MRi Scan two lesions in prostate

Hi PSB,

I took the HT & RT route & was advised that I needed to drink 2 litres of water a day (in addition to any other liquids) to ensure I was keeping properly hydrated.  I started practicing this about 2 months before RT started & initially it was a struggle however, it did get easier over time.  I tried to drink about 1 1/4 litres before lunch & then the remainder in the afternoon.  This then helped ensure I wasn't having to get up too frequently overnight for a pee.

Like you, I had to travel to the hospital  (up to an hour away) to complete my preparation which in my case involved drinking 400ml water (having used an enema & emptied my bowels) & then waiting 30 min before being called through for the RT session.  The amount drunk seems to vary based on the individual but this will hopefully give you an idea. My sessions varied from early morning time slots through to late afternoon.  I know that some hospitals allocate the same time slot each day, so if you can get an early morning slot then there is less chance of them running behind schedule.

Before heading home I made sure I had emptied my bladder twice so travelling back wasn't an issue, but just in case, I had a container in the car that I could use (tinted rear windows are marvellous for discretion) & also knew a few places I could call into if needed.

Best Wishes

Brian

Hi Brian 

That's for your information I'll definitely be taking your advice 2 months before RT starts,400ml doesn't seem to bad ,famous last words  my bladder is a mare  thanks again Brian 

Best wishes 

Peter 

I have had an overactive bladder for years and decided to go with the Prostatectomy, I'm nearly 62 and I will have to take steps to regain an erection but there is still feeling and sex drive.

I made that decision as it's more likely to remove all the cancer (mine was localised) as far as water goes it's a question of learning to hold it and avoid too much tea or coffee.

I believe the radiotherapy is every day for weeks 

Hi Stew 

It's the incontinence that worries me to as my bladder isn't good the Radiotherapy is 4 weeks so somehow I'm going to have to train my bladder which won't be easy oncologist said there's medication that hopefully will help.

Perhaps just try not to drink fluid for at least an hour before treatment, unless you have to? I had this worry before the biopsy but it turned out ok, you'll get in a routine after a few days

Cheers Stew I'll definitely be giving that a go I'll need all the help and tips I can get

Morning all, Was definitely favouring HT/RT treatment but having serious concerns about my overactive bladder not being able to hold the required water in,I'm taking Mirabegron which relaxes the bladder muscles but don't think it will be enough on its own,has anyone had the same overactive bladder issues and been given help ie medication from the oncologist team ?

I'll be doing the muscle exercises have been practicing drinking a pint of water twice a day and seeing how long I can not wee for ,but really worried for 5 days a week for 4 weeks my bladder will let me down,plus I have to give a answer on Tuesday about what treatment I'm choosing was supposed to be on the 31st but got brought forward can I ask to make my decision on the 31st  ?

Thanks again 

Peter 

Hello Peter (Psb2024) 

I am sure you are not the first person to have these issues and needing Radiotherapy.

If you tell your team your issues and concerns they will be able to help you through the course of Radiotherapy. It's a BIG choice your treatment path and you need to do what is right for you with the help of your team.

You will get through this - don't worry.

Best wishes - Brian.

Hi Brian 

I made the mistake of drinking a pint of water at 16.45 lasted till 19.30ish which I was happy with but up three times in the night at 3.30am 5am and 6.30am school boy error only morning and early afternoon practicing from now on.

Hormone therapy Radiotherapy is definitely my preferred option, can't really plan drinking water from home or the bowel  treatment as have a half an hour drive to the hospital so hopefully the Radiotherapy team can give me something to help my bladder. 

Thanks again 

Brian 

Hi Peter I am going through almost exactly what you describe yearly bloodwork PSA 8.2 went to urologist a month later PSA was down to 2.6 urologist said my choice on having MRI I chose to have it done 

results came back I have a lesion on the left side of prostrate from what I can read it’s is contained inside the wall like you my mind is going to the worst can’t eat can’t sleep waiting on follow up with urologist on 12/30

contrast, prostate protocol

INDICATION: Elevated PSA, 8.29.

COMPARISON: None.

TECHNIQUE: MR images were obtained of the pelvis with and without contrast after the administration of 1 mg glucagon, utilizing the prostate protocol.

CONTRAST: 20 ml of Clariscan was administered.

FINDINGS:

PROSTATE: 4.9 cm TR x 3.9 cm AP x 3.1 cmCC for an ellipsoid volume of 31 ml. PSA density 0.27

LESION 1:

Location: Left mid gland, PZpl.

Size: 1.1 x 0.7 by 0.9 cm on series 8 image23 and series 5 image 23

Capsular involvement: The lesion broadly abuts the capsule without distortion.

T2W: 3 - Heterogeneous signal intensity or non-circumscribed rounded moderate hypointense.

DWI: 3 - Focal mild/moderate hypointenseon ADC, iso/mild hyperintense on DWI.

DCE: Positive.

Overall Suspicion: PI-RADS 4.

Linear and wedge-shaped T2 hypointensities in the peripheral zonewithout diffusion restriction or ADChypointensity, PI-RADS 2.

Encapsulated nodules in the transition zone typical of benign prostatic hyperplasia.

NEUROVASCULAR BUNDLES:Unremarkable.

SEMINAL VESICALS: Unremarkable.

LYMPH NODES: No pathologic pelvic lymph nodes.

BLADDER: Slight bladder wall thickening and trabeculation may relate to a component of bladder outlet obstruction.

RECTOSIGMOID COLON: Within normal limits.

OSSEOUS: No worrisome marrow signalabnormalities.

IMPRESSION:

1. PI-RADS 4 lesion in the left mid glandperipheral zone. No metastatic disease in the pelvis.

2. Appearance of the remainder of the peripheral zone typical of current or prior prostatitis, the findings in the left mid gland is possibly granulomatousprostatitis.

3. Findings of benign prostatic hyperplasia.

PI-RADS 1: very low (clinically significantcancer is highly unlikely to be present)

PI-RADS 2: low (clinically significantcancer is unlikely to be present)

PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal)

PI-RADS 4: high (clinically significantcancer is likely to be present)

PI-RADS 5: very high (clinically significantcancer is highly likely to be present)

STUDY: MRI Pelvis without and with contrast, prostate protocol

INDICATION:

COMPARISON: None.

TECHNIQUE: MR images were obtained of the pelvis with and without contrast using the prostate protocol.

CONTRAST:

FINDINGS:

https: //pcheng.org/calc/ellipsoid.html

PROSTATE: cm TR x cm AP x cm CC for a volume of cc.

LESION 2:

Location:,.

Size:.

Capsular involvement: No evidence ofcapsular involvement.

T2W:

DWI:

DCE:

Overall Suspicion:

LESION 3:

Location:,.

Size:.

Capsular involvement: No evidence ofcapsular involvement.

T2W:

DWI:

DCE:

Overall Suspicion:

NEUROVASCULAR BUNDLES: No evidence for neurovascular invasion.

SEMINAL VESICALS: Unremarkable.

LYMPH NODES: No pathologic pelvic lymph nodes.

BLADDER: Unremarkable.

RECTOSIGMOID COLON: Within normal limits.

OSSEOUS: No worrisome marrow signalabnormalities.

IMPRESSION:

1.

PI-RADS 1: very low (clinically significantcancer is highly unlikely to be present)

PI-RADS 2: low (clinically significantcancer is unlikely to be present)

PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal)

PI-RADS 4: high (clinically significantcancer is likely to be present)

PI-RADS 5: very high (clinically significantcancer is highly likely to be present)