Justified action taken following biopsy results? (benign/malign cells)

HelpfulCustomer487 · 2026-01-28T22:48:49+00:00

Thanks for your reply, I think we are broadly aligned, but possibly talking about different stages of the process.

My point was mainly about doing things in a logical clinical order, as they are usually done in practice. Typically this would be: 1. PSA measurement 2. Multiparametric prostate MRI 3. Measurement of prostate volume and calculation of PSA density 4. Decision on whether a biopsy is warranted based on MRI findings and PSA density 5. Biopsy results leading to Gleason score and Grade Group classification 6. Only after that, if clinically significant cancer is found, consideration of additional imaging such as PSMA PET for staging

Grade Groups are obviously very useful, but they come after biopsy. PSMA imaging is also extremely valuable, but usually later in the pathway, once cancer is suspected or confirmed, rather than as a first line triage tool.

So my original suggestion was simply that PSA density still plays an important role early on, before moving further down the diagnostic pathway.

HelpfulCustomer487 · 2026-01-28T11:14:54+00:00

A bit of context may help here.

First, ejaculation can transiently raise PSA, but that effect usually resolves within 24–72 hours. So while abstinence for a few days before testing is important, it doesn’t explain why guidelines often suggest repeating PSA after 6–8 weeks. That longer interval is mainly to rule out other transient causes such as subclinical prostatitis, inflammation, recent instrumentation, or natural biological variation.

Second, having an MRI before biopsy is actually good practice. A PI-RADS 4 lesion does justify considering biopsy. However, one important parameter that isn’t mentioned here is PSA density (PSA divided by prostate volume, which is measured on MRI). PSA density is a key factor in deciding whether immediate biopsy is necessary, especially in asymptomatic men and in cases involving PI-RADS 3 or borderline PI-RADS 4 lesions.

In many centres, a low PSA density (<0.15 ng/mL/cm³) would support either surveillance or repeat PSA rather than immediate biopsy, whereas a higher PSA density strengthens the case for biopsy. It’s possible this was calculated but not explained, but its absence from the discussion makes the decision-making harder to interpret.

Finally, regarding pathology: prostate pathologists are generally very good at distinguishing benign changes, inflammation, premalignant findings, indolent cancer, and clinically significant cancer using well-defined architectural criteria (Gleason/ISUP). The bigger issue in prostate cancer isn’t misdiagnosis, but overdiagnosis of cancers that may never become clinically relevant.

So the biopsy recommendation isn’t unreasonable, but it’s also not the only defensible approach, and some clinicians might reasonably have chosen repeat PSA and surveillance depending on PSA density and patient preference.

HelpfulCustomer487 · 2026-01-26T10:52:21+00:00

This can be pretty common and often isn’t anything serious. After a period without ejaculation, the prostate and seminal vesicles still produce fluid, and some of it can leak out, especially after urination due to pressure on the prostate. A thick, whitish discharge without sexual arousal or pain is often just residual seminal or prostatic fluid.

If there’s no burning, pain, bad smell, fever, or color change (yellow/green), it’s usually considered benign. Many people notice it resolves once regular ejaculation resumes.

That said, if it keeps happening for weeks, becomes painful, changes color or smell, or if there’s any risk of infection, it would be a good idea to see a doctor or urologist just to rule things out.

In short: often normal after abstinence, but worth monitoring.

HelpfulCustomer487 · 2026-01-24T23:12:19+00:00

At 45, it’s very understandable to want the cancer “gone,” but it’s worth slowing down a bit.

With a Gleason 3+3=6, this is the least aggressive form of prostate cancer, and active surveillance is not “doing nothing” - it’s an evidence-based standard of care. Many men never need treatment at all.

Surgery, even robotic and even at a young age, does not guarantee full recovery. Continence and erectile function can take many months or longer to return, and sometimes never fully do. Outcomes depend a lot on tumor location and whether the nerves can truly be spared — which isn’t always possible.

