Announcement

Collapse
No announcement yet.

6 month meeting with new urologist tomorrow and wondering what to go over

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • 6 month meeting with new urologist tomorrow and wondering what to go over

    PSA dropped from 2.2 in January to 1.7 a couple weeks ago (which is what it was 12 years ago) I am on AS so I am guessing he is going to order a biopsy since it will be a year since my first. I think this hospital does a transpereneal method so less chance of E-coli infection. I am guessing the experience will be similar.

    I gave this new hospital the MRI results but they have not independently evaluated that yet. I will probably ask him about that. This is a phone consult so no DRE. This Dr. hasn't been in there yet. But a lot were when I was in the hospital after the last biopsy. So maybe he will know if they felt anything.

    Probably will ask his opinion on the PSA going down. I doubt the unexpected e-coli therapy killed cancer cells!

    Anything else you think I should ask?

    Phil
    born 1958
    PSA History:

    1/22/10 1.7
    12/9/11 1.61
    2/1/14 1.90
    6/5/15 1.57
    6/20/16 1.93
    1/31/18 1.86
    9/16/19 2.33
    7/16/21 2.3
    7/16/21 2.24
    01/10/2022 2.2
    07/08/2022 1.7

    Biopsy 9/2021 slides read by local urology group
    unfelt small leasion found in 3 sectors
    I. Gle 3+3 (SUP Grp 1) .5mm involving(1% & PIN)
    K. a Gle 3+4 (SUP Grp 2)2 mm involving(10%)
    L. Gle 3+4 (SUP Grp 2)1.5 mm involving(5% patchy)
    Gle 3+4

    Decipher score .26 Low Risk

    Johns Hopkins, Dr. Epstein read of slides 10/14/2021
    I. Small focus of prostatic adenocarcinoma, Gleason Score 3+3 (group 1), involving less than 5% of one (1) core
    K. Gle 3+3 (group 1), involving 10% of one (1) core
    L. , Gle 3+3 (group 1), discont. involving 20% of one (1) core

    Henry Ford read of slides:
    I. Gleason score 3+3=6 (Group 1), involving 1% of the length of one core (0.5 mm tumor focus)
    K.Gleason score 3+4=7 ( Group 2), involving up to 10% of the length of one core (1.5 mm tumor focus); Percentage of Gleason pattern 4 = 5%
    L. Gleason score 3+4=7 (Group 2), involving
    10% of the length of one core (2 mm tumor focus); Percentage of Gleason pattern 4 = 5%

    Multi Parametric MRI 12/10/2021 results:
    MPRESSION:
    1. No index lesion identified. Patient's known prostate cancer may not be
    visualized due to small size and/or low-grade. Overall, MRI findings
    compatible with PI RADS 2 abnormality (low likelihood of clinically
    significant prostate cancer).
    2. Prostate volume of 48.0 cc. PSA density of 0.04 ng/mL/mL.
    AS, transpereneal biopsy next fall

  • #2
    I recently switched docs at Cleveland. We basically just reviewed my current and past status.
    YOB 1957

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.

    3/6/19. Post surgery Pathology Report - Grade Group 4 Intraductal Carcinoma
    T3aNO, <1 mm non focal EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.
    7 Nodes, SV, SM, PNI, and BNI were negative.
    LVI and Cribriform pattern present.
    Decipher .86 High Risk.

    Post Surgery PSA
    3/25/19 .03. (25 days)
    4/25/19 <.03. (2 months)
    5/25/19 <.02 (3 months)
    9/10/2019. <.02 (7 months)
    11/27/2019. <.02. T < 3 (9 months)
    5/19/2020. <.02 (15 months)
    11/2/2020. <.02 (21 months)
    5/11/2021. <.02 T <3 (27 months)
    8/25/2021. <.02 T <3 (30 months)
    12/6/2021. <.02 T <3 (33 months)
    6/14/2022. <.02 T <3 (39 months) T=37

    3 Part Modality Treatment Completed

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery #41 in US.
    ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
    ADT - 5/19- 5/21 Eligard and Casodex.



    3 Part Modality Treatment Completed

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery #41 in US.
    ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
    ADT - 5/19- 5/21 Eligard and Casodex.

