The biopsy results are in...

BruceinPA

...and of course I have a few questions. Since my follow-up appointment with my urologist is not scheduled until December 21, I figured this might be a good place to ask. You guys seem like a very knowledgeable crew!

(Note: this is a rewrite of a post I submitted earlier today. It seems to have disappeared when I went in to edit a typo.)

Background: Diagnosed after a biopsy in March 2018 found less than 10% of one core with 3+3 Gleason. Active Surveillance since then. Second biopsy in June 2019 had similar findings. Appointments & PSA every six months, things have been holding steady. But October PSA rose from previous 6.2 to 8.9. Biopsy this week found one core (22%, 4 of 18 mm, left medial base) with 4+4 Gleason.

As stated, I haven't met with my doctor to discuss this -- I did ask for my appointment to be moved up after receiving the results -- but I have enough background to know this is heading toward some sort of treatment option, either surgery or radiation.

Anyway, I have two questions for those of you who have been down this road:

-- Is there anything to be gained by asking for a 2nd lab opinion on the biopsy? I know that there were questions about typing my first biopsy in 2018, and the sample was sent to Johns Hopkins for their opinion. Is there anything I could learn from having this re-evaluated? Should I even suggest it if my doctor does not?

-- For those who have transitioned form Active Surveillance to surgical or radiation treatment, how much time was there between biopsy and the start of treatment? Is this something that happens over a few weeks, or might it be months before things get rolling? My instinct is that this needs to happen ASAP and I will push for that if it seems appropriate. But I'd like to have some sense of what is the norm.

Thanks in advance for any advice you can offer. (And "ClevelandGuy" - thanks for replying to the original post. I did read your note, but when my post went away it took your comment, too.)

VascodaGama

It doesn't harm nobody for asking a second opinion. You should go for it if that gives you peace of mind. In fact, the urologist attending you is just passing you the information he received from the pathologist. He has no interference in the report. You can send or request him to send directly the biopsy all cores to the laboratory of your wish, including the results of an MRI that will provide more information in a second opinion.

The increase of the Gleason grade and score (4+4) sets you in the group of aggressive cases with risk for existing extraprostatic extensions, in spite of having only one positive core. You may investigate in multimodal therapies. Accordingly, most probably your doctor will recommend , stopping AS. You will need an MRI image study and probably a bone scintigraphy scan (BS) to try locating metastases and receive a clinical stage.

With these data (including the second opinion) in hand then you are better prepared to decide on what to do. Surely you have time to research further on options without decreasing any opportunity in having a successful treatment. PCa doesn't spread overnight. Your present status wouldn't alter much in 3 months time.

I think that you should include the opinion of your family at the decision process.

Best wishes and luck in this journey.

VGama

Rob.Ski

Some on this site recommend Epstein at John Hopkins for pathology. He's world renown. Can request him specifically. I had my first biopsy assessed by 3 different pathologist (as a result of switching doctors), all conclusions were the same. If you dig around on this site, you can find some people have had different outcomes from second opinions.

I'm headed for treatment in Jan. following AS for about 2 years but, my situation is a little different. Last biopsy was in May was Gleason 6 in 6 of 12 cores, 2 cores above 50%. High volumes and younger age (51) had me on the fence for AS. Got another rise in PSA in Nov. Felt like I was pushing it so, I'm pulling the trigger on treatment.

Josephg

I strongly recommend that you find and engage a Medical Oncologist to be the long term leader of your PCa medical treatment team. A Medical Oncologist has no professional preference for potential treatment options, such as surgery or radiation, and the Medical Oncologist is the expert in hormone therapies, which may be used in conjunction with other treatments, such as radiation. Personally, I've had PCa for over a decade, and my Medical Oncologist has been at my side for my entire PCa journey. Surgeons and Radiation Oncologists have come and gone with their treatments, at the direction of my Medical Oncologist, but my Medical Oncologist remains my sustaining medical professional and consultant.

BruceinPA

Thanks all for your suggestions and insights. And apologies for posting twice -- now it seems like the original post has reappeared. I have no idea what that's all about or what happened.

Anyway here's an update: I got a phone call from my urologist's office first thing this morning and my appointment was moved up from 12/21 to today at 10A. I was impressed by that.

Doc is sending my biopsy to JH for a 2nd opinion, as I had hoped. And meanwhile we are moving ahead, with me talking to both a surgeon (robotic surgery) and radiation oncologist to assess both approaches. I also have a prescription and will be setting up CT scan (with and without IV contrast) and a bone scan. MRI was done prior to the biopsy and guided the location of the core samples.

Doc was also reassuring about where things stand and is pretty confident that whatever is going on will be confined within the prostate. He took his time with me, answered all of my questions and listened as well as he explained. I have no doubts at this point that we are proceeding in exactly the right way. But I'm also sure that the it's early in the journey.