Prostate Cancer-PIRADS 4

[Gabe H Coud]

2 hours 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......!

See above, sorry my bad i definitely ahve Prostate Cancer

 

The biopsy will probably reveal more but the last one concluded i was PIRADS 3

 

So after the MRI a few days ago he said i was PIRADS 4, i thought well now we know that is there any point in the biopsy? Hence asking others of their experiences

 

there probably is(a reason) so im awaiting his(Urologist) reply 

 

 

[Gabe H Coud]

2 hours ago, simple1 said:

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.

Very sorry to hear that Sir

 

Of course, its the lesser of two evils, but its still an evil all the same, well it is at this stage of my condition.

 

Please understand ive had low grase PC for 6.5 years so in that time i do worry about the side effects of the treatemnt/ surgery as my condition was not regarded as dangerous

 

But its now moving that way 

 

Its sounds like you never had the time to even worry about that 

 

I assume you had a Prostatectomy. Open or robot?

 

[Gabe H Coud]

11 minutes ago, Upnotover said:

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

 

 

Yes! youre a star!

[Sheryl]

8 hours ago, carlyai said:

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.

A tumor and a cyst are 2 different things entirely 

 

Kidney cysts are extremely common -- about half the population will have one at some point --  and usually require no treatment .

 

https://www.mayoclinic.org/diseases-conditions/kidney-cysts/diagnosis-treatment/drc-20374138

 

Kidney tumors on the other hand are cancerous about 80-85% of the time.

[Sheryl]

18 minutes ago, Gabe H Coud said:

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

 

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

 

 

 

Is the tumor now appearing larger? What have your PSA levels done?

 

There must be a reason why your urologist recommends repeat biopsy.

[carlyai]

3 minutes ago, Sheryl said:

A tumor and a cyst are 2 different things entirely 

 

Kidney cysts are extremely common -- about half the population willhave one at some point --  and usually require no treatment .

 

https://www.mayoclinic.org/diseases-conditions/kidney-cysts/diagnosis-treatment/drc-20374138

 

Kidney tumors on the other hand are canceroys about 80-85% of the time.

So from a scan the dr can tell (not think) if it's a syst or tumor?

 

[simple1]

23 minutes ago, Gabe H Coud said:

Very sorry to hear that Sir

 

Of course, its the lesser of two evils, but its still an evil all the same, well it is at this stage of my condition.

 

Please understand ive had low grase PC for 6.5 years so in that time i do worry about the side effects of the treatemnt/ surgery as my condition was not regarded as dangerous

 

But its now moving that way 

 

Its sounds like you never had the time to even worry about that 

 

I assume you had a Prostatectomy. Open or robot?

 

Here in Australia prostate cancer in the number three cancer cause for death in men, At time of diagnosis I had Gleason Score of 4+5. During the decision making process I was provided a booklet which talked to stats on treatment outcomes, stages of prostate cancer etc.  You can download similar info from prostate cancer orgs in UK, USA and so on. I decided to have non robotic prostatectomy surgery  Robotic surgery not available from public medicare. The decision to proceed to surgery was made as Urologist informed me he had a number of patients who had declined surgery due to possible impotence which they later regretted as they faced the consequences.

 

Wishing you the best...

Edited February 12, 2023 by simple1

[Gabe H Coud]

40 minutes ago, Sheryl said:

Is the tumor now appearing larger? What have your PSA levels done?

 

There must be a reason why your urologist recommends repeat biopsy.

PSAs slowly increasing now 11.2

 

Im overdue timewise apparently. Should be annually(now he tells me, didnt state that at last biopsy!)

 

For various reasons it will end up being 20 months so he recently told me repeat biopsy asap

 

the MRI scan showed adenocarcinoma same size but "abnormalities" increased from PIRADS 3 to 4

 

im definitely not against another biopsy i was just wondering how necessary it was IF treatment/surgery is now required. 

 

Just wondered if others had got treatement/surgery when entering PIRADS 4 ie at what stage do they take action ?

