prostate biopsy interpretation - my take is that prostatectomy is called for

moksha2022

Below is my most recent MRI guided prostate biopsy results.

I am in my late 60's and relatively healthy.

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Pathologic Diagnosis

Malignant neoplasm of prostate [C61] - primary.

A. Prostate, right lateral base, biopsy:

Prostate tissue with no significant pathologic change

===> all right side prostate samples (B throuh E) repeat above.

    No finding.

===> Below are the findings on the left side.

F. Prostate, left lateral base, biopsy:

Prostatic adenocarcinoma, Gleason score 3+4=7,involving 2 of 2 cores and 40% of the tissue

Perineural invasion

G. Prostate, left lateral mid, biopsy:

Prostatic adenocarcinoma, Gleason score 4+3=7, involving 2 of 3 cores and 10% of the tissue

H. Prostate, left apex, biopsy:

Prostate tissue with no significant pathologic change

I. Prostate, left mid, biopsy:

Prostatic adenocarcinoma, Gleason score 3+3=6, involving 1 of 1 core and 5% of the tissue

J. Prostate, left base, biopsy:

Prostate tissue with no significant pathologic

K. Prostate, ROI #1, biopsy:

Prostatic adenocarcinoma, Gleason score 4+3=7,

involving 3 of 3 cores and 60% of the tissue

• Perineural invasion

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I have had two urologists - both with robotic surgery skills from different respected organizations - look at me and do biopsies over the last year. The numbers above are from my last.

I have attached the numbers from the one done earlier in 2021.

first-biopsy.txt

Both urologists seem to be recommending surgery. Based on their expertise?

I had been doing weekly testosterone injections to compensate for low levels of testosterone but stopped when the prostate biopsy scare started. I would like to resume those injections largely for the energy, drive and focus it provided. Sex would be another reason - although there is an obvious irony here. ;-)

My take based on my reading and what I'm seeing above is that prostate removal is justified.

Friends are encouraging me to look into other forms of treatment - radiation, etc. for fear of the complications they have heard others have after surgery.

So - just curious as to what the numbers above suggest to this community.

Does surgery make sense?

The decision is clearly mine - but I'd like a little group wisdom.

Thanks!

Rob.Ski

If you talk to RO, probably get the radiation recommendation. I will say that two different RO's told me to go get surgery to leave me with better options down the road. The more info you have the better. I'd talk to an RO in your shoes.

Old Salt

It's not surprising that your urologists recommended removal; it's what they do and what puts the butter on their bread. I would want to talk to radiation oncologists as well and then make a decision. There are several modalities (low-dose and high-dose brachy, IMRT and SBRT) that can be used. It pays to talk to specialists for each of those therapies.

I do note the perineural invasion; it's a concern and I would question your urologists and the radiation oncologists about their approach to that issue.

Clevelandguy

Hi,

I was a 3+4 with Perineurial invasion, I had surgery back in 2014 but each person needs to decide for themselves which course to chart. Good to talk with a radiation oncologist to get their perspective. Great facilities + great doctors = great results, so find the best of both you can. It’s entirely up to you to make the decision based on your unique circumstances. With the Perineurial if it was me I would make the decision sooner than later, don’t want to let the horse leave the barn which will lead to more problems.

Dave 3+4

ASAdvocate

If I were you, with that core having 60 percent G(4+3) I would do a combination of IMRT and high dose rate brachytherapy. Brachy boost therapy has impressive non-recurrence results for higher risk cases.

My opinion is based on my twelve years of researching possible treatments, should it ever become necessary.