Prostate Biopsy: How many snippets?

[portageriver]

So sorry to hear this Lost Sheep - but I know through your posts that you are strong enough for this potential challenge.

Prostate cancer brought me here searching for info on my future implant.

You are on the right path with priorities. Bone scan, blood scan - make sure this is a localized event. Once confirmed it's isolated cancer, you have a lot of options available to you. Including nothing at all if it's "that" kind of prostate cancer. Fresh research suggests sometimes just active monitoring is good enough at 74.

If it's not slow-growing cancer, but angry cancer like I inherited requiring aggressive surgery, you will have some new realities. But first things first, let's see how the lab plays out. But no matter what - it will be fine in the end. Please keep us posted.

[Lost Sheep]

I have had a little bit of time to pore over the lab results. It does not look good. High Gleason scores on both sides of my prostate's biopsies and mention of perineural invasion (PNI). Clearly, this is not a case of detecting the cancer early. PNI usually indicates the cancer is spreading along the nerves with an accompanying high probability of spreading beyond the prostate.

I also suspect that a prostatectomy will not be the "nerve sparing" variety which suggests to me that I will lose sensation. Perhaps lose orgasmic response (but I do not have any idea about those two outcomes - does anyone have any information for me before I go back to the hospital on Monday? I will have the bone scan and go up the Urology department to see if my urologist wants to talk some more - or refer me over to oncology.)

So, specific question: If a prostatectomy is performed (of the NOT nerve sparing type), will I lose my orgasmic ability?

Surprise development: I got the CT scan of my pelvic region (bone scan will be Monday, 4/24/23) and a couple hours later I got a phone call from the VA that they were processing an authorization for radiation treatment. I had not expected any treatment until my surgeon and I had both imaging results and the opportunity to discuss which treatments we would choose. But that appointment is not until May 4.

[Lost Sheep]

I blew it on this one: I am having an MRI/Bone Scan on Monday and do not remember if I am supposed to modify my medications beforehand. I cannot reach anyone at the hospital to advise me and it is not in my notes to myself. (The day was a bit unsettling - cancer diagnois and all).

I take Metformin, Lisinopril, Atorvastatin, Vitamin D, Vitamin B12, Multivitamin, Empagliflozin. Has anyone who had a bone scan intended to detect malignancy know if any of these drugs would affect the dye they will be injecting in my bloodstream?

[graymare]

I started dealing seriously with this in November of last year. My PSA number had actually dropped below 4 and my urologist felt we could wait and see for another 6 months. I said no, let's be proactive and I was sent for an MRI which showed 2 hot spots in the prostate. That led to a fusion biopsy (transrectal) which fused the MRI imaging with Ultrasound so the doctor could not only take his normal 12 samples, but also one from each of the hot spots. Out of 14 samples, only one came back positive for cancer with a Gleason score of 4+3=7, which, as mentioned above, requires action. If you want to know what happened next I can write again in a later post, but I strongly suggest reading up on every option available to you. There are forums available from many who have experienced this and they should be read too. Good luck (and you are right about incontinence-it sucks)

[Old Guy]

Oh crap Lost Sheep, sorry to hear what's going on.
Do what the docs tell you to do. C is a nasty word and it needs to be dealt with aggressively.
Keep all of us updated on any changes.

[Lost Sheep]

Does anyone know anything about the PSMA mocecular imaging or other tests to detect or predict metastasis. My biopsy was positive for perineural invasion (PNI), which suggests a higher likelihood of progressing beyond the prostate.

I also figure that if I have a prostatectomy it will not be the "nerve-sparing" kind, and I will lose sensation and wonder if that will affect my ability to orgasm. Perhaps radiation therapy would be less disruptive?

[ftwabeck3533]

Does anyone know anything about the PSMA mocecular imaging or other tests to detect or predict metastasis. My biopsy was positive for perineural invasion (PNI), which suggests a higher likelihood of progressing beyond the prostate.

I also figure that if I have a prostatectomy it will not be the "nerve-sparing" kind, and I will lose sensation and wonder if that will affect my ability to orgasm. Perhaps radiation therapy would be less disruptive?

I recommend you join a couple of the communities on: https://healthunlocked.com/ (try the Advanced Prostate Cancer community)

Here's a thread from the site relating to PNI and PSMA: https://healthunlocked.com/search/posts ... munity=all , https://healthunlocked.com/search/posts ... munity=all

Best of luck to you.

[SteveD]

The Prostate Cancer Foundation (pcf.org) also has info on molecular imaging - a huge step forward in finding previously undetectable cancer cells. Re: orgasm reflex: response capability after surgery is 'all over the map.' First, note that the seminal vesicles will be removed with the prostate, ending the production, storage and ejaculation of semen. The Cowpers Gland will remain and there will be some lubricating fluid that emerges from the urethra in small amounts.

In my experience with the partial preservation of one nerve there is a very decent orgasm reflex after the first year of recovery with time, patience, frequent exercise and stimulation. You may be in a position whereby other more important decision criteria will affect your treatment choice. It's important to talk with both surgeons and oncologists - they'll recommend the best of their respective specialties. But remember to carefully ask about long-term affects - you can get a cure with surgery, or surgery and then chemo / radiation, or chemo / radiation but take the long view and understand other impacts that may affect your decision.

This is like getting a graduate degree overnight - so much new information - such an impactful decision. Don't let anyone rush you to decision before you've asked all your questions - perhaps sought a second opinion - and sometimes even a third.