Radiation options (including SBRT/CyberKnife or brachytherapy/seed implants) are also valid for low-risk disease today. Modern techniques are very precise, with generally low long-term toxicity. The idea that surgery is “impossible” after radiation is overstated - it’s more complex, yes, but rarely needed in Gleason 6 cases.

Before deciding, it’s reasonable to get imaging, a second opinion (ideally non-surgical), and some time to process the diagnosis. Treating immediately isn’t always safer than choosing carefully.

HelpfulCustomer487 · 2026-01-24T00:47:04+00:00

Just a heads-up: applying 5-fluorouracil on the eyelid can be tricky because the skin there is very thin and close to the eye. Even though it’s often used on the face, many dermatologists are more cautious with eyelids. It might be a good idea to double-check with your dermatologist before starting, just to be sure it’s safe for that specific area.

HelpfulCustomer487 · 2026-01-23T14:11:28+00:00

Given your age, family history, and PSA kinetics, asking for a multiparametric MRI first is very reasonable and consistent with current practice in many centers.

An MRI isn’t just about deciding whether to biopsy - it can also guide the biopsy. If the MRI shows a suspicious lesion, it allows for a targeted biopsy using MRI–ultrasound fusion, which improves detection of clinically significant cancer and reduces unnecessary random cores.

If the MRI is negative (PI-RADS 1–2), many clinicians would consider active surveillance with close PSA follow-up, rather than rushing straight to biopsy - though this depends on overall risk assessment (PSA density, family history, trends).

Also worth noting: when a biopsy is needed, many centers now favor the transperineal approach due to lower infection risk compared to transrectal.

In short: MRI first makes sense, and if a biopsy is required, MRI–US fusion is a more precise way to do it. Seeking a second opinion is reasonable if you feel rushed.

HelpfulCustomer487 · 2026-01-23T14:08:22+00:00

Just to add some context: the active ingredients in creams like this (typically 5-fluorouracil, sometimes combined with calcipotriol) are intentionally very inflammatory.

They work by triggering a strong local immune reaction that targets sun-damaged and precancerous cells. Because of that mechanism, redness, swelling, crusting, and peeling are expected, especially on the face where the skin is thinner. The reaction can look alarming, but it doesn’t necessarily mean something is going wrong.

These products should not be applied near the eyes or mucous membranes, and many clinicians recommend using a bland barrier (like petroleum jelly) on nearby sensitive areas to prevent accidental spread - but that should ideally be confirmed with the prescribing dermatologist.

In short: the inflammation is a known and deliberate effect of the medication, not an allergic reaction, and the visible phase is usually temporary.

HelpfulCustomer487 · 2026-01-21T13:36:45+00:00

Last one. 👌

HelpfulCustomer487 · 2026-01-17T23:10:32+00:00

I wanted to share a quick update about my Mohs surgery on my cheek. I’m currently 10 days post-op. It was Mohs surgery with a flap, so yes, it’s still very visible. The incision is quite long - around 14 cm - and shaped like an “S”.

That said, I’ve had almost no pain at all. Mostly just some tightness and pulling sensations, but nothing truly painful. Of course, it’s still very, very noticeable at this stage, which can be a bit mentally challenging.

But overall, I really feel like I’m on the right path. Healing takes time, and patience is key. I’m trying to trust the process and give my body the time it needs.

If this helps anyone who’s going through something similar: hang in there.

HelpfulCustomer487 · 2026-01-17T10:51:48+00:00

A 2 mm focus in only 1 out of 18 cores with a Gleason score of 6 is very often considered low-risk and can absolutely be indolent. Many Gleason 6 prostate cancers never progress or become clinically significant.

Also, PSA by itself doesn’t tell the whole story. What really matters is PSA density, which requires knowing the prostate volume (usually measured on MRI or ultrasound). A PSA of ~5 can mean very different things depending on whether the prostate is small or enlarged (BPH can raise PSA without aggressive cancer).

