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Your welcome Anon. Glad to help. Reading your last post, we do seem to be in sync now, except on the subject of EPE detection. I said:
“I question the ability of MRI and CDU scans to accurately detect EPE so that a needle can be injected into it. I say this because, while it is said that both scans have that ability, my MRI not only did not find EPE, it didn't detect any cancer at all (and I definitely have cancer)”.
…and you said:
“If I understand correctly, it (meaning the MRI) can show with some degree of reliability, whether there is EPE”.
So, when you talk to Dr. Tewari about an MRI’s ability to detect EPE, I would appreciate you letting me know what he says on the subject.
Alan, was your MRI a 3 Tesla, parametric MRI? My understanding is based on that, which I understand is a new level technically, available only over the last few years.
To answer your question, on 8/30/12 at MGH, I had a 3.0 Tesla MRI with and without contrast that involved the use of an endorectal coil. Whether or not that means that it was “parametric”, I do not know. I could not find any web information that could answer that question, and the hospital was not able to answer it for me either. If you have that knowledge from your research, then I would appreciate you letting me know.
The findings listed on the report are as follows: “Prostate: Normal. No prostate neoplasm identified. There is no evidence of EPE. The neurovascular bundles are intact. The seminal vesicles are unremarkable. No pelvic lymphadenopathy”.
Here is what I had to say about it in my Survivor Story: “The MRI detected NO cancer at all, and I have a rather large visible tumor that can be seen on the CDU. I was disappointed and felt that it was a waste of my time. From my research, it was my understanding that these MRI images tend to miss insignificant tumors and pick up those that are possibly aggressive. On the positive side, one could argue that my large tumor was not picked up because it is not aggressive; hopefully, that is true, but for the MRI to have any value I believe it still should have detected it”.
Anon,
In your case you seem mainly concerned about curing the cancer and not the side effects. So you are going to get your prostate out and then if salvage radiation is required you will get that later. That is the best you can do. No one dies (I've heard of one unusual case) for at least 10 years after getting their prostate out from prostate cancer. Partly because they don't operate if you already have metastatic bone disease.
Once you have the prostate out and receive the pathologist report you will have more information but even then it won't make any difference to your next decision on whether you need salvage radiation treatment. That will be decided on your PSA after the operation. If your PSA goes over 0.2 then you get salvage radiation.
@Frank - It's not that I am not concerned about the SEs, I clearly am. More the Incontinence issue, then ED. I could make adjustments and live with the latter if I had to, if that was the price of cure. The incontinence if it were permanent, would be more difficult. But I have a high degree of confidence that worst case scenario, that gets worked out over time.
So that's why I am meeting with an RO next week. I am still very partial to surgery, but I want to hear what the RO has to say.
@Alan - parametric is the term I think that is used for these MRIs so I think its the same thing. I am also having the endocoil, w and w/o contrast.
I will let you know if I get feedback on accuracy from my Dr. If the results are good, I will have the presence of mind to ask. If the results show anything bad, I may not :-(
Anon, I know about six other chaps who used the same highly recommended surgeon as myself for the radical....and none have any incontinence issues. None of us even do kegels. The top surgeons seem to be pretty adept at protecting against incontinence. We all had issues of some sort with erections and needing viagara which helped somewhat...but you 'never' get fully back to where you were in this area. Kind of a small price to pay at our stage of life to pretty well ensure staying alive.
