Well, a bit of an update. After the two back to back (2 weeks apart) PSA readings (16, 19.8), my urologist put me on 4 weeks of Cipro to ensure that even though my urinalysis was clean, that I did not have asymptomatic prostatitis. So, at the end of the Cipro and another clean urinalysis, my PSA only dropped to 14.2. So off to the imaging center for a 3T mpMRI. Interesting experience, 75 minutes inside a jack hammer! My PI-RADS score came out a 2 out of 5. They found nothing! Nothing in the lymph system, bones, nearby organs, zip! Of course the mpMRI is NOT the best predictor when the PCa is low grade and diffuse. If not for the high PSA#, the PI-RADS score would clearly preclude the need for a biopsy at this time, but the "risk factors" comes into play in interpreting the PI-RADS score and we need to sort out why my PSA is so high. Yes, my prostate is just a tad over 50% enlarged from the normal 25cc size, but such does NOT contribute any significance to my overall PSA # at its present size. My urologist plans to do an end firing ultrasound fusion transrectal biopsy as we both have concerns of sexual injury during a transperineal biopsy at the level of cores he wants to take. Since we have ruled out pretty much all but early stage, preservation and protection of my sexual integrity is even MORE paramount than before. He told me that he will take 20-50 cores most likely and by using the end firing probe where the biopsy needle is parallel to the probe, he can torque the probe and get to ALL of the prostate for sampling but he told me that I did not want to be awake for such, so this will be a general anesthetic, day surgical center procedure. I know this sounds like a lot of overreacting, but that persistent PSA has to be explained and understood before I am willing to just join the active surveillance club. Having ruled out the worst scenarios with the mpMRI, I feel a lot more confident that we caught this so early that we have EVERY option open.
FYI, the imaging center used the French developed Dotarem gadolinium compound which unlike the less safe linear compounds is an ionic macrocyclic compound where the gadolinium is caged completely in its chelating partners rather than just at one end. This version was developed originally for pediatric use and in patients with ONLY exposure to this one type of gadolinium, there have been zero cases of the compound remaining in the system beyond a few hours to a few days and none detected in the brain. The less safe versions have been found in 100% of every patient and the more exposure the more they find in the bones, kidneys and brain. It is not understood what the long term ramifications are but I did NOT want to be part of that risk. I had LOTS of apprehension going into the procedure until I discovered that Dotarem was going to be used. For those that don't know, gadolinium is a heavy metal neurotoxin that is very toxic in humans, so chelation is required to make it even remotely safe. The earlier versions have proved problematic and in the EU have already been pulled. The FDA is dragging its feet with taking hard action, but they have forced black box warnings on all gadolinium compounds and recently advised that they not be used unless the imaging value justifies the risk. Unfortunately they gave most imaging centers a massive loophole that states that unless the patient specifically requests the information, in hospital settings (and most imaging centers are associated with a hospital), the information CAN be withheld if the hospital feels the patient will react negatively to the information. When you read the information there is no way a patient would NOT react negatively, so this is the FDA bowing to pressure from the MRI industry and the hospitals putting more value on the capital aspects than the human aspects. It is crap like this that makes me so cagey about hospitals in general.
david
