PSA 33 but no apparent urgency for diagnosis - PSA33,Scans (CT / MRI / Bone scan),Biopsy

Matron, when I had my ‘bad” news Big C meeting with the consultant urologist, there were two others in the room, I assumed they were the multi-disciplinary team. Wrong, there was a “Mc Millanish” nurse and a.n. other, someone doing a survey. At least I had an audience with a consultant whom I had never set eyes on before.

How can it be that if the guy has a problem, he is not seen by a specialist? I hope it’s for a good reason!

Edited by member 08 Apr 2018 at 17:01  | Reason: Not specified

Yesterday (Monday 9th April 2018) I called my GP surgery and explained to the receptionist that my MRI scan report had been with GP Care (NHS) Ltd since Thursday 5th April and they were now awaiting triage by a Urologist. 

I asked if it would be possible for my GP to enquire about the content of the radiology report. Within hours I received a message from my GP who proposed downloading the results from the database and giving me his non-expert interpretation over the phone. I agreed to this and later in the day he called me and explained that the scan revealed an 'abnormality' on one side of my prostate. I asked if there was any evidence of metastasis and he responded that my bones and lymph nodes appeared to be clear but there was a note concerning a cyst on one of my kidneys. Clearly this will also need further investigation along with the obvious next steps regarding my prostate. 

I also asked if he could tell from the results if my scan had been a multi-parametric MRI. He said he couldn't tell from the data. 

He said he would contact GP Care (NHS) Ltd to get an immediate update and today called me back to say that I have now been referred to North Bristol Trust (Southmead) for an urgent biopsy under anaesthetic and that I would be contacted by Southmead directly for an appointment. I'm assuming that 'under anaesthetic' implies a Template Biopsy using the data from my MRI scan.  

 So it's now 48 days since I visited my GP to ask for a PSA test.  I still haven't seen a Urologist and who knows I may not see one for several weeks yet. At least the order of my treatment has been as I would prefer i.e. MRI scan followed by template biopsy.    

Edited by member 10 Apr 2018 at 20:06  | Reason: Not specified

So good news is if it is cancer it is only on one side and you are getting the biopsy you wanted from the hospital urology team rather than a TRUS in the community. I assume that there will now be no need for GP Care to be involved any further. More waiting for you but at least you know the outcome isn't going to be too bad.

Yesterday 24th April 2018 I attended my appointment at the Bristol Urological Institute. My sister came with me for support and asked some questions and took notes.

The Urologist went through my MRI results with us in some detail and explained that the abnormality on the left anterior side of my prostate is almost certainly a cancerous tumour. It was very close to one of the seminal vesicles and probably the cause of the episodes of haematospermia that I had experienced. (blood in semen)

For the record the Urologist told me that I did indeed have an multiparametricMRI scan.

Because of the position of the abnormality it was judged that a TRUS biopsy targeting that side of the prostate was a better proposition than a template biopsy. We asked about the risk of infection but the Urologist said that this was balanced by the general anaesthetic risks and that a TRUS biopsy could be offered sooner than a template biopsy.

We had some discussion about the treatment options and it seems likely that the options available to me will be external radiation or radical prostatectomy. As the tumour is on one side it may be possible to aim for some nerve sparing on the unaffected side. Timescales appear to be 2 weeks for the biopsy, 2 weeks for the results and possibly 6 weeks for surgery or other treatment.

While there, I was sent for an immediate ultrasonic scan of my kidneys and the results were that there were two aqueous cysts but these were quite common but harmless and no further treatment for them was required.

I was handed over to a specialist consultant nurse who explain some of the details about the next stages. As I was being handed over my sister noted the term T3 being used. We later discovered that this relates to the tumour possibly having broken out of the prostatic capsule. I gave permission to be contacted by telephone regarding progress and results.

So at least I now feel that I'm in the main treatment loop. The general feedback was that the delays I have experienced so far should not impact the outcome as in most cases prostate cancer progresses quite slowly. I wish I felt more confident about that.

Since first seeing my GP for the PSA test I have been experiencing some lower abdominal discomfort and mild back ache particularly in the mornings. After doing some internet research on the function of and potential problems relating to seminal vesicles, it seems that infections in these organs can give rise to similar symptoms.  

Edited by member 25 Apr 2018 at 14:50  | Reason: Not specified

Hi Pjgrinter,

I hope you find the support community on here as helpful as I have. I too was not familiar with all the terminology and am still learning fast. For me I find it helpful to understand every step of the process but others may prefer to leave everything to the professionals.

One good bit of news for your husband is that his treatment seems to have been handled in the right order i.e. MRI scan before biopsy. The thinking behind this is that the MRI scan allows the biopsy to be more targeted as they already know in what area to take the samples.

Please feel free to add to my thread with your experiences or start a new one and I will try to contribute where I can. There are lots of nice people on here who have been a great support to me in these early days. I wish you and your husband all the very best as you join this community that of course none of us really want to be in.  

I am so cross on your behalf - the lesson for other men is not to relocate to the South West :-(

Wednesday 9th May 2018 (74 days after receiving my PSA 33.3 result) I visited my GP. I had originally made the appointment to complain again about the very long delays I have been experiencing and to discuss the possibility of having my prostate cancer diagnosis completed privately.  Since being offered a cancellation on 10th May for a TRUS biopsy, it was agreed to continue with the NHS diagnosis process.

Coincidentally in the post on the same day came a copy of a letter to my GP from The Bristol Urology Institute confirming my diagnosis so far.

Diagnoses:

Likely prostate cancer. PSA 33.3. MRI abnormality in left peripheral zone, PI-RADS 5. Simple cyst on right kidney.

Management:

Ultrasound confirmed the simple kidney cyst needs no further management.

Given that the prostate abnormality is in the peripheral zone it should be easy to target with a transrectal ultrasound-guided biopsy.  

Yesterday 10th May 2018 I had my TRUS biopsy at Bristol Urology Institute (Southmead). Using information from the mpMRI Scan results, 6 samples were taken from the apparently unaffected right lobe of my prostate and 6 samples from the left where the abnormality has been identified.

The procedure went well and apart from some discomfort once the local anaesthetic started to wear off I'm feeling fine with no signs of infection. Just a little blood in my urine and expected passing of blood clots from the rectum. 

I was advised that the results will be available in 2 to 3 weeks.  

I have to say that I have nothing but praise for the way that I have been treated by the doctors and nurses at the Bristol Urology Institute (Southmead). It's just the long delays between the process steps that I find very worrying.  

21st May 2018: I had a consultation with a specialist nurse from the Bristol Urology Institute to discuss the results of my TRUS biopsy.

Biopsy Results: Gleeson score 3 + 4 = 7.  This is about as good a result as I could expect at this stage given the MRI scan findings of an apparently cancerous tumour on the left side of my prostate close to the left seminal vesicle.  The MRI scan report suggested staging as T3b N0 M0.

At the meeting two possible treatment options were discussed both with the aim of a cure: Radical prostatectomy or external beam radiation.  Before prostatectomy could be offered I now need to undergo a complete body bone CAT scan. If this comes back clear then prostatectomy will be an option. If not then only radiation based treatment will be offered. The latter might include hormone treatment and or chemotherapy.

So I'm now waiting for an appointment for a CAT scan.  I feel better knowing my diagnosis and that there is some hope of a cure. I realise of course that any treatment options come with significant side affects that will inevitably impact the quality of my remaining life.