Help with next steps? (2024)

InspireAI

Aug 30, 2024 • 11:44 PM

Hello bt856,

I understand that you're seeking guidance on your next steps regarding your prostate health. It's important to consult with a healthcare professional who specializes in prostate cancer to discuss your specific case and determine the best course of action.

Based on the information you provided, it seems like you have been monitoring your prostate health closely with regular PSA tests and an MRI. A PSA level of 5.2 and Prostate-specific Ag of 6.9, along with the presence of a PI-RADS 4 lesion, indicate the need for further evaluation.

The 4K blood test you mentioned is a newer test that combines four different prostate-specific biomarkers to provide a more accurate assessment of prostate cancer risk. It may be worth discussing this test with your doctor to see if it is appropriate for your situation.

As for doctor recommendations, I'm unable to provide specific names. However, I encourage you to seek out a urologist or an oncologist who specializes in prostate cancer. They will have the expertise to guide you through the next steps, including further diagnostic tests or a biopsy if necessary.

Regarding the choice between seeking treatment in the US or overseas, it's important to consider factors such as the availability of specialized medical facilities, the expertise of healthcare professionals, and insurance coverage. Your doctor can provide guidance on this matter based on your specific needs and circumstances.

Remember, it's crucial to consult with a healthcare professional who can evaluate your individual case and provide personalized recommendations. They will be able to guide you through the next steps and help you make informed decisions about your prostate health.

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Stuart_Jordan

Aug 31, 2024 • 1:59 AM

With your PIRADS 4 from the MRI, has there been discussion about a biopsy. A couple of questions. How old are you? Is there any prostate cancer in your family? Where are you located? If possible I would get to a center of excellence for a consultation and most likely a targeted biopsy. If you are trying to avoid the biopsy, instead of 4K, I would try to take one of the liquid biopsy tests which might give you an indication.

I’m not sure why you would choose not to be treated in the US unless you have a unique circumstance.

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Yes with the mri results it seems the biopsy would be the next steps. I’m 66 years old and live in New Jersey. When you say targeted biopsy are you referring to the mri guided biopsy? The reason I asked about US vs international is it seems they have a lot of experience over seas treating the prostate from my research.

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Stuart_Jordan

Aug 31, 2024 • 11:58 AM

Fusion biopsy where they overlay the MRI on a live ultrasound to target the lesion as opposed to a random biopsy. Though most doctors will do both, target plus random. Also, get a transperineal biopsy as opposed to trans recital.

I assume you are on Medicare which is good as most everything should be covered.

Before looking overseas, I would start in NYC where you have multiple centers of excellence with strong prostate programs. NYU Langone, MSK, Weill Cornell, Mt Sinai are all top notch.

Get your biopsy and find out what you are dealing with. Once you know your Gleason score, you can address treat vs surveillance and what type of treatments would make sense.

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RodneyKahn

Aug 31, 2024 • 5:05 PM

In reply to bt856's comment

depends how much Gleason pattern 4 they find.

you have 1 lesion. PSA 5.

decide between focal therapies and definitive. focal can work for limited contained disease. but the more pattern 4 they find, the greater chance for recurrence. focal therapies might be more advanced in Europe vs USA.

active surveillance is possible up to limited pattern 4. in some cases, it may never progress. but you're always looking over your shoulder. if you can stand that stress, u might avoid urinary side effects for many years, before having to treat. If you make it to 80, almost no need to treat.

i presume u have limited bph symptoms.

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vintage42

Aug 31, 2024 • 9:01 PM

"... If you make it to 80, almost no need to treat."

If the Gleason score from a biopsy should come in at a 4+3, then I think doing something is beneficial at 80, if only ADT. At 78, I skipped ADT after my radiation, which allowed the cancer to spread.

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dakota2012

Sep 1, 2024 • 8:37 PM

A biopsy is the next step to get that Gleason score. No need to go outside the US. Europe, Canada, Australia, the treatment options are the same. Once you get the GS have a consult with a urologist/surgeon, an Oncologist,and a radiation oncologist, you have 9 treatment options depending on that GS. SBRT 2017

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Man0

Sep 2, 2024 • 2:46 AM

One question: you state prostate size as "5.5 x 5 x 5.4 cm", but obviously since the prostate isn't cube-shaped one cannot just multiply to compute a volume. Did any of your tests assign a prostate volume (even approximate)? For example, for me prior to RP my urologist had ordered an ultrasound to estimate my prostate size beforehand, and that produced a value that was almost identical to the size that was later removed, so apparently an ultrasound is capable of being fairly reliable (at least it was for me).

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Stuart_Jordan

Sep 2, 2024 • 3:00 AM

In reply to Man0's comment

MRI should have estimated the size.

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NtheWeeHours

Sep 3, 2024 • 3:35 PM

BT,

I agree with my fellows here. I had an MRI followed by biopsy. The confirmation of the presence of PCa set me on my road. I have to admit that there was fear involved. Fear of what a biopsy was and what it would reveal. But in my case it was good to know that for sure there was PCa, what the numbers were and what my options were. My urologist and I decided on Active Surveillance. And we watched it for 5 years as we watched my PSA rise.

There were no other biopsies until I decided on a second opinion. That brought another biopsy that showed the PCa had advanced to a higher risk category.

The trick it to face the tests head on and get to know what you are really dealing with. Do your research early and stay up to date with the latest technology. And be prepared to advocate for what you want. I trust and appreciate all my physicians but each of them new that what they did would be THE answer to my disease. It wasn't. 8 doctors later I made a decision that I wish I had made years earlier.

But get tested and know what you are dealing with. There is no substitute to having YOUR actual tissue tested and the results read by a highly competent professional, even getting a second opinion (and not being afraid to ask for a second opinion... it is YOUR body here, and your Quality of Life).

And come back here often for guidance and support. I lurk here all the time, but it was the experience of brothers here on Aspire that gave me the information and courage to advocate for myself. And I can't stress that enough!

Welcome to the road none of us wanted to travel. Please continue to reach out.

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Help with next steps? (2024)
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