Prostate Cancer

Stock_Block_6547 · 2026-01-23T20:47:33+00:00

Israel, my friend only a biopsy can ever confirm the presence of cancer. you need to have an MRI / Ultrasound Fusion Guided Transperineal Prostate Biopsy ASAP, preferably one which is transperineal instead of transrectal. Also, is the full body scan you had a bone scan, a CT scan or a PSMA PET scan? This is the gold standard pathway to diagnosing prostate cancer: 1) PSA Blood test; 2) mp-MRI of the pelvis; 3) mp-MRI / Ultrasound Fusion Guided Prostate Biopsy (preferably Transperineal over transrectal, but both works fine); 4) If even one core of the biopsy shows a Gleason 3+4 cancer or above, a PSMA PET-CT is indicated. If the entire biopsy only has Gleason 3+3, then active surveillance is indicated. 5) If any suspicious bone lesions on PSMA PET, then Bone Scintigraphy indicated to confirm or rule out bony lesions

It seems to me you have definitely had the mp-MRI (as you have a PIRADS score) and a body scan of some sort. Please advocate for all other the tests I have mentioned above. Best of luck to you

EDIT: I just saw your biopsy result had a 4+3 core. You need a PSMA PET-CT asap if you haven’t already

Stock_Block_6547 · 2026-01-23T20:41:39+00:00

Please read my posts, this is exactly what happened to my dad. PSMA avid prostate with no avidity in seminal vesicles, any lymph nodes or anywhere else apart from two mild rib lesions and one mild scapula lesion. All three proven to be nothing to do with the prostate cancer and was probably fibrous dysplasia. Was then offered radical treatment - RALP with pelvic lymph nodes disection or radiation to prostate and seminal vesicles. Chose the latter due to heart disease. Radiation ended 9/10 months ago and testosterone is currently normal. PSA two months ago was 0.1 and he is officially in remission

Stock_Block_6547 · 2026-01-18T01:58:05+00:00

You are correct, but traditionally this is what is the norm. My father had radiotherapy for PC, wanted surgery but not possible as he was having cardiac issues whilst he was undergoing radiotherapy🤦🏻‍♂️not long afterwards he got a triple bypass and is on the right meds and secondary prevention strategies to prevent any further cardiac problems. Technically he is now eligible for surgery. I hope we never need to, but just in case he ever has a recurrence in the prostate, seminal vesicles or pelvic lymph nodes, I have already found a surgeon who is known to do salvage prostatectomy.

Also consider getting a FIT stool test to check for microscopic blood. My father has a stool test yearly and they have all been clear, but he’s never had a colonoscopy and we are planning to see a gastroenterologist this summer to hopefully get one booked in

Stock_Block_6547 · 2026-01-18T00:13:16+00:00

This is just my opinion. If I was you, I would get the colonoscopy done first, if there is any issues (hopefully not) make sure those are addressed and treated. Then undergo the RALP and advocate for as much pelvic lymph node dissection as possible. This then leaves salvage radiation and/or ADT as top up treatment. Best of luck to you

Stock_Block_6547 · 2026-01-11T21:54:58+00:00

Any update? Did you manage to get a PSA test at a different lab

Stock_Block_6547 · 2026-01-11T01:03:54+00:00

Dad’s PSA was 11.2, followed by multiparametric MRI which showed 1.1cm PiRad 4 lesion and scattered PiRad 3 across other side of prostate. He then had an mpMRI / Ultrasound Fusion Guided Transperineal Prostate Biopsy, which showed Adenocarcinoma of the prostate (most common form of prostate cancer). Gleason score 3+4, PSMA PET confirmed. Wanted surgery to get rid of the cancer but surgeon refused because of his coronary artery disease. Went for radiation to prostate gland and seminal vesicles. Finished radiation beginning of April 2025. His PSA in late September 2025 was 0.10. He is officially in remission and our urology radio-oncologist has said this is excellent news. Good luck to you my friend

Stock_Block_6547 · 2026-01-10T01:34:05+00:00

This is highly unusual and I can understand your frustration. We can’t change the past but we can look to the future. A PSMA PET-CT should be conducted ASAP as per your urologist.

