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Testosterone Replacement, Low T, HCG, & Beyond
Prostate Related Issues
PSA at 5.3
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<blockquote data-quote="ocman" data-source="post: 157031" data-attributes="member: 770"><p>UPDATE: 8-22-19, [USER=71]@Orrin Israel[/USER] what do you think?</p><p></p><p>I got the results back from the MRI and the score is PI-RADS 4/5, one question I didn't ask was the size of the suspicious area. They recommended that I get a Fusion Biopsy.</p><p></p><p>Here's the test results:</p><p></p><p><span style="font-size: 22px"><strong>Study Result</strong></span></p><p><span style="font-size: 18px"><strong>Impression</strong></span></p><p>IMPRESSION:</p><p></p><p>1. Focal findings suspicious for neoplasia, PI-RADS 4 lesion in the right posterior lateral peripheral mid gland.</p><p></p><p>2. Capsular margin: intact -unlikely extracapsular extension.</p><p></p><p>Overall PI-RADS Category: 4/5</p><p></p><p>Standardized reporting guidelines follow recommendations by ACR-ESUR PI-RADS v2.1</p><p></p><p>I, David Lu, M.D., have reviewed this radiological study personally and I am in full agreement with the findings of the report presented here.</p><p></p><p>Appendix (based on UCLA data/publications)</p><p></p><p>Overall MRI sensitivity for prostate cancer detection = 47%</p><p>Sensitivity for tumors > 1 cm or for Gleason > 3 + 4 = 72%</p><p></p><p>Biopsy yield for prostate cancer based on overall level of suspicion:</p><p>3/5 = 16 - 24%</p><p>4/5 = 37 - 78%</p><p>5/5 = 80 - 96%</p><p></p><p>1. Eur Urol 2019;75(5):712-720</p><p>2. Radiology 2017;283(1):130-139</p><p>3. Cancer 2016;122(6):884-892</p><p>4. Abdom Radiol 2016;41:954-962</p><p>5. Eur Urol 2015;67(3):569-576</p><p>6. Am J Roentgenol 2015;1:W87-92</p><p></p><p></p><p>Dictated by: Eric Rupe 8/16/2019 2:58 PM</p><p></p><p>Signed by: David Lu 8/16/2019 8:41 PM</p><p><span style="font-size: 18px"><strong>Narrative</strong></span></p><p>3T MRI OF THE PROSTATE WITH AND WITHOUT CONTRAST and with 3D post-processing</p><p></p><p>CLINICAL HISTORY: Elevated PSA</p><p>PSA 4.8 ng/mL 7/25/2019</p><p></p><p>COMPARISON: None.</p><p></p><p>TECHNIQUE: MRI of the pelvis was performed on a 3 Tesla Siemens Skyra scanner. A transabdominal phased array was used. Small field of view sagittal, axial oblique and coronal oblique T2W TSE high resolution images and diffusion weighted images with</p><p>apparent diffusion coefficient map were obtained. Pre- and post-contrast axial dynamic view-sharing time-resolved gradient recalled echo T1-weighted images are acquired with intravenous administration of gadolinium contrast. Offline post-processing on a</p><p>dedicated InVivo DynaCAD 3 workstation was performed for generation of time-intensity curves and pharmacokinetic maps and 3D contouring of the prostate gland and any target lesions using combined automated and manual segmentation techniques.</p><p></p><p>CONTRAST: gadobutrol (Gadavist) 1 mmol/mL inj 10 mL.</p><p></p><p>GLUCAGON: No</p><p></p><p>FINDINGS:</p><p></p><p>Quality: Excellent</p><p></p><p>The prostate measures 31 g based on contour, (4.0 cm x 3.8 cm x 4.4 cm).</p><p>PSA Density0.15 ng/mL/cc</p><p></p><p>The background transition zone is heterogeneous. The background peripheral zone is heterogeneous.</p><p></p><p>The following appears suspicious (>= PI-RADS 3):</p><p></p><p>Target #1 / ROI #14 (3D T2 slice #30)</p><p>Location: right posterolateral peripheral midgland</p><p>Clock-face axial location: 8 o'clock</p><p>Cranio-caudal location: 15% of distance from apex to base</p><p>Longest diameter: 0.7 cm</p><p>Capsular involvement: may abut the capsule</p><p>T2 signal: round circumscribed moderately T2 hypointense, 4/5 suspicion</p><p>Diffusion-weighted imaging: focal moderately hyperintense high B-value DWI and moderately hypointense ADC, 1169 square microns/second, 3/5 suspicion</p><p>Dynamic contrast-enhanced perfusion: early intense with mild early washout (< 20% by 40 seconds) positive</p><p>Enhancement kinetics: Ktrans 0.37, Kep 3.53, iAUC 5.44</p><p>Suspicion for extracapsular extension: 2 (1 = very low suspicion, 2 = unlikely, 3 = intermediate suspicion, 4 = likely, 5 = definite)</p><p>Suspicion for neurovascular bundle involvement: 1 (1 = none, 2 = possible, 3 = highly likely)</p><p>Suspicion for seminal vesicle invasion: 1 (1 = very low suspicion, 2 = unlikely, 3 = intermediate suspicion, 4 = likely, 5 = definite)</p><p>Overall PI-RADSv2.1 Score: 4/5 (1=very low suspicion, 5=very highly suspicious).</p><p>Overall UCLA Score: 4/5 (1 = very low suspicion, 5 = very highly suspicious).</p><p></p><p>Limited views of the pelvis reveal no enlarged lymph nodes. Small volume free fluid in the pelvis.</p><p><span style="font-size: 22px"><strong>Component Results</strong></span></p><p>There is no component information for this result.</p></blockquote><p></p>
