Biopsy results are in...

BruceinPA

...and I've got a few questions. Since my follow-up with the doc is not scheduled until December 21, I am going to start by asking here. It looks like you guys are a wealth of great information!

Background: First biopsy in March 2018 found one core (of 12) with less than 10% Gleason 3+3. Active surveillance, with PSA test and appointments every 6 months. Second biopsy in May 2019, basically same result. Third biopsy this month, results show one core with Gleason 4+4 (22%).

I assume I am headed for scans & further testing to make sure this is still contained. And then either surgery or radiation to attack the problem.

Just two preliminary questions that you can help with at the moment:

• How common is it to get a 2nd opinion on the lab results? I know my first biopsy in 2018 was sent to Johns Hopkins for review before the diagnosis was confirmed. Should I request that if it's not offered?
• For those of you who have gone to surgery or radiation after a biopsy, how much time elapsed between getting the results and having the surgery or starting treatment?

Any other advice is, of course, welcome. I have a request in to at least speak with my doctor ASAP.

Thanks in advance.

Clevelandguy

Hi Bruce,

To answer your first question it is not uncommon to get a second opinion about your Gleason score. If you feel the need for peace of mind go for it.

For your second question I had surgery a couple of months after my biopsy after I had a chance to consult with both the Urologist and Oncologist to get both opinions.

4+4 is on the aggressive side so if was me my days of AS would be over, time for action. Depending on the location of the cancer(close to the edge or buried deep inside) should also way in on your timeframe. Both surgery and radiation have good cure rates so now is the time for homework on the side effects. You can view one of my recent posts for my thoughts on the surgery. It’s your body, your choice and you must live with the results so study,study,study. I have included a link to get you going.

https://www.cancer.org/cancer/prostate-cancer/treating.html

Dave 3+4

GoneWest

https://csn.cancer.org/discussion/324463/biopsy-results-are-in

I can only answer your 2nd question and for me it was pretty quickly, within 2 months of getting results. but I suppose that depends a lot on availability of the surgeon and beds. In my case there was not an empty bed in the place for the 1 night I stayed there and the staff seemed overwhelmed. Good luck to you!

Old Salt

It's a really good idea to get a second opinion on the biopsy result.

Ask the urologist that All of your slides be sent to Dr Epstein at Johns Hopkins, the ultimate 'deciderer'.😊

Send a Consult for Second Opinion | Johns Hopkins Pathology (jhu.edu)

With respect to your second question, with your Gleason score (4+4) in one core, and because prostate cancer usually is slow growing, you can wait for Dr Epstein's second opinion. Nothing wrong though with reading up on the various therapies that might be available to you.

Max Former Hodgkins Stage 3

Bruce,

I've never heard anyone here recommend against a second look at a biopsy; if there is any ambiguity, have it reviewed. But from your first post, it sounds as if your treatment center is very diligent in verifying things. Ask your lead doctor if it has perhaps already been submitted at a second lab. Be aware that the general occurrence is for PCa biopsies to show false negatives, and doing so is a sort of underestimation of the disease. I would demand a LOT of proof that the 4+4 Gleason is incorrect. Lacking such proof, you must assume it is accurate. You want to proceed timely, without panic. A few extra weeks in speaking with various experts will improve your treatment outcome, not worsen it. I was diagnosed with advanced lymphoma in 2009, and it was over three months later before I received my first treatment. There was about six weeks between my PCa diagnosis and the day of my R.P. In that interim I met with doctors, discussing options -- time well spent.

BruceinPA

Thanks to all who have responded with personal stories and advice. It’s been awhile since I updated my status, which I’m going to do now in a new post.