 

But im probably jumping the gun and will probably require another biopsy for more detailed analysis of growth and gleason score

 

Sheryl, is the gleason score the be all and end all and ultimate point of the biopsy? Thanks

 

Edited February 12, 2023 by Gabe H Coud

[carlyai]

2 minutes ago, simple1 said:

Here in Australia prostate cancer in the number three cancer cause for death in men, During the decision making process I was provided a booklet which talked to stats on treatment outcomes, stages of prostate cancer etc.  You can download similar info from prostate cancer orgs in UK, USA and so on. I decided to have non robotic prostatectomy surgery  Robotic surgery not available from public medicare. The decision to proceed to surgery was made as Urologist informed me he had a number of patients who had declined surgery due to possible impotence which within three years they regretted as they faced the consequences.

 

Wishing you the best...

Robotic surgery in Aus is available for public patients as with private patients. 

For some reason Robotic surgery is not on the free list and public and private pay the same for the robotic surgery. 

In St Vincent's hospital Sydney the robotic surgery theatre is in the public hospital. So if you're a private patient they wheel you through the labarinth to the public operating theatre.

[simple1]

4 minutes ago, carlyai said:

Robotic surgery in Aus is available for public patients as with private patients. 

For some reason Robotic surgery is not on the free list and public and private pay the same for the robotic surgery. 

In St Vincent's hospital Sydney the robotic surgery theatre is in the public hospital. So if you're a private patient they wheel you through the labarinth to the public operating theatre.

OK. I had the surgery seven years ago, don't recall being told robotic surgery was available as a public patient, only as a private patient. I do recall, even with insurance, gap fee for robotic surgery was AUD20,000. 

[scubascuba3]

3 hours ago, Longwood50 said:

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

She has never eaten Som Tam, the one with crabs in?

[scubascuba3]

3 hours ago, simon43 said:

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,

Maybe worth getting insurance before going down the PSA test road

[Longwood50]

12 minutes ago, scubascuba3 said:

She has never eaten Som Tam, the one with crabs in?

I will ask her

[Hugh Jarse]

4 hours ago, Gabe H Coud said:

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? 

 

Go to Singapore competent doctors and we’ll equipped, though expensive I fear. Forget the Uk nothing works and the health service is on its face.Good luck.

 

[internationalism]

that another 125k on biopsy (on top of the previous 2 for 250k), I would spend rather on any offered treatment.

I would think an operation at the governmental hospital will be less than 125k.

Check for cancer governmental hospitals in bangkok, but shorter waiting lines might be in neighbouring provinces. Some posters mentioned one in chonburi.

Also large governmental hospitals would have oncology department. Siriraj has one.

Looks. like you don't trust your doctor (he failed to inform you about yearly check ups), so look for a new one. Second/third opinion is also valuable - you already have your medical record ready.

I would do all posiible cancer markers plus fecal occult blood to exclude spread. All of them just over 1k bht. For prostate there is f-PSA, also CA19-9, B-HCG.

 

Before radio or chemio, I would go for non invasive and no side effects hormonal therapy. You get pills or injection. They stop testosteron production. Not sure how popular in Thailand, but my brother got it on NHS as the first treatment, injection in abdomen.

My friend self medicates with estrofem 2mg, in thailand OTC and cheap.

Read about ketokonazole 

http://www.thethaicancer.com/Webdocument/Onco_drug/Oncodrug_Letter/Oncodrug_Letter_K.html

It's on an official cancer list medicines in thailand, for hormonal cancers. Not sure how many doctors know and prescribe it. Dirt cheap.

 

Read about the other repurposed for cancer medicines, readily available in thailand: mebendazole, niclosamide, itraconazole, griseofulvine, disulfiram, ivermectin. Also metformin. Just google search each of those with "prostate cancer" for research papers. They are experimental treatments, used around the world for tens of years

 

Please bear in mind I don't have any experience with any cancer, just reading this forum and hearing from cancer patients

Edited February 12, 2023 by internationalism

[Longwood50]

39 minutes ago, Longwood50 said:

She has never eaten Som Tam, the one with crabs in?

No she indicates that she has never eaten any raw sea food.  

[Gabe H Coud]

4 hours ago, Sheryl said:

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?

