Prostate Cancer-PIRADS 4

[Gabe H Coud]

My latest MRI scan of prostate shows that I'm now PIRADS 4.
Doc now wants to do MRI Fusion TRUS biopsy(last done 18 months ago) but I've asked the question is that genuinely necessary now? Or have I reached the stage where I need radiation treatment or surgical removal? (await his response. I'm an old cynic. I'm wondering if it's just another good pay day at 125, 000 baht?! If its really necessary then fair enough. I'm not insured!) 

So I was looking to compare notes with people about what happens from here now? How immediately pressing is PIRADS 4? I know it means that "clinically significant cancer is likely to be present" 
But at what PIRADS stage do they normally take it out(or commence other treatment) ? 

 

I also wanted to compare notes about the latest views on Hospitals/ Doctors 

and of course prices for prostate removal (or radiation treatment) 

I live in Hua Hin so naturally I'm thinking Bkk

In that regard I list below names of Doctors I collected from when I posted about 2 years ago (on a thread that I simply just cannot find despite searching for it this morning) 

 

Dr Sittiporn Srinualnad - Siriraj Private and Bumrungrad 
Dr Viroj Chodchoy at Bumrungrad
Dr Charuspong Dissaranan at Bumrungrad
Dr Danaiphand Bumrungrad 
Dr Sarayuth Viriyasiripong Bumrungrad
Dr Thanoo Choovichian at Samitivej (no longer does surgery) 
Dr Niti in Pattaya (Bangkok Hospital) 
Chula Cancer Centre?
Try BHN Bangkok Nursing Home 

 

 

thanks in advance

[Longwood50]

I am certainly not in a position to give you specific advise on your condition however Prostate Cancer is extremely slow growing.

Typically in the USA after 65 they do nothing unless there is clear evidence that the cancer has reached the point where it is likely to spread outside of the prostate. 

My doctor many years ago told me that even young men coming back from Vietnam during autopsies were found to have the very beginnings of prostate cancer.  He said for the vast majority of people they will die with the cancer, not from the cancer.

He also said that modern medicine had created a dilema.  It had allowed physicians to see conditions very early but that presents the dilema.  What do you then do.  The vast majority of time treatment is worse than the disease.  The removal of the prostate, or radiation has significant side effects.  He stated in most instances vigilant monitoring was the best course for you were far more likely to die from other causes than the prostate cancer.  

[BritManToo]

I'd worry more about the competence of the Thai doctor and their diagnoses.

My advice would be to go back to a western country,and get a real doctor to do the work.

I've encountered 3 total doctor failures in Thailand in the past 10 years.

1. 8 years back my gall bladder needed to be removed or I'd die, it wasn't and I'm fine.

2. 6 years back my 5yo son needed an emergency appendectomy or he'd die, it was constipation.

3. 4 years back I needed prostate surgery, I didn't and it was actually a UTI.

 

No faith in the competence of Thai doctors.

If I'd had insurance that paid for everything, I'd at best now be missing some body parts, and at worst they would have killed me.

[Gabe H Coud]

Just now, BritManToo said:

I'd worry more about the competence of the Thai doctor and their diagnoses.

My advice would be to go back to a western country,and get a real doctor to do the work.

I've encountered 3 total doctor failures in Thailand in the past 10 years.

1. 8 years back my gall bladder needed to be removed or I'd die, it wasn't and I'm fine.

2. 6 years back my 5yo son needed an emergency appendectomy or he'd die, it was constipation.

3. 4 years back in needed prostate surgery, I didn't and it was actually a UTI.

 

No faith in the competence of Thai doctors.

Crikey, scary stuff! Thanks for feedback

 

Going back to UK is not a good option at the moment though surely? NHS is on the brink of collapse I'm reading. Would I get treated/operated on if necessary? 

 

So where else could I go for it? 

 

Any recommendations anyone? 

 

 

[Gabe H Coud]

7 minutes ago, Longwood50 said:

I am certainly not in a position to give you specific advise on your condition however Prostate Cancer is extremely slow growing.

Typically in the USA after 65 they do nothing unless there is clear evidence that the cancer has reached the point where it is likely to spread outside of the prostate. 

My doctor many years ago told me that even young men coming back from Vietnam during autopsies were found to have the very beginnings of prostate cancer.  He said for the vast majority of people they will die with the cancer, not from the cancer.

