Back at the end of March (2024) I had an MRI which according to my urologist indicated 2 suspect areas he called "lesions."
Two months later, at the end of May (2024), I had a prostate biopsy which after it was over, I was told (by assistant helping with procedure) there were 3 suspect areas showing.
So the Question begs: Did the prostate biopsy pick up a third suspect area that the MRI had missed. Or is it likely that within the 2 month window, a third suspect area developed?
MRI doesn't have great specificity and it's up to interpretation. Mine showed a PI-RADS 4 lesion that was biopsied twice and was benign. But another location that was PI-RADS 2 (diffuse abnormalities usually due to prostatitis) was positive for prostate cancer.
These MRI's are still "only" a bunch of grainy splotchy pictures, a diagnostic tool. If they don't show something doesn't mean there isn't cancer.
I see. So an MRI finding alone is not totally reliable?
a biopsy would tell you if you have tumoral cells or no if you have a Gleason score 6 or more etccc a biopsy can miss tumoral cells. But the result is black or white. Patholog sees cancercells or no.
MRI can guide to do a better targeted biopsy
I guess the ultrasound saw something that the MRI didn't. Did the third area find anything significant?
Thanks Tall_Allen. Well that would be "news" to me because I didn't think that ultrasound could detect questionable areas on the prostate more effectively than the MRI.
They are different, which is why it is used in TRUS biopsies. TRUS biopsies have a higher detection rate than MRI, but the detected tumors are usually lower grade.
Yes Tall_Allen, after discussion with the urologist he indicated that the third area was positive also. So now my concern is elevated PSA (15.6)/Prostate Lesions/Low RBCs/WBCs lined up together. What other test can be done to add even more definition to the picture?
I don't understand. Weren't those areas biopsied?
Yes they were Tall_Allen. But the urologist still seems to have questions as if what the biopsy can show is not quite enough, or is missing something. So I've done 2 MRI's, the first negative, the recent one positive, and the biopsy positive. In last discussion, the idea of a PET scan was brought up by the doctor. Could that show what the MRI and biopsy can't?
Nothing is more revealing than a biopsy. If the biopsy did not find higher grade, that should give you some comfort, because if there were a lot of higher grade cancer, it would have been discovered. (I'm assuming they took 4 cores from each suspicious area). Many active surveillance protocols entail a confirmatory mpMRI-targeted biopsy within a year. PET scans do not show grade and don't give a sharp image for targeting a biopsy.
Thanks for confirming what I thought, that biopsies were the most telling way to assess the condition. The urologist suggested surgery or radiation. I've opted to consult with radiation and a medical oncologists.
Shouldn't the oncologist know a lot more about the exact nature of the situation in terms of the biological processes and mechanisms driving it? The urologist seems to know very little about this kind of stuff.
I endorse your seeing a radiation oncologist only if you are ready to pursue treatment, but are you? Medical oncologists are experts in using medicines to treat cancer, and since you don't need any medicines, it is a useless opinion.
Urologists typically run active surveillance programs.
Little confused here Tall_Allen. If there are indications of malignancies with the prostate, then seemingly it needs to be addressed "medically" if not by radiation. There should be medical options to tackle the situation now, rather than "watch it worsen." So that's the reason I'm wanting to see what types of "medical options" might be indicated. Hopefully ADT or Immunotherapy.
No. "Metastatic" is different from "malignant." All cancer is "malignant," even though some argue that Gleason 6 isn't. "Metastatic" means that the cancer has genomically mutated so it can live and travel outside of the prostate. As long as the cancer is not metastatic, it can be cured by local (prostate) treatment by a urologist or an RO. An RO will also prescribe any adjuvant medication required.
Right, I understand metastatic is the process of spreading beyond localized areas. I think what I did not understand in the reply before the last one was the explanation that "Medical oncologists are experts in using medicines to treat cancer, and since you don't need medicines, it's a useless opinion."
Actually, I'm thinking that the "right kind of medicines" is exactly what I'm needing for the condition , and my preference would be "medicines" to treat the situation over radiation, or anything invasive. Providing that the medicines are fairly safe and have limited toxicity to healthy cells and tissues.
But I get the funny feeling that what you're saying by medical oncologist using "medicines" you are referring to "chemotherapy drugs," an option as worse as surgery. And I believe what you're saying by "since you don't need any medicines, it's a useless opinion" is that if the condition is localized, it doesn't need systematic drugs to treat it.
Two hours ago, I did talk with a urology radiologist who initially insisted on 5-6 rounds of 3700 RAD, saying studies show that getting high power radiation over a short spell of time was more effective than lower doses over a longer spell. It sounded "insane" to me and in so many words I let the Dr. know. Then we discussed a more moderate level over a more moderate period of time--which to me makes a lot more sense, given that each person's body responds differently to radiation, and as such it doesn't make sense to get hit with high dosages of the stuff without knowing how your body is going to respond to it.
He was right and far from insane. It's what I had, called SBRT. I actually had 40 Gy over 5 treatments. What you don't understand is how radiobiology works. It has been found that prostate cancer has a very low alpha/beta ratio, which means it responds better to fewer more intense doses. This is called hypofractionation.
I was not referring to chemotherapy. Localized prostate cancer is curable by prostatectomy or radiation. No medicines are needed unless you have an unfavorable risk kind of prostate cancer, in which case hormone therapy improves the results of radiation. ROs are trained in such things. Medicines alone are not curative.
Well, I hope he didn't think I was "insane" then. "Stereostatic Beam Radiation Therapy." Is this a relatively newer form of radiation therapy? Does it have a more precisely targeted beam of radiation to PCa cells than non-stereostatic radiation?
In reference to "medicines" and "chemotherapy" what I was saying was that in your comment "you don't need medicines" it was because of having a localized condition, you were suggesting they weren't necessary. Because these are best addressed with surgery or radiation--not chemotherapy.
So Tall_Allen, can patients recover or bounce back well from SBRT? Can it cause long-lasting side effects?
SBRT for prostate cancer began in 2003, so relatively newer than IMRT (which began in the late 1990s). It has to be more precisely targeted because it is more intense.
I have no side effects from my 2010 treatment. I am typical.
PIRADS?
Prostate Imaging Reporting & Data System (PI-RADS®)
The goal is to expedite the transfer of high-quality MRI from laboratories to patients to help improve early diagnosis of clinically significant prostate cancer and reduce unnecessary biopsies and treatment for benign and subclinical diseases.
Good Luck, Good Health and Good Humor.
j-o-h-n
I'm confused. How does this relate to the Question?
Introduction - 56 years old, stage 4 - bone mets, lymph node and likely lung involvement
Please advise about treatment
New here, After treatment, the waiting game
My oncologist said it's a bad ass cancer that trying to kick my ass 
Next step options after lupron/zytiga failed