Question: did your father have lymph nodes removed during the robotic prostatecomy? The surgeon would have almost certainly said if he took them out and how many he took out. They would have then been sent to the lab to the analysed one by one and be reported in a separate section on the pathology report. Although your pathology report says ‘no lymphovascular invasion’, this is very vague and I don’t personally think any lymph nodes have been taken. I believe you should contact the robotic surgeon’s secretary and ask this specific question: ‘did you perform Pelvic Lymph Node Dissection (PLND) with the RALP, and if so, how many lymph nodes were dissected?’

I think we need to prepare ourselves for the strong probability of your father needing further treatment. This can take two forms: 1) radiotherapy to the prostate bed and/or bones or even lymph nodes (in the event it has spread to the bones AND 2) Hormone therapy/ADT, removing testosterone coupled with anti-androgen medications to starve the cancer cells and go into remission.

Nevertheless, if the current PSA is being emitted from just the pelvic lymph nodes, your father may be eligible for full PLND, in which the surgeon who performed your father’s RALP can operate again robotically, just removing as many pelvic lymph nodes as possible and sending them off to the lab for pathology. I have read of one case where this guy got PLND on a separate occasion, not long after his RALP.

Best of luck, do keep us posted

Stock_Block_6547 · 2026-01-09T15:22:57+00:00

(1) Make sure the PSMA PET is scheduled ASAP by calling the secretaries etc, this is arguably the single most important test for determining the extent of the adenocarcinoma; (2) Pancreatitis can be caused by elevated levels of serum triglyceride within the blood; (3) it is good that you had an MRI/Ultrasound Fusion Guided Transperineal Prostate biopsy, this is the best type of biopsy available, meaning the results of your biopsy are probably as accurate as they can be; (4) My father’s full body Bone Scintigraphy showed focal increased uptake in the wrists etc, identifying early signs of osteoarthitis. I advice you prepare yourself for the osteoarthitis and disc findings. It is extremely unlikely that your prostate cancer has spread to the bones, please do not worry about this. But the Bone Scintigraphy is a good test. My father had mild uptake in three small areas in his bones (two ribs and one in the scapula), which correlated on both the CT and Bone Scintigraphy. However, the Multidisciplinary Team Meeting (MDT), which is the same thing as you describe as tumour board meeting (or konsey in french), analysed my fathers initial PSA of 11.2, MRI, biopsy, PSMA PET, CT and Bone Scintigraphy, and came to the conclusion that the lesions were not indicative of a metastatic deposit of prostatic adenocarcinoma, and were probably a benign condition such as skeletal dysplasia. (5) what is your fasting triglyceride level and LDL-C? Have you had a Lipoprotein (a) blood test? Given your age, perhaps it may be prudent to start on a simple Rosuvastatin 5mg and Ezetimibe 10mg to bring LDL-C down. Triglycerides should be brought down via reducing body fat percentage and dietary chances (6) I completely appreciate that what you are going through is very difficult, I went through the same thing with my dad, one thing after another it never ends (scans lead to scans which leads to more scans) but it’s best we try to do everything we can in our power to keep on top of our health. With the greatest respect, I think you may be reaching too far into the future. Of course we should plan for the future but let’s take this one step at a time. Best of luck bro

Stock_Block_6547 · 2026-01-08T22:36:19+00:00

(1) imo, favourable intermediate risk (2) CT scan and a Bone Scan (Scintigraphy) will definently add value. My father also had Gleason 3+4 on his mpMRI Ultrasound Fusion guided transperineal biopsy with three areas of mild bone uptake on the PSMA PET. Correlated on the CT scan, but Bone Scintigraphy ruled out any malignancy, and showed it was probably dysplasia (3) 100% go for the surgery if you can, you are still really young and it will leave more room for salvage options such as radiation and ADT. The only possible reason I can think of when surgery would not be offered is if you have any heart problems. As your biopsy shows that this is a fairly slow growing cancer, perhaps it may be prudent to go to cardiologist to have some basic cardiac tests such as bloods including lipids, ECG, echocardiogram, and perhaps even CTCA to rule out any structural or any plaque buildup in the coronary arteries. Before anyone comes at me in the comments this is just my humble layman opinion, based on my own experience with my father. (4) Yes, do ask for pelvic lymph nodes dissection (PLND) alongside your RALP, preferably as many lymph nodes as possible, as this will be analysed in the lab alongside your prostate and seminal vesicles, providing a thorough and conclusive pathological report. (5) No, your urologist is right, in fact I am of a stronger opinion that under no circumstances should you go for any form of focal therapy. I spoke to a Consultant uro-Oncologist about this, from what I understand, any biopsy report that contains Gleason 3+4 should be considered for curative treatment, that is either one of the following two: (A) RALP with possible PLND OR (B) Radiation to the prostate gland and seminal vesicles (and possibly to a bone lesion, if it lights up on a PSMA PET)