Sheryl 

PSA 8 rising to 11.2 over 4 yrs 

 

MRI fusion TRUS biopsy may '21 showed  gleason 3+3 in 60% of cores of one specific area. Assessed as PIRADS 3 

 

Doc wants it repeating as part of active surveillance. Have to do MRI scan before MRI fusion TRUS biopsy. Mri scan assessed PIRADS 4

 

Biopsy next week 

 

 

Edited February 12, 2023 by Gabe H Coud

[Dan747]

 Sorry about your condition, BritManToo is right on to go back to the UK. I was very sick about 5+years ago and had a MRI scan at Bumrungrad (Cost $1,200 cash USD) and a Doctor there diagnosed me having a Heidel Hernia and he pressed me needing Surgery "ASAP." Thank God my Gut Feeling was to get a second opinion and left two days later to the USA. Took me about one week to see a Surgeon with another MRI and he told me I did not need any surgery at all.  Good luck!!

[Longwood50]

6 hours ago, BritManToo said:

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

Not just Thailand.  Like anyplace research your doctor and get at least a second opinion.  My experience here in Thailand is that the quality of care is very good.  However I am private pay and so I go to hospitals and see doctors who I have done some research on.  If one thing the for profit hospitals try to push to to have some needless tests and want you running back to see them.  My GF had high cholesteral so they put her on a drug to lower it and asked her to come back in 90 days to test.  The cholesteral was lower and so they said to go off the drug and come back in 90 days and get tested.  She did, and her cholesteral was back up.  They put her back on the drug and wanted her to come back in 90 days.  I said, enough nonsense,  keep on the drug and we can go to Lifecare and have your blood work analyzed and I can read the cholesteral number just as good as the doctor can. 

Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States (U.S)., making medical errors the third leading cause of death.

https://pubmed.ncbi.nlm.nih.gov/28186008/

[Gabe H Coud]

2 minutes ago, Dan747 said:

 Sorry about your condition, BritManToo is right on to go back to the UK. I was very sick about 5+years ago and had a MRI scan at Bumrungrad (Cost $1,200 cash USD) and a Doctor there diagnosed me having a Heidel Hernia and he pressed me needing Surgery "ASAP." Thank God my Gut Feeling was to get a second opinion and left two days later to the USA. Took me about one week to see a Surgeon with another MRI and he told me I did not need any surgery at all.  Good luck!!

i completely agree with you both( i once had a hernia op in UK privately and im utterly convinced i never needed it!)

 

to be fair no Thai doc has suggested surgery yet

 

and if they did i would get at least one other opinion

 

but as per my OP i would be most interested to receive any intel on best places to go for PC surgery/treatment (other than UK where im from) as and when i need to do that 

 

thanks for all replies to date

 

 

 

 

[internationalism]

india.

several year ago there was a threat with some newbe advertising delhi clinic, with names, addresses, prices. 

[Sheryl]

1 hour ago, Gabe H Coud said:

Sheryl 

PSA 8 rising to 11.2 over 4 yrs 

 

MRI fusion TRUS biopsy may '21 showed  gleason 3+3 in 60% of cores of one specific area. Assessed as PIRADS 3 

 

Doc wants it repeating as part of active surveillance. Have to do MRI scan before MRI fusion TRUS biopsy. Mri scan assessed PIRADS 4

 

Biopsy next week 

 

 

You are almost surely in need of treatment at this point but have the biopsy first to be sure.

 

It is not the  case that the UK is not an option, it is. Waits for cancer treatment are not excessive as they are for elective procedures. One TV member there right now for this. It does likely depend on which hospital/part of the country you go to as some areas more overloaded than others.

 

If you opt for surgery (as opposed to say brachytherapy)  and want it

do it here, this doctor and his team at Sriraj do nerve sparing robotic prostatectomy

https://www.siphhospital.com/en/medical-services/doctor-biography?id=246

[Sheryl]

3 hours ago, carlyai said:

So from a scan the dr can tell (not think) if it's a syst or tumor?

 

Of course.

 

Even from a simple ultrasound, can usually distinguish between a cyst and a tumor. Totally different appearance. A cyst is a fluid filled sac.

[crouchpeter]

8 hours 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.  

It's the 2nd biggest killer of men in Australia. Watchful waiting is for the very old. If it spreads out of the capsule, you'll probably be dead within 10 years. If you're 85 this doesn't matter. If you're 65 it could matter! And, a radical prostaectomy is major surgery. I don't know morbidity figures for different ages, but the older the worse. My advice, for what it's worth, is don't wait. Have the biopsies. Sexual impotence is better than the alternative!

[simple1]

3 hours ago, internationalism said:

I would go for non invasive and no side effects hormonal therapy

It is incorrect to state hormone treatment for prostate cancer has no side effects. As an example potential side effects from Lucrin...

