was ordered because the urologist seemed concerned regarding the PIRADS 3 lesion and also it’s not that difficult to get the scan here and it’s relatively inexpensive.

Hoping for the best now with the biopsy reports and further plan of management.

[Tall_Allen in reply to Headstrongpratz]

PIRADS 3 are really equivocal, and PSMA gives many false positives in and around the prostate, causing a lot of needless anxiety. Good luck with the biopsy! Where are you located?

[Headstrongpratz in reply to Tall_Allen]

Located in India.

Fortunately my dad has an excellent medical insurance so the scans weren’t that difficult

Biopsy and further management planned in Rajiv Gandhi Institute of Cancer New Delhi

[Hidden in reply to Headstrongpratz]

Good luck to Dad! It seems that he’s caught it earlier than I did . That’s very good for him . Not that any pc is good. I was 53 and it was out of the barn with me . Imrt Lupron and a test drug adt put me clear . I’m now 61 . Been clear over seven years now . I did a holistic diet ,alt med and a full nutrition plan from a Nat dr . My advise as a non doctor is to get to a medical oncologist for a treatment plan . Unless he has complete confidence in the uro . I lucked into a test drug that failed many , but worked for me until I dropped it six months ago . So he’s young . I relate to him . He’s got you . That’s wonderful . Giving him compassion and just caring for him will save the day .. I think that he can beat this ! And a cure might be possible for him . Ask him to drop bad habits and live healthier than ever before . We all suffer to different degrees with this .I can relate to his plight . I love when loved one seek advocation for there guys. That is real love ! Keep him positive ! No naysayers ! 🙏❤️

[Headstrongpratz in reply to Tall_Allen]

Update:

Biopsy was done.

Initially planned on doing MRI fusion biopsy

But they couldn’t find any lesion on the mri so went with TRUS

26 cores were taken

Reports due Thursday.

[Tall_Allen in reply to Headstrongpratz]

That's a lot of cores! He may have some blood in urine for a few days, and in semen for a few weeks. If he has fever, get treated immediately.

[Headstrongpratz in reply to Tall_Allen]

Yes. They’ve already given him an antibiotic course for the same. It baffled me as to why the lesion wasn’t visible on the MRI. The urologist did say that he has a large prostate (90cc) but even while taking the biopsy he told me that even he didn’t find any apparent nodule as such.

Just contemplating whether it’s just a case of BPH if it’s possible?

[Tall_Allen in reply to Headstrongpratz]

It's usually not visible on an MRI

[NecessarilySo]

I'm not a doctor but I would say you need to establish a history of PSA. One reading is not enough. Blood tests are easy and cheap. Biopsy will probably give guidance and direction but could miss the lesion. I would not say it's incurable. At this point it isn't definitely cancer, although it could be. If cancer, next PSA will jump.

[Hidden in reply to NecessarilySo]

I’m praying that he has caught this early! 👏👏🍀

[cancerfox]

When I had radiation treatments to my prostate they told me that they were also going to radiate the bottom part of my bladder "just in case," so if there is prostate cancer and base of bladder involvement that might be an option for your father. Good luck!