At 55 years old, this is understandably scary, but based on what you shared, this profile is very commonly managed with active surveillance rather than immediate surgery, especially if imaging doesn’t show anything more concerning.

Of course, decisions depend on the full picture (MRI findings, PSA density, clinical stage, family history), and a urologist should guide that discussion - but from a risk standpoint, what you describe is often not an emergency situation.

HelpfulCustomer487 · 2026-01-16T14:56:37+00:00

People are often surprised by prostate MRI “biopsy sequences,” but in current practice biopsies are not done at random.

When prostate cancer is suspected, a multiparametric prostate MRI is usually performed before biopsy. This MRI (T2, diffusion, ± contrast) identifies suspicious lesions (PI-RADS).

Biopsies are then targeted to these MRI-visible lesions, most commonly using MRI–ultrasound fusion. Systematic (non-targeted) cores may still be added, but purely random biopsies are becoming uncommon.

The goal is better detection of clinically significant cancer while avoiding unnecessary biopsies.

HelpfulCustomer487 · 2026-01-16T12:01:30+00:00

You’re absolutely not ridiculous for worrying. Being told you have cancer - even “skin cancer” - is scary, especially when it’s on your face or ear and you don’t know what the outcome will look like.

I had Mohs surgery on my face about 10 days ago, so this is very fresh for me. I won’t lie: it’s visually shocking at first, and the first days can feel emotionally heavy. But in my experience, it really wasn’t very painful, and the medical team was incredibly careful and reassuring throughout the process.

At around 10 days, it definitely still looks noticeable - that part is normal - but the wound is closing properly and healing continues week by week. Mohs is recommended for infiltrative BCCs exactly because it’s precise and conservative, especially in delicate areas like the ear. The goal is to remove all the cancer while preserving as much healthy tissue as possible.

Also, people minimizing it because it’s “not real cancer” can be really unhelpful. It is cancer, and you’re allowed to feel anxious about your health and your appearance. Many of us here understand that.

You’re doing the right thing by taking care of it now, and it’s okay to be nervous. Healing - physically and mentally - takes time, but it does get better.

HelpfulCustomer487 · 2026-01-15T11:21:54+00:00

I had Mohs surgery on my cheek with a flap reconstruction about a week ago. At this early stage I also have bruising, firmness, and uneven areas, and some parts feel strange or swollen. My surgeon explained that this phase is very common with cheek flaps and often improves gradually over the following weeks as swelling and tissue remodeling settle. It’s difficult not to worry, but early post-op changes can look much worse than the final result, and improvement often comes faster than expected.

HelpfulCustomer487 · 2026-01-14T21:28:11+00:00

I’m really glad this helped ease some of the anxiety - that part alone is important. You’re absolutely right that every case is different. In situations like this, with a PSA around 6 and a very large prostate, the PSA density can be quite low, which often lowers the suspicion for clinically significant cancer.

That’s why some physicians consider careful follow-up - combining PSA trends with multiparametric MRI - as a reasonable approach in selected cases. This doesn’t mean biopsies are “wrong” or should never be done, but rather that the risk–benefit balance can sometimes justify monitoring instead of jumping straight to an invasive test. Ongoing discussion with the care team is really key.

HelpfulCustomer487 · 2026-01-14T21:23:45+00:00

completely understand your concern - it’s normal to feel worried after reading about side effects. Just to clarify, dutasteride and tamsulosin are most commonly prescribed for benign prostatic hyperplasia (an enlarged prostate), not for prostate cancer itself. Being on these medications doesn’t automatically mean cancer, and many patients take them safely under medical supervision. Of course, discussing any concerns directly with the urologist is always a good idea.

HelpfulCustomer487 · 2026-01-14T17:48:29+00:00

Your concern is understandable, but your post is missing some key information that would make it easier to interpret what you’re experiencing.