    Comment


    • #3
      Philtoo,

      Your psa dropped...That said, it is 1.7 and was 2.2 That's fantastic news. Typically, men 70 and under, the benchmark is 4.5. They don't want the number to go above 4.5, if it does go to 6 or above, typically they will do a Mri/biopsy. I am surprised you had a biopsy with a low psa. I wander Why the doctor requested this??You have low grade cancer. I don't know your age.?? You are also AS.

      I have had 3 MRI's & 3 Biopsies. Biopsies were all different. Last one was uncomfortable....I don't believe surgeon knew what he was doing. I got 20 needles that time.

      If I was you, I wouldn't get a biopsy with 1.7 psa. There is No immediate worry! I would monitor psa over next 6months.

      Keep us informed going forward,

      Danno
      YOB: 1953

      Pathology report July28/2020

      Right apex anterior x4 prostatic adenocarcionoma, gleason score 6/10 (3+3), Grade group 1, 2/4 cores involved, 20% &< than 5%
      Left mid lateral : prostatic adenocarcinoma, gleason score 7/10 (3+4), grade group 2. 4% pattern : 15%. Tumor involves 40% core.
      Left mid peripheral zone x4: prostatic adenocarcinoma, gleason score 7/10 (4 + 3), grade group 3. 4% pattern: 85%; cribriform pattern. 2/4 cores involved (fragmented), 75% of overall tissue
      Left apex: prostatic ad enocarcinoma, gleason score 7/10 (4+3), grade group 3, tumor involves 5%
      HIFU treatment, Toronto Canada on Nov.22/2020....Volume prostate prior to HIFU 43cc

      PSA History:


      Aug/2011 2.42, Oct/2012 3.1, Feb/2016 5.1; Apr/2017 6.0; Sep/2018 6.7
      Oct/2019.. 8.5; Nov/2020 10.6 HIFU treatment Nov22/2020 Feb/2021 2.9
      Jul/2021 3.2; Nov/2021 3.0 Next...Feb.23/2022 3.5

      MRI Aug/2021 & Volume 30cc
      Ablation defect on left posterior. Low signal extending from left peripheral zone from base to apex. Left peripheral reduced in size. No discrete high signals present on right/left peripheral. No suspicious lesions.

      Comment


      • #4
        I'm 64. My other doctor felt something and then had an ultrasound done, and I think saw something. Then they did an ultrasound guided 12 needle biopsy and found something. Then I got sepsis from antibiotic resistant e-coli which apparently could be pretty serious. Really low probability of that... should have played the lottery that week. Then that urologist went to Colorado and this is my second appointment with the new one.

        I'm guessing a biopsy is in my future. It is good that the PSA went down. AS is still kind of unnerving. But all in all any of the PC is all unnerving.

        born 1958
        PSA History:

        1/22/10 1.7
        12/9/11 1.61
        2/1/14 1.90
        6/5/15 1.57
        6/20/16 1.93
        1/31/18 1.86
        9/16/19 2.33
        7/16/21 2.3
        7/16/21 2.24
        01/10/2022 2.2
        07/08/2022 1.7

        Biopsy 9/2021 slides read by local urology group
        unfelt small leasion found in 3 sectors
        I. Gle 3+3 (SUP Grp 1) .5mm involving(1% & PIN)
        K. a Gle 3+4 (SUP Grp 2)2 mm involving(10%)
        L. Gle 3+4 (SUP Grp 2)1.5 mm involving(5% patchy)
        Gle 3+4

        Decipher score .26 Low Risk

        Johns Hopkins, Dr. Epstein read of slides 10/14/2021
        I. Small focus of prostatic adenocarcinoma, Gleason Score 3+3 (group 1), involving less than 5% of one (1) core
        K. Gle 3+3 (group 1), involving 10% of one (1) core
        L. , Gle 3+3 (group 1), discont. involving 20% of one (1) core

        Henry Ford read of slides:
        I. Gleason score 3+3=6 (Group 1), involving 1% of the length of one core (0.5 mm tumor focus)
        K.Gleason score 3+4=7 ( Group 2), involving up to 10% of the length of one core (1.5 mm tumor focus); Percentage of Gleason pattern 4 = 5%
        L. Gleason score 3+4=7 (Group 2), involving
        10% of the length of one core (2 mm tumor focus); Percentage of Gleason pattern 4 = 5%