He also said that modern medicine had created a dilema.  It had allowed physicians to see conditions very early but that presents the dilema.  What do you then do.  The vast majority of time treatment is worse than the disease.  The removal of the prostate, or radiation has significant side effects.  He stated in most instances vigilant monitoring was the best course for you were far more likely to die from other causes than the prostate cancer.  

Completely agree! You make an excellent point

 

But I need to establish at what point am I 'red-lining'?! 

 

But like you suggest I'll need convincing that it actually needs removing/radiation etc. 

 

 

[BritManToo]

7 minutes ago, Gabe H Coud said:

Going back to UK is not a good option at the moment though surely? NHS is on the brink of collapse I'm reading. Would I get treated/operated on if necessary? 

@Simon43 has a thread about returning to the UK with suspected prostate cancer.

His insurance company cancelled his policy when he tried to claim.

So far he's encountered no problems with getting NHS treatment.

He's currently staying in a Blackpool B&B at 18 pounds a night.

 

You didn't state your age, it makes a big difference.

At 50 it may be worth treating, at 70+ probably not.

And also your sex life, even a biopsy can stop you having an erection for the rest of your life. Obviously if you don't care any more about sex that won't matter.

[Gabe H Coud]

2 minutes ago, BritManToo said:

@Simon43 has a thread about returning to the UK with suspected prostate cancer.

His insurance company cancelled his policy when he tried to claim.

So far he's encountered no problems with getting NHS treatment.

He's currently staying in a Blackpool B&B at 18 pounds a night.

Sorry for being thick how do I find that thread? Thanks 

 

 

[BritManToo]

 

4 minutes ago, Gabe H Coud said:

Sorry for being thick how do I find that thread? Thanks 

 

 

There you go .................

 

[ezzra]

Echoing Britmantoo, i would seriously consider going back to your country of origin or to any other country that has advanced knowledge and treatment in finding solutions for your predicament and see what the best treatment i can get there.. with all due respect for Thai medical profession i wouldn't put my life in their hand if i has other options...

[bkk6060]

No one knows if it is going to spread beyond the Prostate as it did with my father.  I would invest in a biopsy to get a better indication. 

Good luck.  Most of us older men will likely get it hope you get proper diagnosis and treatment. 

[Longwood50]

7 minutes ago, Gabe H Coud said:

But like you suggest I'll need convincing that it actually needs removing/radiation etc. 

I know this, I am 74.  If I was diagnosed with prostate cancer, I would have to have some really strong evidence that it was imperative that I do something about it.  Typically it is very slow growing.

 

However prostate removal leads to incontinence, and impotence.  Though better outcomes today than years ago, it is still a real possibility.  The radioactive seeds are less invasive however once implanted if they don't work, they preclude the option to remove the prostate at a later date because of the radioactivity.  

Typically in the USA they do nothing but vigilant watching to see if the cancer is progressing.  My GF has a cyst on her liver.  They say most of those are there from birth.  Though Thai doctor wants to send her for MRI, Mayo Clinic the top hospital in the USA says in the majority of instances the cysts are not malignant and also slow growing and reccomends only to have additional ultra sounds to see if the cyst remains the same size or grows. 

 

[Longwood50]

17 minutes ago, Gabe H Coud said:

NHS is on the brink of collapse I'm reading. Would I get treated/operated on if necessary? 

On the brink of collapse?  Oh in the USA they are showing those government health programs with "healthcare for all" as the panacea.

As Margaret Thatcher once said.  The trouble with socialism is that eventually you run out of OTHER PEOPLES MONEY. 

[BritManToo]

13 minutes ago, Longwood50 said:

My GF has a cyst on her liver.  They say most of those are there from birth. 

Not if she's Thai!

 

Liver cysts are commonly caused by dead liver flukes from eating uncooked fresh water fish/snails/crabs. Eventually they will become cancerous.

[Gabe H Coud]

22 minutes ago, BritManToo said:

@Simon43 has a thread about returning to the UK with suspected prostate cancer.

His insurance company cancelled his policy when he tried to claim.

So far he's encountered no problems with getting NHS treatment.

He's currently staying in a Blackpool B&B at 18 pounds a night.

 

You didn't state your age, it makes a big difference.

At 50 it may be worth treating, at 70+ probably not.

