Gedman's MRI/questions

I’m not a radiologist.  Sorry, that should have already been obvious, but I wrote that so as to minimize the goofy side comments which may have otherwise followed...   T2 is a reference to the MRI imaging, and has absolutely nothing to do with your PC staging.   T2 in MRI imaging is a reference to the orbital alignment of atoms relative to the magnetic field. The diffuse low T2 signal throughout the peripheral zone (which is usually produces a higher signal relative to the other zones) is a typical characterization for PC.   With normal aging the transition zone of the prostate generally increases and compresses the peripheral zone. Extra Capsular Extensions are seen as a focal irregular bulge, asymmetry, or invasion of the nerve bundles.     See this paper by Dr Peter Carroll:   LINK

I was wanting to follow up on how you are doing after the operation.

I just had an MRI after I was doing watchful waiting for over 5 years where my PSA was stable from the time of diagnosis at 4.8. I have been doing the bloodwork every six months and apart from the time the PSA spiked a bit after two biopsies, it stayed at 4.8. However when I did the 3T MRI, I was surprised to find out that I was staged at PI-RADS V2: 5 with a mild capsular bulging in the left postrolateral peripheral zone. I feel that I need to take treatment as this now raises concern for extracapsular invasion. The seminal vesicles, neurovascular bundles, bladder neck, membrane uretha, lymph nodes and bone marrow all appear normal.

My concern is that with the possibility of extracapsular invasion, what would the success rates of a surgery be. I also surprised that the concern seems to have grown without any any increase in my psa so if there is disease after the surgery, would it show up if my cancer is not exhibiting itself with an increasing psa.

Thanks Allen.

My gleason score when they found the cancer was 3+0 = graded as Gleason 6 at the right side. It was 1/12 and only 5% in that core. With the second biopsy they found no cores positive only one graded as suspicious, yet they seem to have found substantial decreased T2 intensity measuring 2.5x 2x 2 on the left side

I was diagnosed with cancer at age 47 and now I'm 52. My psa has stayed pretty much constant - 4.7 at the time of diagnosis and now 4.8.

The word mild bulging seems to indicate that it may have a more rounded contour - no?

I am wondering if I should a have biopsy done prior to planning surgery or whether I should take a second opinion/second MRI.

Thanks Allen. My latest psa that was done last week has dropped to 4.4 from 4.8. I am scheduled for an appointment with my URO later this month and will ask about doing a biopsy at the area identified by the MRI. Is it easy to do a biopsy at the "mild bulging". I see that your psa is now 0.1, is that normal after surgery or did you end up with SBRT? Thanks.