Posted 11/9/2019 3:03 PM (GMT -6)
At a crossroad I think.
Although the doctors I saw suggested I should get treated instead of doing AS I chose to go the AS route to start. I have been doing AS for the past 2 years. I have been able to keep my PSA down from a higher point I had just before the 1st biopsy. (I was careful to change my diet and increased my exercise and have benefited greatly there. ) With my last MRI imaging my doctor has suggested to forego the biopsy and actually start a treatment option. Looking for input and thoughts. (surgery VS. combo brachy/IMRT were the main options I was suggested to choose from when I first started this journey)
My last MRI was as follows:
MRI shows multiple lesions consistent with significant prostate cancer as well as suspicion of extension beyond the prostate. Dr. recommends treatment versus repeat biopsy.
MRI PROSTATE WWO;
CLINICAL INFORMATION: Reason: prostate cancer on active surveillance History: above
TECHNIQUE: Multiplanar, multisequence MRI of the prostate. Pre and post contrast sequences
were obtained following intravenous administration of 17 mL of Dotarem.; Endorectal coil
COMPARISON: MR prostate with and without contrast on 9/4/2018
Prostate Size: 4.3 x 2.8 x 3.1 cm
Peripheral Zone: Heterogeneous intermediate low T2 signal throughout the peripheral zone,
likely sequela of previous prostatitis.
There is a T2 hypointense PI-RADS 3 lesion in the left apex that measures 0.6 x 0.4 cm
without corresponding low ADC signal, possibly corresponding to the previously seen
PI-RADS 4 lesion. On today's examination, this lesion appears as mild capsular thickening
and may be external to the prostate gland (image 15, series 501).
There is a PI-RADS 5 lesion in the right mid gland with extension to the base measuring
2.3 x 1.1 x 0.5 cm. There is broad interface with the capsule as well as focal capsular
discontinuity with ill-defined T2 hypointense signal extending beyond the capsule that is
suspicious for extracapsular extension, particularly at the level of the neurovascular
bundle (image 11, series 701).
There is a PI-RADS 4 lesion at the midline apex of the gland that measures 0.6 x 0.7 cm
and demonstrates low T2 and ADC signal with associated hypervascularity.
Central Gland: BPH with circumscribed nodules.
Seminal Vesicles: Mildly fluid distended
Extracapsular Extension: Possible extracapsular extension associated with a right-sided
mid gland lesion that extends to the base.
BLADDER: No significant abnormality noted.
LYMPH NODES: No significant abnormality noted.
BONES, SOFT TISSUES: Degenerative changes involving the bilateral hips.
OTHER: No significant abnormality noted.
IMPRESSION: Multiple lesions in the bilateral peripheral zones with a PI-RADS 5 lesion
noted in the right midgland with extension to the base. This lesion demonstrates features
suspicious for extracapsular extension. See above for additional details.