u/Icy_Self634

Age 60, physically fit, PSA had been fluctuating up and down between 4.69 and 9.5 for the past 10 years due to chronic prostatitis, a 52 cc prostate (BPH), and tight pelvic floor. Previous 3TMP-MRI’s were PIRADS-2. Previous Biopsy was negative. On May 8 of this year I had a 3TMRI with a PIRADS 4 (10mm) Anterior (but not apical) lesion and also a PURADS-3 lesion.

The first hurdle I encountered was that the most suspicious lesion of interest in the anterior peripheral zone could not be reached by the most ubiquitous TRUS Biopsy performed everywhere. I got on board with the University of Texas and had a 16 needle MRI fusion trans perennial biopsy under general anesthesia on July 8. The biopsy included 10 systemic cores and the remainder targeted three each at the two MRI identified lesions.

On July 14, I received the path report. Only the PIRADS 4 lesion came back with cancer. All three needles pierced the lesion. Two of three came back with cancer. The longest core was 4 mm: 70% of which was pattern three and 30% was pattern four. Gleason 3+4=7. GG2. I’ve got a follow up appointment with the university of Texas on September 1.

The hardest thing I’ve encountered so far is the relatively lengthy timeline of gaps in between appointments at the university because of my relatively early moderate risk (small volume) biopsy finding. My Army veteran mentality tells me they should have brought me in yesterday, but I am learning that this cancer timeline - at least in my case - is not triggering any urgency. Although, it certainly feels important to me!

We have ordered a decipher test and the university should be receiving the results at any time. I do know they will speak with me about active surveillance, focal treatment, and whole gland treatment. I have learned that my health insurance company’s internal policies categorize all focal therapies as “experimental when used as a primary treatment” and are therefore excluded from coverage.

On my own, I reached out to a physician at MD Anderson conducting a focal cryotherapy trial (for GG2 and select GG3) this past week. I didn’t know what I did not know. The majority of clinical trials at MD Anderson and in the US charge the patient’s insurance as standard of care. I had been under the impression that clinical trials would cover the cost of therapies and treatment. But I was wrong. Lesson learned.

So for me it looks like the decipher score will provide insight into either active surveillance or the pursuit of whole gland treatment. Honestly, I am not comfortable with the rigorous surveillance needed given the pattern 4 presence. For my personality and nervous system I think - at least at this point- I want it eradicated, and not simmering at a low boil inside of me for the next 1 to 4 years on active surveillance.

The diagnosis was almost a relief for me given my wild PSA swings for the past decade. Awaiting the results of each previous blood draw (4x per year)was a nail biting experience. I’m glad to be through that part of it. I had been expecting a cancer diagnosis at some point it just took time for it to show up on the MRI so a fusion Biopsy could target it.