[QUOTE="ocman, post: 157031, member: 770"] UPDATE: 8-22-19, [USER=71]@Orrin Israel[/USER] what do you think? I got the results back from the MRI and the score is PI-RADS 4/5, one question I didn't ask was the size of the suspicious area. They recommended that I get a Fusion Biopsy. Here's the test results: [SIZE=22px][B]Study Result[/B][/SIZE] [SIZE=18px][B]Impression[/B][/SIZE] IMPRESSION: 1. Focal findings suspicious for neoplasia, PI-RADS 4 lesion in the right posterior lateral peripheral mid gland. 2. Capsular margin: intact -unlikely extracapsular extension. Overall PI-RADS Category: 4/5 Standardized reporting guidelines follow recommendations by ACR-ESUR PI-RADS v2.1 I, David Lu, M.D., have reviewed this radiological study personally and I am in full agreement with the findings of the report presented here. Appendix (based on UCLA data/publications) Overall MRI sensitivity for prostate cancer detection = 47% Sensitivity for tumors > 1 cm or for Gleason > 3 + 4 = 72% Biopsy yield for prostate cancer based on overall level of suspicion: 3/5 = 16 - 24% 4/5 = 37 - 78% 5/5 = 80 - 96% 1. Eur Urol 2019;75(5):712-720 2. Radiology 2017;283(1):130-139 3. Cancer 2016;122(6):884-892 4. Abdom Radiol 2016;41:954-962 5. Eur Urol 2015;67(3):569-576 6. Am J Roentgenol 2015;1:W87-92 Dictated by: Eric Rupe 8/16/2019 2:58 PM Signed by: David Lu 8/16/2019 8:41 PM [SIZE=18px][B]Narrative[/B][/SIZE] 3T MRI OF THE PROSTATE WITH AND WITHOUT CONTRAST and with 3D post-processing CLINICAL HISTORY: Elevated PSA PSA 4.8 ng/mL 7/25/2019 COMPARISON: None. TECHNIQUE: MRI of the pelvis was performed on a 3 Tesla Siemens Skyra scanner. A transabdominal phased array was used. Small field of view sagittal, axial oblique and coronal oblique T2W TSE high resolution images and diffusion weighted images with apparent diffusion coefficient map were obtained. Pre- and post-contrast axial dynamic view-sharing time-resolved gradient recalled echo T1-weighted images are acquired with intravenous administration of gadolinium contrast. Offline post-processing on a dedicated InVivo DynaCAD 3 workstation was performed for generation of time-intensity curves and pharmacokinetic maps and 3D contouring of the prostate gland and any target lesions using combined automated and manual segmentation techniques. CONTRAST: gadobutrol (Gadavist) 1 mmol/mL inj 10 mL. GLUCAGON: No FINDINGS: Quality: Excellent The prostate measures 31 g based on contour, (4.0 cm x 3.8 cm x 4.4 cm). PSA Density0.15 ng/mL/cc The background transition zone is heterogeneous. The background peripheral zone is heterogeneous. The following appears suspicious (>= PI-RADS 3): Target #1 / ROI #14 (3D T2 slice #30) Location: right posterolateral peripheral midgland Clock-face axial location: 8 o'clock Cranio-caudal location: 15% of distance from apex to base Longest diameter: 0.7 cm Capsular involvement: may abut the capsule T2 signal: round circumscribed moderately T2 hypointense, 4/5 suspicion Diffusion-weighted imaging: focal moderately hyperintense high B-value DWI and moderately hypointense ADC, 1169 square microns/second, 3/5 suspicion Dynamic contrast-enhanced perfusion: early intense with mild early washout (< 20% by 40 seconds) positive Enhancement kinetics: Ktrans 0.37, Kep 3.53, iAUC 5.44 Suspicion for extracapsular extension: 2 (1 = very low suspicion, 2 = unlikely, 3 = intermediate suspicion, 4 = likely, 5 = definite) Suspicion for neurovascular bundle involvement: 1 (1 = none, 2 = possible, 3 = highly likely) Suspicion for seminal vesicle invasion: 1 (1 = very low suspicion, 2 = unlikely, 3 = intermediate suspicion, 4 = likely, 5 = definite) Overall PI-RADSv2.1 Score: 4/5 (1=very low suspicion, 5=very highly suspicious). Overall UCLA Score: 4/5 (1 = very low suspicion, 5 = very highly suspicious). Limited views of the pelvis reveal no enlarged lymph nodes. Small volume free fluid in the pelvis. [SIZE=22px][B]Component Results[/B][/SIZE] There is no component information for this result. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Prostate Related Issues
PSA at 5.3
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