And also your sex life, even a biopsy can stop you having an erection for the rest of your life. Obviously if you don't care any more about sex that won't matter.

Sixty 

 

Becoming impotent and/or incontinent scares the living **** out of me! 

[simon43]

Concerning the NHS being on the brink of collapse, there is a huge difference between different departments, surgeries etc.  In the case of cancer diagnosis and treatment, there are target times of 2 weeks from GP referral to hospital consultation, and then 4 weeks target time from that consultation to start of treatment or diagnostic procedures such as biopsy.  Most NHS hospitals achieve those targets with about a 98% level.

 

Now if you need a hip replacement, you might have to wait years..... but not for cancer.

[simon43]

5 minutes ago, Gabe H Coud said:

Sixty 

 

Becoming impotent and/or incontinent scares the living **** out of me! 

The risk of being impotent and/or incontinent depends on if the surgery can spare the nerves outside your prostate.  If the tumours are wholly within your prostate, then any ED or urinary incontinence should be temporary, but I guess it will also depend on your own health, whether overweight etc.

[simon43]

I'm no doctor but I think an important point would be how fast your PSA value is increasing.  My PSA was around 5 for maybe 7 years or so (slightly raised due to BPH), but I only visited the hospital when it jumped to 11.5 after I had no PSA tests for 2 years (stuck in Laos due to Covid).  My MRI scan at Bumrungrad showed a Pirads level 5, but still wholly contained within my prostate.  But time for further investigation and treatment,

[Longwood50]

37 minutes ago, BritManToo said:

Liver cysts are commonly caused by dead liver flukes from eating uncooked fresh water fish/snails/crabs. Eventually they will become cancerous.

She is Thai however she has has and continues to eat only salt water sea food and never uncooked. 

[simple1]

OP I had a PSA test in Thailand which claimed to show no presence of PSA. A few months later I had returned to Australia and out of curiosity had another PSA test - I had no symptoms. Cut a long story short I was diagnosed with advanced aggressive prostate cancer. Given the result of your Pirads test I would not hesitate to follow up with a reputable oncologist. It is claimed surgery is the 'golden' treatment. Regards the possibility of impotent and/or incontinency, would you prefer death from prostate cancer? From my story I suffered from inability to pass urine after surgery which was very stressful, but resolved after four months, but I am impotent - personally I prefer my current status to death - each to their own.

[Will B Good]

Went through the exact same thing at Bumrungrad...Level 4 cancer as it was put to me.......had the biopsy and it was found to a benign lesion......if you believe the MRI results I would go for the biopsy before launching into treatments for cancer......!

[Tedkhon]

Sorry a bit unclear but do you have prostate cancer?

 

In the original post it mentions a biopsy done 18 months ago , did that find cancerous cells or none?

 

As I understand it the only time to say its prostate cancer is when a prostate biopsy finds cancerous cells.

 

If thats a mistaken understanding I look forward to the correct information being posted.

[simon43]

18 minutes ago, Will B Good said:

Went through the exact same thing at Bumrungrad...Level 4 cancer as it was put to me.......had the biopsy and it was found to a benign lesion......if you believe the MRI results I would go for the biopsy before launching into treatments for cancer......!

I think doctors will not start cancer treatment unless they know that the growth is cancerous, and that needs a biopsy.  I'm currently awaiting a biopsy in the UK, following my MRI at Bumrungrad which shows 2 small growths at Pirads 5 level.

[carlyai]

1 hour ago, BritManToo said:

Not if she's Thai!

 

Liver cysts are commonly caused by dead liver flukes from eating uncooked fresh water fish/snails/crabs. Eventually they will become cancerous.

Scans before my last back operation picked up a tumor on my kidney. Kidney dr said most of these are bad news so robotic surgery to remove it before my back surgery.

Wondering if liver tumors/systs/polyps are better removed.

How do the drs tell from a scan if its a syst?

[mokwit]

4 minutes ago, carlyai said:

Wondering if liver tumors/systs/polyps are better removed.

How do the drs tell from a scan if its a syst?

Don't know how, but after an MRI scan I was found to have fluid filled cysts on my liver, whereas with CT scan could not eliminate tumours as a possibility. Water filled cysts maybe nothing to worry about as about 10% of the population over 50 have these - blood filled cysts could be a problem - MRI scan seemingly does not differentiate. Need MRI scan for liver - CT scan doesn't image liver well.

