Recent MRI - Lesion 13mm, Likert 4 maybe 5. Urgency, timelines ?

Hi Peroni

Just wondered why u started down the private route, wouldn't NHS sort out BPH?

You have had a biopsy a few months ago and now they wanting do another one?

They suggested active surveillance but now there is some concern it could be near the gland edge.

Perhaps I 'm reading it incorrectly but does seem a bit strange 

Regards 

Steve 

Hi Steve.   Thanks for the response.

Re the BPH, my preference was for a particular procedure (alternative to TURP), with a lower risk profile, which I was not able to access via the NHS in my area, or indeed in most areas.  

The earlier Gleason 3+3 was not picked up via a biopsy (where tissue is extracted from the prostate on a targeted or systematic basis).  It was picked up, on an incidental type of basis, from the tissue removed during the BPH procedure.

At that time (Apr.2024) the consultant recommended an MRI approx 6 months after the BPH procedure, to be followed by the normal (as I understand it) active surveillance schedule of subsequent MRIs at 12 months and PSAs at 3 or 6 months.  Assuming of course that the first MRI was 'good', which unfortunately is certainly not the case.

So the upcoming biopsy will be my first.  Cheers.         

Ok Peroni , thank you for explaining, clearer now.

Stats don't look too bad, is your concern because the MRI talks about the larger lesion near the apex? Or something else

Steve

Just one other thing.

Strange why they didn't do another biopsy if they saw a Gleeson 3+3 from a non direct prostate biopsy and then said , oh, go on AS

Again I could be reading it wrong 

Steve 

That's a fair comment.  However given my age (69 - will add this to my profile), I understand that it's a statistical probability that I will have Gleason 3+3.  So that may have provided (false) reassurance.    

I also understand that these days biopsies are at least partially targeted, which would have necessitated doing an MRI first (my only other MRI was in 2017).

I do agree with your general drift that there could have been more thorough investigation / follow-up at an earlier point(s).

Don't think correct , most men over certain age have a 3+3 but obviously could be wrong.

Anyway thinking positively good luck with the upcoming biopsy, let's hope 3+3 or less..

One thing to confirm with them, is how near tumour to capsule edge , probably the most important point.

PSA near normal, so there's a good point

Best wishes 

Steve 

Hi Peroni  and Grundo .

I'm not usually keen to quote the Daily Telegraph, but I foudn the article on this link interesting:

https://www.telegraph.co.uk/health-fitness/conditions/cancer/prostate-health-cancer-how-to-check/

It matches some figures that I have seen before, possibly on Cancer Research, but I have been unable to find them immediately.

Steve

Hi mstev2. 

I have now read this article, which is similar to those found in the DT from time to time.  Thank you for flagging. 

Cheers !

Thanks, interesting.

Steve

(update Tue 05 Nov)

Saw my GP (who has been notably proactive and helpful) last Wed 30 Oct late afternoon. He booked an appt with the Urology Dept for Mon 04 Nov. 

However on the following day (Thu 31) I received a call from a urology dept 'care path navigator', who very helpfully offered me an appt for 10am on the following day (Fri 01 Nov) instead, subject to the detailed MRI images generated by the private clinic, and the associated detailed report, being acquired in sufficient time for the urologist to study them prior to the appt.

It was a bit of a scramble to get the images in time, but apparently there is a back-office system whereby the NHS can acquire the images directly from registered health entities, and upload them to their system for review.  Anyway, it got done in time.

So on Fri 01 Nov I had a very useful meeting with the consultant - impressive credentials, and excellent 'bedside manner', which always really helps.  Key points:

- Probability of cancer 90%. (guessing this means cancer exceeding the AS threshold).  Not a surprise to me.  

- Stage currently seen as T3a (tumour has spread through the capsule surrounding the prostate)

- Primary treatment seen as surgery, possibly with radiotherapy as a supplement (just touched on, no discussion).  

- Treatments such as brachytherapy seen as unlikely to be suitable. 

- Biopsy transperineal under local anaesthetic  

- Biopsy is 'fusion guided'.  i.e. real-time ultrasound images merged with stored MRI images.

- Full set of targeted and systematic cores.  I forget the number, maybe 12.

- Said that the subcapsular nature of the lesions did not adversely impact the ability to take accurate cores.  

- Next step is a biopsy, now scheduled for Fri 08 Nov

- Results appt expected Wed 20 Nov.  

- PET scan may follow.