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Oncology (General Cancer)/prostate cancer with MRI result

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QUESTION: Dear Dr Claes-Gustaf Nordquist ,
Thank you for your time and devotion in helping the suffering of others. I have been having a trouble with my prostate for last six months. I have been back and forth to hospital .I had CT scan, but showed nothing…As such, they treated me with antibiotics .Sadly ,the pain in tip of my penis and anus carried on. I begged the urologist for MRI, but he argued as nothing showed on blood test and CT scan, just let the nature take its place!!! However, at the end he sent me for MRI which the result is as followed:
MRI Pelvis prostate: No evidence of any bone deposits. No evidence of a capsular breach. The seminal vesicles are normal .There is no pelvic lymphadenopathy. There is some low signal bilaterally suggesting a bilateral tumour but no evidence of a capsular breach and this appears to be an organ confined disease.
I have not seen the urologist as yet (I might have to wait few weeks more), but my GP has provided me with the results. He is a very busy GP, just told me this is the result and I have a cancer.
Please kindly would you please explain to me ‘There is some low signal bilaterally suggesting a bilateral tumour but no evidence of a capsular breach and this appears to be an organ confined disease.’ ?
At the moment I have pain in my anus and sometimes tip of my penis’   I am worried if the cancer have moved to other parts .Thank you
Kind Regards
Essi

ANSWER: An MRI scan can suggest that a cancer may be there but it is NOT a firm diagnosis! For that a pathology diagnosis of a biopsy is needed! That can in your case best be provided in 2 ways. 1. With a fine/thin needle aspiration biopsy. That would be simplest and easiest for you but I do not know if it is done in the UK at all. It can also only provide a cytology diagnosis which does not provide all the information of a histopathology diagnosis. 2. A wider gage (medium gage) needle biopsy or rather biopsies. That CAN provide a histopathology diagnosis and therefore more information. So a sure diagnosis can only be had with either of these 2 methods. Best with no 2. Your MRI scan seems to indicate that any tumour in your case has not breached through the capsule of your prostate so it seems to be located only in your prostate. However, cancer cells can also spread via lymph and blood vessels so we can not be sure of that if it is a cancer in your case. I recommend that your urologist tries to determine if there is a cancer there or not before any surgery is tried. Best with needle biopsies (several may be needed). Was a PSA test done in your case? If there is a cancer either surgery or radiation therapy can be used to treat it. I had a prostate cancer 6 years ago. My own choice was radiation therapy only. It seems to have worked. My PSA which at the time of my needle biopsy diagnosis (medium gage) was 8.8 is now and since the end of my treatment 5.5 years ago below 0.05! So I seem to be cured st least so far! Good luck!



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---------- FOLLOW-UP ----------

QUESTION: Dear Dr Claes-Gustaf Nordquist,
Many thanks for your kind informative replay. I have to thanks you for the time you devote for worried sufferers like me .However, according to urologist in July my PSA was fine, also the CT scan was fine .That is the reason when I saw him on 29th September he told me, to let the nature to take its course .But after, I virtually begging him .He agreed to arrange the MRI and repeated PSA for me .Hopefully, he will see me soon and put me out of my mental tortures.
I have nagging pain in my anus when I sit down, and burning pain when I pass water. Also pain in my lower belly and lower back. I don’t even know if these pains are part and parcel of prostate!!?
I will let you know as soon as I get the full results of recent PSA and decision of my urologist (when he sees fit to see me).
Thank you again and I shall pray that your cancer never come back again. I believe that lord look after good people like you. Thank you again
Warmly
Essi

Answer
MRI is better than CT. There are prostate cancers without increased PSA and threre are cases of increased PSA without prostate cancer. So PSA is not a very good test but so far it is the only one we have. I can so far only repeat that I do recommend  that you ask your urologist to have several medium gage prostate needle biopsies done, for example 4 per prostate lobe = 8 in total. That way your risk of missing any prostate cancer should be minimal.



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Oncology (General Cancer)

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Claes-Gustaf Nordquist, M.D.

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Questions concerning Cancer, Oncology, radiation Therapy, Tumours, Chemotherapy, Cytotoxic Drugs, Hormonal Therapy, Radiation Protection.

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I'm a Doctor of Medicine and specialist in Medical Oncology and Radiation Therapy educated & trained in Sweden. Now retired. Background in Radiation Therapy, Medical Oncology, Radiation Protection, Nuclear Medicine, Diagnostic Radiology, Gynecological Oncology, Clinical Pathology, Clinical Cytology,Hematology and Internal Medicine. M.D. from the faculty of medicine, Royal Karolinska Institute, Stockholm, Sweden. Have also been an exchange student at the Hebrew University, Hadassah Medical School, Jerusalem Israel. Former medical consultant, Swedish National Board of Radiation Protection. Former Police Surgeon and Medical Examiner, Stockholm Police Department. Former Chief Medical Officer, The Royal Guards, The Royal Horse Guards and the Royal Household Brigade, Royal Swedish Army Medical Corps. You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128 I have no restrictions in the number of questions there. I also answer questions in these other categories: General History, Military History, Brain Tumors, Breast Cancer, Colon Cancer

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I'm a medical doctor and specialist in medical oncology and radiation therapy

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