biopsies and diagnosis

[Darryl]

Excellent discussion about biopsies and diagnosis, from the BBC

bbc.co.uk/programmes/b086s7jr

[Hidden]

I wish they had said what the risk is for having prostate cancer with a normal PSA, and also the risk for having metastatic PC with a normal PSA (or a graph of risk vs PSA). Some numbers.

Misclassification is negligible, I assume, and included just for logical completeness.

And of course they dont talk about circulating tumor cell counts, or the characterization of those CTC's if found, or the fashionable "liquid biopsy".

The talk of the role of the MRI for diagnosis is good. What is the hold-up? Cost?

[Roger2Dodger]

Great discussion, but I am still left with uncertainty of an informed decision.

Since I was diagnosed with prostate cancer, I have researched extensively, and gathered information from sources from every possible avenues to help me understand PCa.

This video just reiterates all the knowledge I have gained over the course of 9 months. There are so many different opinions on treatment versus Active Surveillance. The more I read and gather this information, the more my anxiety and stress becomes. (not to mention confusing.)

However, I am having a Artemis MRI/Ultrasound Semi-Robotic Fusion prostate biopsy Tomorrow, and after the results of this test I think I can make an informed decision.

I am tired of all the other test I have gone through MRI, Biopsy (TRUS), and genetic testing.

[Hidden in reply to Roger2Dodger]

MRI guided biopsy sounds like a good thing. You had a TRUS biopsy already, and an MRI already. Did the MRI suggest that the TRUS biopsy missed a suspicious location? Which of the genetic tests did you settle on, and I presume that you felt that the cell sample from the original biopsy was not representative of the risk.

If the cancer in your prostate is visibly diverse (not the whole gland involvement) did you consider "focal" treatment, like HIFU or that thing that Mark Emberton just announced in London. Or maybe SBRT - although SBRT seems too something for "lumpectomy". There is a second generation of HIFU that can treat smaller targets.

[Roger2Dodger]

The MRI did not suggest nothing was missed. The result showed PIRADS 4.

My biopsy remains were sent to Prolaris (myriad Laboratories) which my PCa came back in the non aggressive range.

This compelled me to choose AS. However, my Gleason score from the blind biopsy was 4+3=7 and this is why I am concerned about AS and getting treatment.

After I see the results of the Guided MRI, and go for a second opinion, which I have scheduled. I will then make an informed decision whether it be treatment or stay on AS.

Thanks for the reply,

Roger

[Darryl Partner in reply to Roger2Dodger]

Please let us know the results of your Guided MRI biopsy and your second opinion. Good luck with all of that!

[Roger2Dodger]

Thank you Darryl , I certainly will. Second opinion scheduled Jan. 13.

Roger

[Hidden]

Pi-Rads 4 was an assessment of

"High (clinically significant cancer is likely to be present)"

cancerimagingjournal.biomed...

The Prolaris test of a biopsy sample was an assessment of

non-aggressive

(Hard to see how a sample of grade 4 could be thought to be non aggressive. But it is a genetic test, so "looks" don't count.)

These two are quite different assessments and no wonder you want another opinion.

A biopsy of 4+3 is problematic, as any grade 4 is worrying, and 4+3 is currently (after 2014) thought a higher grade than 3+4.

It is always good to get more information, if it has a good chance of eliminating doubt about treatment options, but I would be surprised if they recommend continued active surveillance.

But the number of cores involved were low (2 of 12). And your PSA doubling time is in multiple years (from 6ish to 7ish over 9 months), so that actually seems pretty good.

Sigh. This is confusing.

I think you want to go for ten year survival, so that means treatment. Take your pick. I wont tell you what I would pick, cause I am a little weird. [[For example, if I expected I would start treatment within a month after a multi-parametric MRI scan, if it looked like I should, I would try to get testosterone supplementation prior to the scan, to wake up any indolent metastatic prostate cancer that was outside the "capsule", so it would show up on the scan. There shouldn't be any, so no harm, but if some showed up, I would want to know about it, and try to get it.]]

Oh wait, was your upcoming biopsy will use a mpMRI. Yes.

Here is a video which unfortunately says that things are not black and white. youtube.com/watch?v=IYtlRh9...(Not working as expected?)

And rags on Mark Emberton (of London).

[Roger2Dodger]

Thanks for sharing!

[David1958]

Just for comparison, I was 52 when diagnosed (urinary changes made me seek out a urologist) and my PSA was 5. Half the gland was cancerous with a Gleason score of (3+4)7. My T score was T2b prior to surgery, and T3a after. My PSA has been undetectable since June 2011. I do not believe I ever had the luxury AS. I have no regrets.

[MelbourneDavid in reply to David1958]

Very similar here DHeberling

PSA 6.1 half the gland Gleason 3+4. Nothing on DRE so t1c before surgery but MRI showed a large anterior lesion with apparent extracapsular extension.T3a after surgery in 2014 with a 20cc lesion. No recurrence so far. PSA undetectable at 2 years.

Waiting would have let it grow bigger, block things and perhaps spread.