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

Hi Grundo / Oasca2023 / Brian

Thanks for all for your comments - very much appreciated. Some additional info:

Last MRI: mid Oct.2024.  Biopsy: Nov.2024.
Tumour 1 - 13mm subcapsular lesion between 7 and 8 o’clock within the right mid-gland towards the apex. [biop G3+4]
Tumour 2 - 7mm subcapsular lesion in the left mid-gland. [biop G3+3]

My take is that the latest PSA number is probably accurate. My previous PSA of 4.0, which was my first after a procedure (Mar.2024) to address BPH, resulting in prostate size reduction from ~86 to ~43cl was somewhat higher than I had hoped for. That test was somewhat rushed due to poor hospital admin. My last pre-procedure PSA was 7.2 (Jul.2023).

The hospital's protocol for AS is: PSA test interval 6m. MRI scan interval 12m. So my next routine PSA and MRI would be in approx late Oct 2025.

On the basis of the info available , I rather doubt if they would sanction an MRI before then, so if I was not happy with the AS path, I presume that the only option would be to move to whatever is my preferred (or 'least unwelcome') active treatment.

Hello Peroni 

Thanks for the post and as I said, I respect your choice. I don't want to be the "doom monger" BUT and I quote from your private consultants letter:

Peroni said:

within the right mid-gland towards the apex.”

To me "towards the apex" = near the edge!

Peroni said:

high-risk lesion.”

I think that says it for itself.

Anyway, please do keep us up to date and I wish you well moving forward.

Best wishes - Brian.

I reckon with the two tumour sizes probably time to do something, similar size to mine before I started treatment in 2017.

Did I see somewhere about a perineural invasion, apologies If I am mistaken. but if so , again time to do something, am surprised they are agreeing to AS

Steve 

Hi Brian -

I can assure you that I regard your view as an entirely valid one, which is genuinely appreciated !  

toward the apex. Yes I agree that the apparent proximity (at least as I very incompletely understand it) to the urinary sphincter, with apparent potential adverse consequences especially in a prostatectomy situation, is a concern.

high risk lesion - my take here is that this simply refers to the high percentage probability of the subsequent biopsy detecting cancer (i.e. G3 or above). Once the biopsy is done, the MRI-based observation is effectively superseded by the biopsy result.  In my case, the risk has effectively materialised, primarily in the form of a G3+4 result. 

Anyway, rather than offering to cancel the appt, I have just dropped the CSN a note to advise, in case useful, that the blood sample has been provided in good time and that I am already aware of the PSA result. It's not clear whether the appt is with a consultant, which is what I initially assumed, or a CSN. The letter simply refers to 'a member of the urology services team'.   (<- later clarified as doctor, not nurse)

So assuming it is with a consultant I may well go ahead with the objective of getting a better handle on the prostatectomy v alternative(s) decision.

Peroni

Your comment about biopsy superseding the MRI.

I may be reading incorrectly but I have always thought that MRI more important than biopsy cos it shows where the tumour (s) are..

Obviously Gleeson important (and needed to confirm it is cancer) as well but if cancer escaped the gland but Gleeson 6 , well, massively important to start some treatment 

Steve 

Hello Peroni 

The longer I have been around the Community, the more I learn and the more I have developed my personal opinions. I try to be objective with my posts and your situation to me is shouting "intervention". 

I am a great believer in the MRI scan and I would be pressing for another one.

Once you have spoken to the oncologist we can continue the debate:

Peroni said:

prostatectomy v alternative(s) decision.

I have my views here too, but again I try to give everyone a balanced view.

Let us know how you get on.

Best wishes - Brian.

Hi Grundo / Steve    (re your post at 5:23pm)

I reckon with two tumour sizes probably time to do something, similar size to mine before I started treatment in 2017.

Indeed you may well be right, but I can only really move ahead on the basis of what, subjectively, feels best for me.

Did I see somewhere about a perineural invasion ...... am surprised they are agreeing to AS.

Yes, the histopathology report details previously posted includes the comment 'Perineural invasion: Yes'. I've done a fair amount of follow-up reading on PNI, but the result was very inconclusive.  The general consensus 'feeling' seems to be is that it is better for PNI to be absent rather than present, but also that is difficult to measure it. The current info capture is simply a binary Yes/No, which seemingly is not sufficiently meaningful to reliably influence the treatment path.

The letter to the GP advising the MDT's recommendation of AS included the comment 'the volume of cancer identified was incredibly small, and therefore active surveillance remained a recommended option'.  BTW, the letter did not refer to PNI.

Ok Peroni, thanks for the details.

It's just that with a 13mm tumour and a smaller one and the possibility.of a Perineural invasion which I thought meant it had escaped the gland but I could be wrong then time to start treatment of some kind..

As a matter of interest why do u not want treatment at this stage

Actually just read up on the invasion, not necessarily escaped the gland but infiltrated the nerves within the gland which can complicate things.

Steve 

Hi Grundo / Steve 

....As a matter of interest why do u not want treatment at this stage...

It's a good question.  This forum may not necessarily be the right place for a detailed explanation. But in summary I retired later than I should really have done (just turned 68 at the time), with amongst other things covid and family commitments delaying that step. 

So my remaining 'enjoyable retirement time' was already reduced before I even started.  Then some other factors including BPH and the need to deal with some other obligations and issues (ongoing at this point, unfortunately) have taken a huge bite out of that reduced time.   

So I am fairly desperate to have, hopefully, at least a couple of good quality years, which I would define as including a decently functioning prostate and the absence of the issues typically associated with PC treatment.  The probability of having active treatment at some point is definitely accepted.

Cheers, Peroni.   

Ok I understand.

I will just add this, Radiotherapy is possibly the easiest option with minimal side effects so do consider at some point.

Good luck

Steve