MRI and Pet result concerns - “extraprostatic disease”

5 replies
171 subscribers
629 views

Hi everyone,

Sorry for the long post but I hope I can pick your collective brains again.

After a recent steep rise in my PSA, I got my scan results and they seem both positive and negative. Postive because my existing bladder cancer hasn’t spread but negative that both MRI and PSMA Pet show a PIRADS 5 lesion in the same place in my prostate.

I spoke to the urologist who recommends both targeted and “mapping” biopsies under general anaesthetic. He said there was still a chance it might not be prostate cancer but that with both MRI and Pet being positive, the chance was slim. He also started talking about treatment.

Here are some extracts from the reports’ conclusions:

MRI:

“Prostate volume: 30 cc, PSA density: 0.20

There is a highly suspicious lesion at the right posterior base to apex, PIRADS 5 Likert 5. There are some features which are equivocal for extraprostatic disease.The lesion may extend slightly across the midline and has broad contact with the prostate capsule.”

PSMA Pet:

“There is tracer uptake at the posterior aspect of the right prostate, corresponding to the area of MRI signal abnormality and likely to represent prostate malignancy.”

Can someone please explain the significance of the midline comment and “extraprostatic disease”? Wouldn’t that have shown up on the PSMA Pet?

Also, I’m probably way ahead of myself but urologist said the mapping biopsies were to see if focal treatment would be a possibility. What does he mean? I was too stunned to ask.

If it’s relevant I’ll be 51 in a couple of days.

Thanks again

Alex

Bill2021 over 3 years ago

Focal treatment means radiotherapy or ultrasound highly targeted on the malignant area and leaving the rest untouched , which means fewer side effects than whole gland treatments. Examples of this are HiFu , Laser knife , or TULSA . I am not an expert here so seek further advice .

if the tumour , if there is one , crosses the midline , then that makes it a higher staged tumour ( at least a 2c ) , and if it has grown into the capsule , then it’s at least a 3a - a locally advanced tumour .

Neither of these things is great , but not a barrier to treatment . They may change the type if treatment you get - if the capsule is breached , then surgery , if feasible , would have a high chance of needing adjuvant radiotherapy..

Pet scan and MRI show different things and may give different information which must be considered together to get full picture .

But with the information given , I think it’s still a potentially CURABLE problem.

Im no expert , but one will be along shortly .

bill

AlexMP over 3 years ago in reply to Bill2021

Hi Bill

Thanks very much for the explaining things so well. It really helps to get information. I see the report also mentions equivocal right seminal vesicle infiltration which I guess isn’t that positive either.

Bill2021 over 3 years ago in reply to AlexMP

Not ideal , but still wouldn’t preclude a cure . Have you had radiotherapy for your bladder issues ? Bill

AlexMP over 3 years ago in reply to Bill2021

No. Just surgeries and immunotherapy. I declined bladder removal as it would mean losing my prostate. Thanks Bill.

Bill2021 over 3 years ago in reply to AlexMP

Out of my depth here , but that does mean that radiotherapy is a real option for the backbone of your treatment, and also leaves surgery as an option - I don’t know , but I suspect prostatectomy would be difficult or impossible after pelvic radiotherapy - it certainly is after prostate rx .
i had relatively straightforward surgery for my tumour , so hoping someone who has had similar issues turns up. All the best , anyway . Bill

More from this forum

MRI and Pet result concerns - “extraprostatic disease”