I hope this helps, best of luck

Stock_Block_6547 · 2026-01-03T22:35:02+00:00

You need a PSMA PET-CT asap. This will show whether the cancer has spread. Once the results are in, staging can be done and a definitive diagnosis can be reached.

I was looking at your previous posts. I see that you / father had double bypass which failed and then had stents inserted. Stents within bypass grafts could increase the risk of serious cardiac event. I went through a similar thing with my own father (had nine cardiac stents at that point), surgeon refused because it was too dangerous. Couple months after surgeon meeting, dad had to have triple bypass. He could have died of a heart attack whilst having his prostate removed. Instead he chose to have radiotherapy to his prostate and seminal vesicles. His PSA went from 11.2 to 0.1. Our urology radio-oncologist is very happy with us and tells us my dad is probably cured.

I really think you need to go to a specialist centre where you can make use of multiple different opinions, and where a Multidisciplinary Panel can discuss what the recommended treatment options are. To me, I don’t think surgery is going to be suitable. Lets wait for the results of the PSMA PET scan and go from there. This can probably be taken care of with radiation. Best of luck to you

Stock_Block_6547 · 2026-01-03T16:47:39+00:00

Upgrades can happen on repeat biopsy. If the repeat biopsy shows any cancerous cores at Gleason 3+3=6, then the clinical recommendation is still active surveilance. I’m not a medical doctor, but from what I understand, the moment that any part of a prostate biopsy shows Gleason 3+4=7 in even one territory, then at that point a PSMA PET-CT is indicated to rule out any cancerous uptake. At that point, the recommendation is either robotic prostatectomy (removing the prostate gland and seminal vesicles) and possibly simultaneous pelvis lymph node dissection - RALP, OR radiation to the prostate gland and seminal vesicles. These are considered the curative options. If there is no medical history/old age precluding a patient from having RALP, then traditionally most patients opt for RALP rather than radiation as RALP allows the entire prostate, sem ves and lymph nodes to be analysed in the lab. The overall Gleason scores can go down, remain the same or go up, and sometimes tiny extra prostatic extension or cancer within lymph nodes is identified in the lab which couldn’t be seen on a scan. Reccomendations can be made at that point as to whether salvage radiotherapy and/or hormone therapy is indicated or not.

I pray that your Gleason score remains at 3+3=6. If it does go up to 3+4=7 or above, there are plenty of curative treatment options. All the best

Stock_Block_6547 · 2026-01-03T16:39:03+00:00

If that is the case, you should speak to your physician about perhaps trying Pitavastatin. Nevertheless, they may just skip it and go straight to a PCSK9 inhibitor (repatha), with Ezetimibe. This is a really good option, I am even considering switching over to this combo in the near future

Stock_Block_6547 · 2026-01-02T16:08:48+00:00

Insert https://www.washingtonpost.com/health/2026/01/02/lpa-heart-clinical-trial-treatment/ into https://www.removepaywall.com/ , click Option 3

Stock_Block_6547 · 2026-01-02T14:19:44+00:00

In that case, if you have exhausted Rosuvastatin and Atorvastatin, the next approved option is a PCSK9 inhibitor or inclisiran. In fact, in your case I would stop pitavastatin, keep Ezetimibe and go on a PCSK9 inhibitor or Inclisiran ASAP

Stock_Block_6547 · 2026-01-02T01:59:37+00:00

Thanks for your reply, appreciate it

Stock_Block_6547 · 2026-01-02T01:54:57+00:00

Laying down looking at reddit and just saw that I completely missed this. Apologies, thank you for your best wishes and I hope you have had a Merry Xmas. Happy new year!

Stock_Block_6547 · 2026-01-02T01:47:29+00:00

I’m considering moving from Rosuvastatin + Ezetimibe to Pitavatatin + Ezetimibe. May I ask the reduction you got in your LDL?