        Multi Parametric MRI 12/10/2021 results:
        MPRESSION:
        1. No index lesion identified. Patient's known prostate cancer may not be
        visualized due to small size and/or low-grade. Overall, MRI findings
        compatible with PI RADS 2 abnormality (low likelihood of clinically
        significant prostate cancer).
        2. Prostate volume of 48.0 cc. PSA density of 0.04 ng/mL/mL.
        AS, transpereneal biopsy next fall

        Comment


        • #5
          He said the lower PSA was good. Scheduling a biopsy for the fall.
          born 1958
          PSA History:

          1/22/10 1.7
          12/9/11 1.61
          2/1/14 1.90
          6/5/15 1.57
          6/20/16 1.93
          1/31/18 1.86
          9/16/19 2.33
          7/16/21 2.3
          7/16/21 2.24
          01/10/2022 2.2
          07/08/2022 1.7

          Biopsy 9/2021 slides read by local urology group
          unfelt small leasion found in 3 sectors
          I. Gle 3+3 (SUP Grp 1) .5mm involving(1% & PIN)
          K. a Gle 3+4 (SUP Grp 2)2 mm involving(10%)
          L. Gle 3+4 (SUP Grp 2)1.5 mm involving(5% patchy)
          Gle 3+4

          Decipher score .26 Low Risk

          Johns Hopkins, Dr. Epstein read of slides 10/14/2021
          I. Small focus of prostatic adenocarcinoma, Gleason Score 3+3 (group 1), involving less than 5% of one (1) core
          K. Gle 3+3 (group 1), involving 10% of one (1) core
          L. , Gle 3+3 (group 1), discont. involving 20% of one (1) core

          Henry Ford read of slides:
          I. Gleason score 3+3=6 (Group 1), involving 1% of the length of one core (0.5 mm tumor focus)
          K.Gleason score 3+4=7 ( Group 2), involving up to 10% of the length of one core (1.5 mm tumor focus); Percentage of Gleason pattern 4 = 5%
          L. Gleason score 3+4=7 (Group 2), involving
          10% of the length of one core (2 mm tumor focus); Percentage of Gleason pattern 4 = 5%

          Multi Parametric MRI 12/10/2021 results:
          MPRESSION:
          1. No index lesion identified. Patient's known prostate cancer may not be
          visualized due to small size and/or low-grade. Overall, MRI findings
          compatible with PI RADS 2 abnormality (low likelihood of clinically
          significant prostate cancer).
          2. Prostate volume of 48.0 cc. PSA density of 0.04 ng/mL/mL.
          AS, transpereneal biopsy next fall

          Comment


          • #6
            I would not put any faith in the fall in PSA. It does not change the fact that you have significant Prostate Cancer, no matter how you slice the three different biopsy interpretations. I was diagnosed with G6, 1 of 18 positive cores, entered AS, and over the following year my PSA went down. Tried to talk the urologist out of a repeat biopsy-no dice. Second biopsy, 3 of 14 cores positive for G7(4+3, 4+3, 3+4). It is just sampling error, the more you sample the more accurate a picture you will have of your pathology. Probably nothing wrong with doing AS with your pathology although it does kind of look like doctor shopping to me, not sure how you decide which reading to believe. But repeat biopsy is excellent advice. Maybe a better scan will come along soon but most of them cannot diagnose cancer. First and foremost the issue is tissue.

            Comment


            • #7
              You are just under my longstanding trigger criterion for leaving AS.

              That would be two or more cores having ten percent or more of Gleason 4 pattern.

              i agree with Scratch, another biopsy is in order. Definitely find a provider who uses the Precision Point transperineal device. No sepsis, no infections, and no antibiotics needed.

              Comment


              • #8
                Did you have a second DRE with new urologist? If not, I would have this done first to confirm what first urologist felt. (a bump). If new urologist also feels a bump...yes...i understand going forward with a biopsy in fall. Did you ask your doctor (new urologist) what justifies psa drop?
                YOB: 1953

                Pathology report July28/2020

                Right apex anterior x4 prostatic adenocarcionoma, gleason score 6/10 (3+3), Grade group 1, 2/4 cores involved, 20% &< than 5%
                Left mid lateral : prostatic adenocarcinoma, gleason score 7/10 (3+4), grade group 2. 4% pattern : 15%. Tumor involves 40% core.
                Left mid peripheral zone x4: prostatic adenocarcinoma, gleason score 7/10 (4 + 3), grade group 3. 4% pattern: 85%; cribriform pattern. 2/4 cores involved (fragmented), 75% of overall tissue
                Left apex: prostatic ad enocarcinoma, gleason score 7/10 (4+3), grade group 3, tumor involves 5%
                HIFU treatment, Toronto Canada on Nov.22/2020....Volume prostate prior to HIFU 43cc

