Thank you for all the kindness, optimism and sage advice to my last post. My dad found out today that his biopsy results are in and he has an appt with the urologist tomorrow at noon to review.
Given the MRI report (PIRADS 5, “lit up” lymph node, PSA doubling), we and the doctors suspect it’s cancer. Just waiting for the official biopsy to confirm.
My question to all of you who have gone through this, is going into urologist appt tomorrow, what questions would recommend my dad ask? Anything you wish you asked or did at the start?
Thank you in advance for any guidance.
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As a suppliment to Tall_Allen's list of questions, I thought to ask Malecare's Cancer Copilot AI for questions for you. Here's what Malecare's Cancer Copilot replied:
Biopsy Results Interpretation:
How do the biopsy results work in conjunction with the MRI findings to provide a complete picture of my prostate cancer?
Impact on Diagnosis:
Can you explain how the biopsy results might confirm or alter the initial assessment made based on the MRI?
Grading and Staging:
How will the biopsy results affect the grading and staging of my prostate cancer, especially in light of the PIRADS 5 score and the "lit up" lymph node on the MRI?
Treatment Decision-Making:
How do the biopsy findings influence the selection of treatment options compared to the information obtained from the MRI?
Accuracy and Reliability:
How do you assess the accuracy of biopsy results in relation to the MRI findings, and is one considered more reliable than the other in certain aspects?
Additional Testing:
If the biopsy results differ significantly from the MRI findings, would you recommend additional testing to reconcile these differences?
Future Monitoring:
How will both the biopsy and MRI results inform the monitoring and follow-up strategy for my condition?
Risk Assessment:
Do the biopsy results provide additional information about the aggressiveness of the cancer or the risk of spread not apparent in the MRI?
Genomic Testing:
Is there a role for genomic testing on the biopsy tissue, and how would that information be used alongside the MRI findings?
Second Opinion:
Would you recommend getting a second opinion on the biopsy results or MRI findings to ensure a comprehensive evaluation of my condition?
Understanding PIRADS 5:
Can you explain what a PIRADS 5 score means for my prostate health and cancer risk?
How does a PIRADS 5 finding influence the urgency or aggressiveness of the treatment I might need?
About the "Lit Up" Lymph Node:
What does it mean when a lymph node "lights up" on an MRI? Does it definitely indicate cancer has spread?
Are there additional tests needed to confirm the nature and significance of this "lit up" lymph node?
Implications for Staging:
Based on these MRI findings, what stage is my prostate cancer likely at?
How do the PIRADS 5 score and the "lit up" lymph node affect the staging of my cancer?
Treatment Strategy:
Given these findings, what are the recommended treatment options for me?
How do my MRI results impact the decision between surgery, radiation, hormone therapy, or other treatments?
Risks of Spread or Metastasis:
Does a "lit up" lymph node indicate that the cancer has spread beyond the prostate?
What is the likelihood that the cancer has spread to other parts of my body?
Further Testing and Monitoring:
Will I need any additional imaging or biopsy procedures to further assess the affected lymph node or to check for metastasis?
How will my treatment plan be adjusted if further tests show more extensive cancer spread?
Impact on Treatment Effectiveness:
How does the presence of a "lit up" lymph node affect the effectiveness of potential treatment options?
Are there specific therapies that are more effective in cases where cancer has spread to lymph nodes?
Potential for Recovery and Remission:
What are the chances of complete recovery or remission considering these MRI findings?
How do these findings impact the long-term prognosis compared to cases without lymph node involvement?
Management of Side Effects:
What side effects should I expect from the treatment options suitable for my diagnosis, and how can they be managed?
Are there specific side effects associated with treatments when cancer has spread to lymph nodes?
Involvement of Specialists:
Will my case be reviewed by a multidisciplinary team, and if so, who will be involved in planning my treatment?
Is there a benefit to consulting with a specialist in advanced prostate cancer or a radiation oncologist given my MRI results?
Supportive Care and Resources:
What support services (like nutrition, physical therapy, counseling) do you recommend to help me manage my condition and treatment side effects?
Are there local or online support groups for individuals with similar diagnoses that you can recommend?
Diet and Lifestyle Adjustments:
Are there any specific diet or lifestyle changes that could support my treatment and recovery process?
Can you provide or recommend any resources for lifestyle adjustments specific to prostate cancer patients with my diagnosis?
Future Monitoring and Check-Ups:
How will my condition be monitored during and after treatment, and how frequently will I need check-ups?
What specific signs or symptoms should I report immediately during my treatment?
Involving Family in Care:
How can my family best support me through my treatment, and what should they be aware of or prepared for?
Are there educational resources or training available for my caregivers or family members?
Financial and Practical Considerations:
Can you provide information or resources to help understand the potential costs and insurance coverage for my treatment?
Are there logistical or practical aspects of treatment, like scheduling or the need for hospital stays, that I should plan for?
The main points are to find out your Gleason score and Stage, which will determine your treatment options. If it’s > GL 8 or > Stg 3, it’s advanced, high-risk PCa.
Ask to record conversation on your phone so that you can replay it. My doctor offered, I said no because I had pen and paper, but still missed information.
If it is cancer, be sure your next appointment is with an oncologist who specializes in prostate cancer. If it us not 'advanced' cancer I'd plug in to the prostate cancer groups on this forum that are not fir advanced cancer- you'll get better answers to your questions for his diagnosis.
A question to ask about the biopsy itself: Was it "blind" or guided by the MRI?
I gave my urologist/oncologist a disk of my MRI, and I assume it was looked at to aim the sampling, but the latest technique is active guidance using active MRI. I did not see him before or after the biopsy, and later found that he did not personally do the biopsy, but instructed an intern in a group of others (he was at a teaching hospital). I have wondered about the quality of my biopsy and accuracy of my 3+4 Gleason score, because the cancer spread after radiation (maybe not having any ADT was a factor in that).
The questions in Tall_Allen's link were directed at surgery, good to ask a urologist because that's what they do. Mine did favor surgery. It would be good to also consult with a radiation oncologist, as there are advances in that field since 2017, and which is what I chose for my early stage and old age.
Whew, a bunch of questions suggested. Whatever, if Gleason score is high, get a bone scan and/or PSMA Pet scan to make sure it's not out of the prostate. Urologists get big money from taking out your prostate then you deal with the consequences after that. Make double sure surgery will solve the problem before you agree. If they want to add radiation to that be extra wary. Get an oncologist involved before the urologist starts cutting.
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Biopsy results back finally and first step of treatment. 
Planned Chemo tomorrow need suggestion and information
Fusion Biopsy Results - GC5 - Gleason 9 (4 + 5) 
Question Regarding Biopsy
PSA test results question