 

https://www.pcfa.org.au/awareness/further-detailed-information/commonly-used-drugs-in-treatment-of-prostate-cancer/lucrin/

 

Naturally side effects vary from person to person. In my case Lucrin contributes to weight gain (i.e. male breasts) and constant constipation.

[internationalism]

yes, all medicines might have side effects.

Ther are many hormonal anticancer medicines, which can be swapped at any time.

But from chemo/radio patients do die, damaged kidneys, liver and other body organs.

 

Edited February 12, 2023 by internationalism

[simon43]

36 minutes ago, internationalism said:

yes, all medicines might have side effects.

Ther are many hormonal anticancer medicines, which can be swapped at any time.

But from chemo/radio patients do die, damaged kidneys, liver and other body organs.

 

Which is why I don't understand why older men who require hormone reduction do not opt for orchiectomy (surgical removal of the testicles).  This kills testosterone production stone dead, is a simple 30-minute local anaesthetic outpatient operation, and is a common procedure in developing countries where they can't afford Big Pharma hormone treatment.

[Longwood50]

2 hours ago, crouchpeter said:

t's the 2nd biggest killer of men in Australia. Watchful waiting is for the very old.

At 65 in the USA that is exactly the process.  They don't believe in surgery after 65 because statistically the person will die with the disease not from it.  I agree with you however that a biopsy will ascertain if it is slow growing or a fast growing prostate cancer.  Typically a digital exam can determine if the growth is toward the anus in which case it is almost always slow growing.  I have had for the past two years a physical that includes a full ultrasound of the stomach.  It can also determine the size and any abnormalities with the pancreas.  For the OP I would opt for a urologist and first do a biopsy if I was really concerned.  After that if the cancer was the typical cancer very slow growing, I would in all liklihood do nothing. 

[Gabe H Coud]

2 hours ago, Longwood50 said:

At 65 in the USA that is exactly the process.  They don't believe in surgery after 65 because statistically the person will die with the disease not from it.  I agree with you however that a biopsy will ascertain if it is slow growing or a fast growing prostate cancer.  Typically a digital exam can determine if the growth is toward the anus in which case it is almost always slow growing.  I have had for the past two years a physical that includes a full ultrasound of the stomach.  It can also determine the size and any abnormalities with the pancreas.  For the OP I would opt for a urologist and first do a biopsy if I was really concerned.  After that if the cancer was the typical cancer very slow growing, I would in all liklihood do nothing. 

to be clear im due to have my third if not fourth biopsy next week since diagnosis in 2016

 

it will be my second MRI Fusion TRUS biopsy in 20 months where they use the MRI scan to pinpoint exactly where to take samples

 

 

 

this is to check the progress of the cancer

 

 

 

 

[HauptmannUK]

Don't believe all the doom and gloom concerning the UK NHS.... If there is a suspicion of cancer then you'll automatically be put on the 'two week pathway' and be seen within two weeks. I don't have a lot of trust in Thai doctors .......here is a example of what happened to my wife last year....

We split our time between UK and Thailand. My wife is Thai but also has a British passport.

When we were in Thailand around a year ago she started to have some 'female trouble' (bleeding when she shouldn't).  She was pretty worried so I did a bit of research and booked a session with a recommended specialist at a very well known and rather expensive hospital in Bangkok. He recommended blood tests, a scan etc.  We went back a few days later and he prescribed some hormone pills and suggested an operation (hysterectomy). All this was looking expensive and my own research (Google) made me doubt his diagnosis. In fact he didn't properly explain his reasoning.

We already had a plan to go back to UK for a few months in the summer so I told my wife to hold on a few weeks and seek a second opinion in the UK.

Two days after arriving in the UK my wife saw her GP. GP booked an ultrasound scan in clinic. 7 days wait. U/S scan found something, so was booked an internal camera examination and biopsy at hospital. About 14 days wait. Biopsy negative for C but minor thickening of womb wall observed - booked 'Myosure' keyhole procedure to trim wall of the womb.  About 14 days wait. So start to finish less than six weeks and no cost of course.  Everything went very smoothly and the hospital even provided a Thai lady translator to accompany my wife for the procedure. We showed the consultant the notes from the Thai doctor and he was horrified that a hysterectomy was suggested and said that the hormone medication was not appropriate.