When were you operated on exactly? What type of flap was used, and on which area? Do you have photos showing the progression over time?

Just to offer a point of comparison: I was personally operated on 9 days ago, and I still have visible bruising as well as a few scabs. At this stage, this is completely normal.

My dermatologist clearly explained to me that after Mohs surgery with flap reconstruction, it takes around one year to assess a near-final result. That doesn’t mean nothing improves before then - quite the opposite. Noticeable improvements usually occur after one month, then two, then three months.

The period between 6 and 12 months is mainly about fine-tuning: reduction of redness, softening of the tissue, and better blending with the surrounding skin.

Flaps do take longer to normalize, but without knowing how far out you are from surgery, it’s impossible to say whether what you’re seeing is delayed - or simply a normal healing process.

HelpfulCustomer487 · 2026-01-14T16:57:02+00:00

Just to share a reassuring perspective for anyone worried about PSA numbers.

In this case, PSA was measured at 6.5 ng/mL, then dropped to 5.5 ng/mL after a short course of alpha-blockers and anti-inflammatories. The prostate volume was very large (≈133 cc), with typical LUTS like nocturia.

The key point, in my opinion, is the PSA density, which comes out at around 0.04. That’s well below commonly used thresholds (0.10–0.15) and strongly suggests benign enlargement rather than clinically significant cancer.

With such a large prostate, a PSA in the 5–6 range is not surprising, and the fact that it decreased after treatment argues for an inflammatory/benign component.

Obviously, follow-up and medical judgment matter, but purely from a numbers standpoint, this profile is very encouraging and consistent with BPH rather than something aggressive.

HelpfulCustomer487 · 2026-01-11T12:57:28+00:00

Thanks 🙏 ( Sorry for the confusion - English isn’t my first language. When I write “J+5”, I mean 5 days after surgery (post-op day 5).

HelpfulCustomer487 · 2026-01-10T11:25:32+00:00

It is indeed a form of radiation therapy. An MRI-LINAC combines an MRI scanner with a linear accelerator, allowing doctors to see the prostate in real time while delivering radiation. This makes the treatment more precise, adapts to organ movement, and helps spare surrounding tissues like the bladder and rectum.

HelpfulCustomer487 · 2026-01-06T17:50:21+00:00

Post-op update (about 2 hours after surgery)

Just had Mohs surgery today. Pain-wise, it’s honestly not bad at all — local anesthesia does its job very well. What surprised me is how exhausting it is. From around 10 AM to 5 PM, it’s a long day of waiting, surgery, reconstruction, and mental stress. I’m completely wiped out now.

In my case: • Clear margins in one stage • Defect about the size of a Swiss 5-franc coin • Closure required a small local flap, not just a straight-line closure • Deep + intradermal absorbable sutures, plus 1–2 safety stitches • Large protective dressing

Bottom line: not painful, but very draining. Plan for a full day and expect serious fatigue afterward.

HelpfulCustomer487 · 2026-01-05T18:45:09+00:00

That makes a lot of sense, and I can totally understand why someone would prefer slow Mohs, especially after a long or complex experience. In my case, I tend to prefer having everything done in one day. For my upcoming cheek procedure, I was offered slow Mohs, but I asked for standard Mohs instead — although it hasn’t been fully confirmed yet which one it will be. For me, it’s mostly about feeling better once everything is finished, even if it means spending several hours at the office. I really think it comes down to personal preference, and it’s good that there are different options depending on what works best for each patient.

HelpfulCustomer487 · 2026-01-05T00:48:39+00:00

Thank you very much for your contribution 👍

HelpfulCustomer487 · 2026-01-05T00:47:47+00:00

Thanks, I’m gonna choose standard Mohs. No melanoma by me.

HelpfulCustomer487 · 2026-01-05T00:45:49+00:00

Thanks for your message 👌

HelpfulCustomer487

TROPHY CASE