I am new here, and found out about this place from reading TallAllen's blog "Prostate Cancer News, Reviews & Views"
I am 72 now, and was AS since 2013, where a small volume 3+3 was found on random biopsy. I have BPH, and on Advodart since 2013. Prostate size 50-60cc.
I will share my lhistory. Sorry it is so long-winded.
In 2013 they "encouraged" treatment, but I elected AS.
PSA under Avodart had been running around 2.0 since 2014.
Had a follow-up biopsy in 2014, 18 core, was negative, but received a severe infection, prostatitis from it. Almost went sepsis, because they had me on CIPRO, and the e-coli infection was resistant to fluoroquinolones. From that experience, I decided to avoid TRUS biopsies hence forward. I also changed my urologist, and moved to a comprehensive center.
Have been Monitoring through MRIs, PSA's since then.
In 2019 PSA increased from 2.0 to 2.5, and MRI indicated two areas in Anterior TZ PiRad 4.0. Had a directed TP Biopsy in those areas. One area was BPH, and the other area was fragmented 3+3 Gleason.
PSA from 2019 to 2022 increased from 2.5 to 2.8. Because of the effect of Avodart, it is recommended to double the PSA to get the actual PSA value.
Had a Precision Point Transperineal Biopsy on 4/15/2022 where 15 cores were taken, from an area on the MRI done on 2/7/2022 rated at PIRAD 3. Previously that MRI area was read as a PIRAD 4.
The results of the TP Bx from two cores from the PIRAD 3 area at 3+4:
M. L1-Left Anterior Medial 3+4, Grade Group 2 (Most cells still look similar to normal prostate cells. The cancer is likely to grow slowly)
10% pattern 4, involving 1 of 1 core, 50% of tissue.
O. L1- Left anterior mid transition Zone 3+4, Grade Group 2, involving 10% pattern 4 involving 1 of 1 core, 70% of tissue.
The results of the TP Bx were one core at 3+3:
In addition, one core from the biopsy at the right apex found a 3+3:
B. Prostate, Right Posterior Medial Apex. Score 3+3 = 6 Grade Group 1, involving 1 of 1 Core 10% tissue.
I had a second read of the slides at John Hopkins, and there was a slight upgrade:
M. Gleason score 3+4 = 7 Grade Group 2, 10% Gleason pattern 4, 80% of tissue
O. Gleason score 3+4 = 7 Grade Group 2, 10% Gleason pattern 4, 90% of tissue
B. Gleason score 3+4 = 7, Grade Group 2, involving 5% of 1 core. Too small to accurately assign a percent of pattern 4. This was previously viewed as 3+3.
TULSA focal therapy was suggested, and I requested a PSMA.
1. There is an intense focus of pylarify activity in the anterior left prostate gland corresponding to MRI finding and concerning for prostate malignancy.
2. There are nonspecific left pelvic lymph nodes with subtle pylarify uptake which are uncertain to be metastatic or benign.
There is focal Pylarify uptake in the prostate bed, suspcious for malignancy.
* intense focal radiotracer activity in the anterior left prostate gland at the apex on image 321, correlating with prior MRI findings.
Nonspecific degree of Pylarify update in the lymph nodes is equivocal for malignancy:
*Mildly prominent left common iliac node measuring 10x9mm in CT image 264 without increased radiotrace uptake. It is nonspecific.
*Similarly, there is a nonspecific left obturator node on CT image 304 with mild Pylarify activity roughly equivalent to blood pool measuring 17x18 mm. (I wonder if the "blood pool" is from the TP biopsy I had 4 weeks earlier?"
There is no focal Pylarify uptake within the skeleton to suggest metasatic disease.
I am waiting on the results of the Decipher test.
Consult with physician, indicated all options were open to me, though they would not recommend continued AS.
While not a "hard sell", they are trying to push me in the direction of TULSA PRO.
Based on reading the analysis and impressions by Tall Allen on TULSA, I am currently not inclined to take that approach. It sounds good on paper, no incisions, real-time monitoring under MRI, temperature control, etc., but they are putting a probe up your urethra, under general anesthesia, followed by a two week catheter, and recovery period, with a fair probability one may have to revisit additional treatment options down the road. I don't know if it is worth it.
I am asked my urologist for a radiologist recommendation because I want to understand all my options.
I am in bay area in Northern California, going to Stanford, and have no complaints, but want to consider one or two other places for second opinions.
Any recommendations for second opinions, or other things I should look at, are sure welcomed.