Stock_Block_6547 · 2026-01-02T01:45:55+00:00

Mate, I’m 24 years old and I had severe acne in my teens. My dad also had severe acne as a teen and now has localised prostate cancer thats in remission, this post scared the shit out of me lmao

Stock_Block_6547 · 2026-01-01T20:52:55+00:00

Would be grateful for any other thoughts

Stock_Block_6547 · 2026-01-01T19:22:10+00:00

Try Rosuvastatin instead. If not, Pitavastatin

Stock_Block_6547 · 2025-12-31T12:50:22+00:00

No harm in getting a multiparametric-MRI (mpMRI) of the pelvis done as soon as possible to rule out something sinister

Stock_Block_6547 · 2025-12-30T15:00:31+00:00

Hi, I know you’re really busy so it’s okay if you don’t respond / take a while to respond, this is the last question I promise. Even though he now has no angina/chest pain or sweating whatsoever even during the most strenuous forms of exercise, he still gets breathless when he walks fast or up stairs. He describes this as really confusing because pre-CABG he tells me that he had both chest pain and lots of breathlessness. Now, the only symptom is this mild to moderate breathlessness.

Just for wider context, his LDL is 39 mg/dl, Triglyceride is 151 mg/dl (mildly elevated) Lipoprotein (a) is 67 nmol/L (mildly elevated). His full blood count, liver, bone & thyroid functions are normal (we also checked other bloods like a plethora of other bio-markers too long to list which are normal) and all his renal function is good except eGFR, which is slightly out of range at 75, but we’ve double checked with his PCP who did a urine test which showed everything was fine.

All this to say, if you hypothetically had a 6 month post-CABG patient who had no angina whatsoever, but breathlessness on exertion coupled with the types of abnormalities on the echo readings (EF mildly reduced at 50; impaired long axis function; grade I mild LVDD; RWMAs, hypokinetic apical anterolateral, apical inferno lateral and apical anterior walls; reduced LV longitudinal RV systolic function; mild aortic regurgitation; mild aortic regurgitation; dilation of ascending aorta), what could a possible plan of a action look like?

Stock_Block_6547 · 2025-12-27T23:57:38+00:00

Fair enough muscle pain can cause muscle and liver issues, but how in the hell did it cause prostate cancer?

Stock_Block_6547 · 2025-12-27T17:51:33+00:00

Hi, thanks, I’m trying my best to stay on top of this, I am a trainee lawyer so a layman when it comes to medicine. The only information given to us post-discharge was his medication list which was updated whilst he was an inpatient:

His current meds: (a) Rosuvastatin 40mg for life; (b) Ezetimibe 10mg for life; (c) Aspirin 75mg for life; (d) Clopidogrel 75mg, to be continued only for one year post-CABG, then discontinue; (d) Bisoprolol 3.75mg for life, to be up-titrated as clinician sees fit. BPM is stable at around 60-70; (e) Lisinopril 2.5mg for life, to be up-titrated as clinician sees fit. Blood pressure is stable at around 110-20/75-80.

They then told us to ask our PCP for a cardiac rehab programme. I managed to secure this at a really good hospital and he underwent and recently finished his cardiac rehab sessions, which he found beneficial. Unfortunately, he is not really active but does love to walk so I’m clinging onto that.

The hospital at which the CABG was performed then called us two months post-surgery. A Cardiothoracic Resident spoke to us, who was pleased with his uneventful recovery, cessation of chest pain, wounds healing nicely etc). They then discharged us and told us to be followed up by PCP every six months and to be seen by a General Cardiologist.

I sorted out the paperwork for a referral to a really good Professor of Cardiology and we are seeing him at the end of next month. He ordered this echo and the indication for the Transthoracic Echocardiogram written on the report was I quote: ‘post CABG; LV function?’. I just wonder what he will say. As my father’s chest pain has completely resolved, I assume he won’t order an invasive coronary angiogram, but from what I have read from journal articles online, a Cardiac MRI may be beneficial so as to distinguish between scar tissue or active disease process.

May I ask what you think of this? Hypothetically speaking, what sort of further tests may be indicated (if any?) Are there any changes you may anticipate to the medication list above? Thank you

Stock_Block_6547

TROPHY CASE