[Sheryl]

1 hour ago, Longwood50 said:

I am certainly not in a position to give you specific advise on your condition however Prostate Cancer is extremely slow growing.

Typically in the USA after 65 they do nothing unless there is clear evidence that the cancer has reached the point where it is likely to spread outside of the prostate. 

My doctor many years ago told me that even young men coming back from Vietnam during autopsies were found to have the very beginnings of prostate cancer.  He said for the vast majority of people they will die with the cancer, not from the cancer.

He also said that modern medicine had created a dilema.  It had allowed physicians to see conditions very early but that presents the dilema.  What do you then do.  The vast majority of time treatment is worse than the disease.  The removal of the prostate, or radiation has significant side effects.  He stated in most instances vigilant monitoring was the best course for you were far more likely to die from other causes than the prostate cancer.  

This is an oversimplification.

 

Prostate cancers can be either slow growing or aggressive. A biopsy can determine which it is.

 

Aggressive prostate cancers not only can kill but do so on a large scale. It is the 5th leading cause of cancer death in men. In other words men die both with and from prostate cancer and it all depends on the type.

 

In the case of a slow growing prostate cancer, and especially in an olde rpatient, conservative approach (active surveillance or what you call "Vigilant moniotoring"). ) can make sense.

 

In the case of an aggressive prostate cancer, immediate treatment is needed. Even in a very old man - death from prostate cancer is not easy to say the least.

 

No reputable physician - including I am sure the one you quote ( your hearing may have been a tad selective, or he may have been speaking specific to your situation) would recommend against treating an aggressive prostate cancer.

 

OP - biopsy is indeed the normal next step in PIRADS 4 but I am confused by the inference that you already had a biopsy 18 months ago. What did that biopsy show? And what are your PSA results over the past 2-3 years?

[Longwood50]

2 minutes ago, Sheryl said:

Prostate cancers can be either slow growing or aggressive. A biopsy can determine which it is.

That is the first I have ever heard of that. I know a number of years ago I had a spike in my PSA which was normally very low even now at 74 it is 2.5.  

The same doctor I referenced did send me in for a needle biopsy which proved to be negative.   Though uncomfortable and led to bleeding for an extended number of weeks, it was worth the reassurance and my PSA did drop back. 

What you suggested is good advise.  Get the biopsy and know what you are dealing with. 

 

[Sheryl]

1 hour ago, carlyai said:

Scans before my last back operation picked up a tumor on my kidney. Kidney dr said most of these are bad news so robotic surgery to remove it before my back surgery.

Wondering if liver tumors/systs/polyps are better removed.

How do the drs tell from a scan if its a syst?

Cysts have a very clear appearance on both ultrasound and scans.  So do liver abscesses and parasitic cysts.

 

Most liver and kidney cysts do not need treatment,. Parasitic cysts would. Solid masses on the liver may need to be biopsied unless it is clear they are a hemangioma, which is a very common and usually foes not need treatment.

[carlyai]

52 minutes ago, Sheryl said:

Cysts have a very clear appearance on both ultrasound and scans.  So do liver abscesses and parasitic cysts.

 

Most liver and kidney cysts do not need treatment,. Parasitic cysts would. Solid masses on the liver may need to be biopsied unless it is clear they are a hemangioma, which is a very common and benign finding.

 

 

 

Liver and kidney

Well with kidney my surgeon disagreed. Any tumor on the kdney needs to be removed as most are bad. That's what he said. No biopsy, just removal. 

He said can have a biopsy but better gone.

[Gabe H Coud]

1 hour ago, Tedkhon said:

Sorry a bit unclear but do you have prostate cancer?

 

In the original post it mentions a biopsy done 18 months ago , did that find cancerous cells or none?

 

As I understand it the only time to say its prostate cancer is when a prostate biopsy finds cancerous cells.

 

If thats a mistaken understanding I look forward to the correct information being posted.

My bad. Yes diagnosed prostate cancer 2016(Gleason 3+3)

 

Had several MRIs and at least 2 biopsies under the active surveillance programme

 

 

 

[Upnotover]

3 hours ago, Gabe H Coud said:

I simply just cannot find despite searching for it this morning

Was it this one? (if you still need it).