Been a while since I have posted here, but have been an avid follower since 2013 When I was first DX with PCa with 3+3 Gleason score involving 10% of one core in a 12 core biopsy, and decided on AS.
Had a follow-up biopsy a year later, 2014, and nothing found, but unfortunately I got an infection from that biopsy, which wasn't fun. Actually, I was pre-septic, because they didn't realize the e-coli infection was from a ciprofloxacin resistant strain, and they kept me on the fluoroquinolones for a month before they discovered it through a urine culture.
Finally got me on the correct antibiotic, but whenever I stopped, the infection came back, though it was less severe than the initial infection, but ended up on suppression therapy with low dose Bactrim. It is possible the infection that was in the prostate is burned out by now, but I am still on low dose Bactrim.
Because of that experience I have been monitoring my situation through Prostate mpMRIs since, and the last MRI results came back with the following suspicious findings:
1. Focal findings suspicious for neoplasia identified in the left anterior fibromuscular stroma midgland, with an overall level of suspicion of 4/5 by Pi-RADSv2. Compared to the prior exam, this lesion is new. Of note, specificity is limited by lack of intravenous contrast, as the imaging findings of normal anterior fibromuscular stroma and prostate cancer overlap. (Note this MRI was done with contrast, and even though I have reduced kidney function from long standing hypertension, I should have had the contrast).
2. Capsular margin grossly intact - no suspicion for involvement.
location: Left anterior transition and fibromusular stroma midgland
Capsular involvement mildly bulges the capsule anteriorly
T2 signal: round markedly hypointense signal with blurred margins, 4/5 suspicion.
Diffusion-weighted imaging: focal markedly hyperintense high B-value DWI and markedly hypointense ADC,
766 square microns/second, 5/5 suspicion
Suspicion for extracapsular extension: 3
Suspicion for neurovascular bundle involvement: none
Suspicion for seminal vesicle invasion: none
Overall level of suspicion: 4/5
Here is my dilemma, and would appreciate any thoughts or insights
I am scheduled for a directed mpMRI biopsy at UCLA next month, but I am very concerned about
the previous infection that I received from my last biopsy in 2014, and am wondering if I should see if they would just go right to the treatment phase, and explore the options, rather than going through another biopsy, and risk another pre-septic/septic prostate infection, especially in light of the mpMRI piRad of 4.
I also have been dealing with occular inflammation for about
a year, which was managed by steroid drops, but whenever I tapered off, the inflammation in the eye came back, so they have put me on oral prednisone, 30 mg 3 weeks, 20 mg 3 weeks, 15 mg until I see eye doctor in 2 months, and I worry about
having the biopsy while I am on oral prednisone.
The frustrating thing is I have tried to contact UCLA to talk to someone about
my biopsy concerns with previous biopsy infection, and antibiotic resistance, and use of prednisone through phone calls, and emails for the last two weeks, but no one is getting back to me. Locally I am not getting any solid answers.
On Monday I will be having a phone consult with Dr. Mark Scholz, and hope he can provide some clarity to my situations.
Sorry be so long winded, but wanted to give a full picture of my situation.
My basic question is would I be able to go right to the treatment phase instead of going through another biopsy and risk another infection based on the 2013 biopsy results?
Any insights are greatly appreciated.
Also, I don't think I am a candidate for brachytherapy because my prostate is 68 cc, and don't they usually want it 50cc or less?
Post Edited (johncl) : 6/22/2018 11:09:35 AM (GMT-6)