Acworth Georgia Man 2nd Opinion Results - Prostate Cancer N...

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Acworth Georgia Man 2nd Opinion Results

I went yesterday for a 2nd opinion and the Dr said it is 50% chance. I am considered a very young man to have prostate cancer at age 46 and it does not show signs of spreading. He also says that I have a very large prostate that is most likely just the way I was born and not due to aging. He suggests that we use my MRI to complete a guided biopsy. He believes this will help me to be able to address the issue and hopefully conclude no cancer and be able to move on with my life. He seems to believe that I will be able to go back on the testosterone with my negative results. It has been really difficult falling back into a low testosterone life. I feel tired all of the time, with no desire for sexual activity, and my true goal each day is just to sleep. This is the same that I experienced before being diagnosed with low-T. I am just afraid that the Testosterone is what caused the cancer cells to grow.

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Testosterone replacement therapy will flush it out of the woodwork and this is very common. The advantage is that it sounds like if you have cancer that it may be at a very treatable stage. Nevertheless exercise helps with the symptoms of low T. TRT may have hastened my recurrence of cancer 16 months ago. It a subject of great debate.

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I agree with everything Rust said. Exercise is important for recovering vitality. I strongly (should I say "strenuously"?) recommend it. I also think that testosterone replacement therapy is greatly debated right now. If you search for "bipolar androgen therapy prostate cancer" you'll find articles about its use in castration resistant men.

If there is a real chance that you have prostate cancer, then I think it's a good idea to get the biopsy. Men diagnosed at a younger age may have more aggressive cancers. If the biopsy does show cancer, you might or might not need immediate treatment, but it's a good idea to know your situation.

If you decide you want to continue TRT, I recommend that you try to find and consult an expert on testosterone and prostate cancer. Most urologists, and for that matter, probably most oncologists, aren't keeping up with the latest research on testosterone and prostate cancer. They'll probably tell you not to do it - which may be good advice, I don't know. But if you still want to do it it seems to me very much in your interest to have a doctor who is familiar with the issues and has done this before.

Best of luck.

Alan

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Thanks for sharing your thoughts and ideas. It helps to discuss with other men.

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As suggested you may want to discuss issues about testosterone replacement and PCa with an oncologist who is aware of the issues. Since you are in the Greater Atlanta area you may want to contact Dr. Vasily Assikis at Piedmont Cancer Institute in Atlanta. He is knowledgeable about research in this area. As others have written, it does make sense to go ahead with a biopsy. You might want to read up on the pros and cons of MRI biopsies while in the tube vs. MRI fusion guided ones. Best of luck.

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I was wondering if the MRI fusion was done while in the tube.

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MRI guided biopsy is done in the MRI tube, matching the multiparametric prostate MRI with a more simple nearly real time MRI to find the matching position.

MRI fusion biopsy uses an ultrasound image to guide the needle to a corresponding spot, but the ultrasound probe pushes things around a bit and isn't seeing the same things as the MRI so it's thought to be less precise than MRI guided. With a small lesion that matters. With a large lesion it's less important.

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This is very helpful. Thanks. I will be checking this out

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A question:

. . . Why does either doctor think you _might_ have prostate cancer ?

You haven't had a biopsy (the only _sure_ way to know).

. . . What's your PSA level ?

. . . What's your prostate volume ?

A comment:

An MRI is non-invasive (that is, it won't damage you), and might give you (and the doc) useful information about what's inside your prostate. If it shows regions that might be cancerous, you can go on to have a biopsy.

If you can afford it. the MRI might be a reasonable choice.

. Charles (with no letters after my name)

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Quality of life is an important issue. Testosterone replacement lets the prostate produce the PSA it would have if you didn't have a testosterone deficiency. I don't think it makes cancers more aggressive. I do think that were there is a real testosterone problem testosterone replacement is often a major quality of life improvement.

I'd investigate the cause without delay, treat appropriately, and continue testosterone replacement unless androgen deprivation therapy is required.

At 47 I had a PSA of 3.3 on retest and must have had significant prostate cancer. 5 years later when retested, it had grown to 20cc with quite a bit of shallow extracapsular extension. Surgery would have done a lot less harm to my erections if it had been treated while smaller.

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Thanks for sharing with me. I wonder if I will lose this sexual side of myself in this journey

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Three general treatment options: radical prostatectomy surgery, radiation (external beam or seeds), and what I opted for; High Intensity Focused Ultrasound - HIFU. Research all these and other treatment options. I suffered no QOL (quality of life) penalties with HIFU but it was expensive and out of pocket.

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The Dr that is doing my fusion guided biopsy in Atlanta was completing HIFU procedures in Mexico and Canada before approved here. I was leaning toward this procedure if the results come back positive. Is this option still expensive and out of pocket or was that before it was approved here?

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Still mostly out of pocket but the moderator of this forum mentioned that Cigna now covers HIFU. Maybe other insurance will climb on board? I have to think that a 4 hour HIFU procedure is maybe cheaper than the 45 radiation treatments I was scheduled for? Certainly more convenient although the supra-pubic catheter wasn't much fun.

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I will look at the HIFU option if the biopsy results require treatment.

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If I could turn back time and had the opportunity to have a biopsy at age 46 to confirm or not to confirm PCA I would do it in a heart beat! I had no physicals through my 40’s because I was in great shape and took care of myself...who wants to see a Dr? Ohhh was I wrong! At 49 my first PSA reading was 12. An astute Dr. requested a PSA test, during a physical and I am forever grateful! I had Radical Prostatectomy shortly after biopsy in Oct. of 2013. My diagnosis was G9, T3b, N0x, M0x, EPE, Neg margins, SVI. 2.5 years later received SRT due to rising PSA near the detectable level of 0.2. Today my PSA is undetectable at 0.025. No idea when my PSA may rise again. I sure wish I had the opportunity to catch this disease sooner in life. If I would have caught this 3 years sooner I most likely would have a completely different prognosis with a much better chance of being cured. You didnt mention your PSA? I would evaluate your PSA as well as DRT results. Then I would evaluate the downside of a biopsy. At your age you will most likely have very little issues with the biopsy. Not telling you what to do...just sharing what your world could look like if you ignore monitoring your PSA and prostate health. Good luck with your decision!

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Thank you for sharing your story. This helps me to know that I am doing the right thing with moving forward with the biopsy. He is going to do a fusion biopsy in July.

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I think you made a wise choice and good luck! Don’t worry about procedure you will do just fine.

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