                PSA History:


                Aug/2011 2.42, Oct/2012 3.1, Feb/2016 5.1; Apr/2017 6.0; Sep/2018 6.7
                Oct/2019.. 8.5; Nov/2020 10.6 HIFU treatment Nov22/2020 Feb/2021 2.9
                Jul/2021 3.2; Nov/2021 3.0 Next...Feb.23/2022 3.5

                MRI Aug/2021 & Volume 30cc
                Ablation defect on left posterior. Low signal extending from left peripheral zone from base to apex. Left peripheral reduced in size. No discrete high signals present on right/left peripheral. No suspicious lesions.

                Comment


                • #9
                  Thanks for the thoughts. Yeah I am right on the edge of AS. The biopsy was targeted but more samples will be better. I think the more they take the more chances they didn't miss something.

                  He said it was good it wasn't going up. I think we discussed that the one in January was a few month after the infection which could have affected the PSA. He did say that it is good it isn't going up. I haven't had any further DRE's. The new urologist hasn't done one yet. The original urologist said it felt harder on one side than the other. I wasn't really shopping. That urologist left the area. I think they will do a DRE before the new biopsy.

                  as far as the biopsy readings, I guess the Epstein one should be the most reliable. My new doctor stated that Epstein has trained his Doctors. But it is troubling that the two local ones both saw 3+4 in two of the cores and Epstein said it was all 3+3. That is good that the foremost expert saw all 3+3 but worrisome having two other mostly matching 3+4.

                  The fall biopsy is transperineal so less chance of a further infection. I scheduled it for Early September and should hear in a week what the results are. Gottta do it.

                  I guess it is also good that the MRI didn't see anything. Keeping my fingers crossed. Hey no fleet enima for this biopsy. I have that going for me!
                  born 1958
                  PSA History:

                  1/22/10 1.7
                  12/9/11 1.61
                  2/1/14 1.90
                  6/5/15 1.57
                  6/20/16 1.93
                  1/31/18 1.86
                  9/16/19 2.33
                  7/16/21 2.3
                  7/16/21 2.24
                  01/10/2022 2.2
                  07/08/2022 1.7

                  Biopsy 9/2021 slides read by local urology group
                  unfelt small leasion found in 3 sectors
                  I. Gle 3+3 (SUP Grp 1) .5mm involving(1% & PIN)
                  K. a Gle 3+4 (SUP Grp 2)2 mm involving(10%)
                  L. Gle 3+4 (SUP Grp 2)1.5 mm involving(5% patchy)
                  Gle 3+4

                  Decipher score .26 Low Risk

                  Johns Hopkins, Dr. Epstein read of slides 10/14/2021
                  I. Small focus of prostatic adenocarcinoma, Gleason Score 3+3 (group 1), involving less than 5% of one (1) core
                  K. Gle 3+3 (group 1), involving 10% of one (1) core
                  L. , Gle 3+3 (group 1), discont. involving 20% of one (1) core

                  Henry Ford read of slides:
                  I. Gleason score 3+3=6 (Group 1), involving 1% of the length of one core (0.5 mm tumor focus)
                  K.Gleason score 3+4=7 ( Group 2), involving up to 10% of the length of one core (1.5 mm tumor focus); Percentage of Gleason pattern 4 = 5%
                  L. Gleason score 3+4=7 (Group 2), involving
                  10% of the length of one core (2 mm tumor focus); Percentage of Gleason pattern 4 = 5%

                  Multi Parametric MRI 12/10/2021 results:
                  MPRESSION:
                  1. No index lesion identified. Patient's known prostate cancer may not be
                  visualized due to small size and/or low-grade. Overall, MRI findings
                  compatible with PI RADS 2 abnormality (low likelihood of clinically
                  significant prostate cancer).
                  2. Prostate volume of 48.0 cc. PSA density of 0.04 ng/mL/mL.
                  AS, transpereneal biopsy next fall

                  Comment

                  Working...
                  X