What's next

[twoodogs]

I have been on AS since 2019 have undergone 3 biopsy's gleason 6 and 7 . Just got the results back from this years MRI at from Moffit in Tampa. Prostate volume increased from 24ml to 34ml. Peripheral zone lesion last year was 1.4 cm and pirads 4 now its 2.4cm and pirads 5. Also there's stuff i don't know what it is like sequela of chronic prostatitis. I have a zoom with Moffit next week to discuss but it looks to me like its time for treatment. Any thoughts or suggestions are appreciated. Feeling a little lost not sure which way to go.

[Tall_Allen]

Only a biopsy can show progression.

[twoodogs in reply to Tall_Allen]

would it be worth it or I'm I just delaying treatment, after 3 biopsy's I hate the thought of another

[Tall_Allen in reply to twoodogs]

Your MRI, PSA, and prostate size are consistent with BPH. So a biopsy is necessary to determine whether grade progression has occurred.

[twoodogs in reply to Tall_Allen]

TA I really appreciate your insight that's the first time I've heard I might have BPH. My 2020 MRI showed a volume of 24.1 ml. It has been the same till this year now 34ml is that normal? The lesion was 0.7 in 2020 now 2.4cm . I am 66 years old it seems like sooner rather than later i need to make a decision. I was thinking I might go with radiation of some type but not sure now that surgery might be a better option now to address the BPH.

[Tall_Allen in reply to twoodogs]

24cm is still small. Cellular enlargement is what BPH is. If it is not obstructive, it doesn't have to be addressed. I'm just saying it could be the reason for what you are seeing on the MRI and PSA. Radiation fixes it too.

[twoodogs in reply to Tall_Allen]

Again thanks for the insight. MRI report states evidence of BPH moderate. So if I have BPH radiation would solve that? When should i consider SBRT or just normal radiation? The fact that I won't really know what the cancer is doing without another biopsy is problematic. I just don't tolerate them well. It would make 4 biopsy's in 5 years. Everything is getting worse PSA has bounced around but slowly getting higher 6.43 now. Just trying to be realistic. A couple more things on the MRI "patchy T2 hyperintensity involving the entire prostate gland, representing sequela of chronic prostatitis. Heterogeneous patchy bone attenuation, likely representing marrow conversion changes". T2 Circumscribed, homogeneous moderate hypointense focus/mass AND = or >1.5 cm or with definite extra-prostatic extension/invasive behavior (score 5 ) DWI Focal markedly hypointense on ADC and markedly hyperintense on DWI AND = or > 1.5 cm or with definite extra-prostatic extension/invasive behavior ( score 5 ). DCE positive.

[Tall_Allen in reply to twoodogs]

Ah, prostatitis!

[Bourbon2024 in reply to twoodogs]

I would insist a trans-perineal biopsy be done vs trans-rectal.

[groundhogy]

Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.

prostatecancerfree.org/comp...

It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.