biopsy results prostate Comments please !!!

bruce12345
bruce12345 Member Posts: 4 Member
edited February 2022 in Prostate Cancer #1

Psa 3.98 4k blood test 5.1 regular blood test

Comments please. Talking to Dr tomorrow. Thank you !!! 72 years old excellent health.


A. Prostate, region of interest; needle biopsy:

  • Benign glandular and stromal prostatic tissue demonstrating focal minimal chronic inflammatory infiltrates and areas of acinar atrophy.
  • No evidence of high-grade prostatic intraepithelial neoplasia (HGPIN) or malignancy identified.

 

B. Prostate, left base; needle biopsy:

  • Prostatic adenocarcinoma, Gleason's pattern 3+4 = 7 (grade group 2) involving 1 of 2 tissue fragments and approximately 5% of the total submitted prostatic tissue (1.0 mm in maximum dimension).
  • No definitive evidence of tumor perineural invasion or lymphovascular invasion identified.
  • Focal mild acute and chronic inflammatory infiltrates and areas of acinar atrophy are also present.

 

C. Prostate, left apex; needle biopsy:

  • Benign glandular and stromal prostatic tissue demonstrating focal mild chronic inflammatory infiltrates and areas of acinar atrophy.
  • No evidence of high-grade prostatic intraepithelial neoplasia (HGPIN) or malignancy identified.

 

D. Prostate, right base; needle biopsy:

  • Benign glandular and stromal prostatic tissue demonstrating focal minimal chronic inflammatory infiltrates and areas of acinar atrophy.
  • No evidence of high-grade prostatic intraepithelial neoplasia (HGPIN) or malignancy identified.

 

E. Prostate, right mid; needle biopsy:

  • Benign glandular and stromal prostatic tissue demonstrating areas of acinar atrophy.
  • No evidence of high-grade prostatic intraepithelial neoplasia (HGPIN) or malignancy identified.

 

F. Prostate, right apex; needle biopsy:

  • Benign glandular and stromal prostatic tissue demonstrating focal minimal chronic inflammatory infiltrates and areas of acinar atrophy.
  • No evidence of high-grade prostatic intraepithelial neoplasia (HGPIN) or malignancy identified.

 

Comment:

For quality assurance purposes, a second pathologist has reviewed the case and concurs with the above diagnostic interpretations.

Comments

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    edited February 2022 #2

    Hi Bruce,

    According to the above, they found only one positive core with prostate cancer. The Gleason score 7 is considered as of intermediate risk but the low percentage of 5% gives you the possibility in discussing with your doctor on the possibilities in active surveillance (AS). In other cores they diagnosed benign chronic inflammatory infiltrates which could justify the high PSA.

    Surely you may want to do some sort of intervention to get rid of the cancer but you need to also consider the risks involved in treatments which will prejudice your present quality of life.

    I wonder what made you to get a biopsy. Do you have/had any symptoms?

    In your shoes I would go for a 3t MRI to get additional information and be more certain of the biopsy report. In any case, with such diagnosis I would give preferences to Active Surveillance.

    Welcome to the board.

    Best wishes

    VG

  • bruce12345
    bruce12345 Member Posts: 4 Member
    #3
    https://csn.cancer.org/discussion/comment/1693281#Comment_1693281

    I had a MRI

    LEFT LOBE: In the left lobe of the gland posterior transition zone at mid gland there is a non circumscribed, homogeneous, moderately hypointense lesion that measures 1.3 x 1 cm and axial dimensions and 1.1 cm in craniocaudal

    diameter. This demonstrates moderate increased signal on the high B value diffusion sequence and is moderate decreased signal on the diffusion sequence. This is considered a PI-RADS 4 lesion. There is a benign-appearing nonenhancing non diffusion

    restricting cyst left base near the left seminal vesicle which could be a degenerative BPH nodule or cyst related to the seminal vesicle measuring 1.6 cm.

    CONCLUSION: There is 1 reference lesion described above in the left transition zone posterior mid gland with maximum diameter of 1.3 cm. This is a PI-RADS 4 lesion.

  • centralPA
    centralPA Member Posts: 341 Member
    #4

    So it seems like they sampled the region of interest from the MRI and did not find cancer, but did find a small amount from an additional random sample, correct? And you only had 6 samples? Or are you leaving some out?

  • bruce12345
    bruce12345 Member Posts: 4 Member
    #5
    https://csn.cancer.org/discussion/comment/1693288#Comment_1693288

    That is correct. They took 15 samples, the normal 12 and 3 where the MRI said there was one. It was on the left side. Even the Dr was surprised. They did a fusion biopsy .

  • centralPA
    centralPA Member Posts: 341 Member
    #6
    https://csn.cancer.org/discussion/comment/1693289#Comment_1693289

    Hmmm, I had a similar fusioned 12 and 3, but the 12 were normal while 2 of the 3 were grade group 1 (3+3=6). I had 70% of one of them being the cancer. I’ve opted for AS.

    I can see why the doctor would be surprised.

    Best of luck with your decision.

  • ASAdvocate
    ASAdvocate Member Posts: 193 Member
    #7

    My personal threshold for leaving active surveillance and having interventional treatment would be two cores with ten percent or more Gleason pattern 4 present. You are below that criteria.

    I am seeing more and more men with small amounts of Gleason 4 choosing AS. Those who have a Decipher test with favorable results are confident in that choice.

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,819 Member
    #8

    My Comment is that everything points toward minor PCa, intermediate aggressivity, of very limited volume. It should be very easily monitored and controlled, via any of the common modalities: AS, radiation, surgery, brachytherapy, etc. You have a long time, probably years, to make or change these responses, as the data suggest.

  • centralPA
    centralPA Member Posts: 341 Member
    edited February 2022 #9
    https://csn.cancer.org/discussion/comment/1693290#Comment_1693290

    FYI, commenting on my own post, I just got a second opinion on my biopsy, from Dr. Epstein at Hopkins. Original was 3+3=6, his reading came back 3+4=7, with 5% of that being pattern 4. Still intend to pursue AS, but it changes a the risk calculus a bit. Moved from Low Risk to Favorable Intermediate. Waiting on the genomics test.

  • bruce12345
    bruce12345 Member Posts: 4 Member
    #10
    https://csn.cancer.org/discussion/comment/1693349#Comment_1693349
    https://csn.cancer.org/discussion/comment/1693349#Comment_1693349

    Just talked to my doctor yesterday he's going to run the same test on my leftover biopsy parts and see what it says. He says I have such a small amount that he doesn't think surgery is for me but perhaps proton radiation.

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,819 Member
    #11

    Bruce, proton is a very reasonable choice, with very few side-effects. About as easy and minimally disruptive is brachytherapy ("seeding"). Surgery would be a bit draconian at this point. And AS is quite reasonable, allowing curative intervention later if necessary. Ask about brachytherapy next doctor's visit.... But do wait for the further biopsy that the doc is running, since underestimation of Gleason is a relatively common thing, as is completely false negative results. You are obviously quite engaged in this process, and by all indications you have an excellent doctor. You will decide the best path,

    max

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