Biopsy returns with gleason score 4+4, nervous about getting schedule setup with specialist

vmen70

Got my biopsy report and its worse than I hoped. Had a fusion mri assisted biopsy. Area of interest was one lesion. Two core samples were taken at the area of interest - both had 4+4 Gleason score, with Perineural invasion present. Other core samples (12 core samples were taken through out prostate. All negative for carcinoma. Trying to set up appointments with the various treatment specialists. Seems that appointments are only available at month out. After a high psa number it took a month to get a mri, after the mri results it took another month to do the biopsy. Now its going be a month before a I can see a treatment specialist. Should I worry about not getting quicker appointments? Is this typical time frame in getting appointments? The cancer specialists I am trying to get to see are part of Duke U cancer center.

Clevelandguy

Hi,

You stated that you had Perineurial invasion which probably means the cancer is very close to escaping the Prostate capsule. In my non doctor opinion I would get it looked into soon rather than later. Once the cancer leaves the Prostate capsule it can be harder to treat. You should also be meeting with an Oncologist for possible radiation treatment if you choose that route. As far as doctor appointments you could shop around to get a quicker appointment or if you really like this doctor you might have to wait. Great doctors + great facilities = great results, so be careful on selecting your team. As an extra note I too had Perineurial invasion but after 7 yrs. my PSA is still undetectable so all is not lost just because of the Perineurial thing.

Dave 3+4

Old Salt

I would like to know your PSA 'history' before making a statement. Did it go up quickly of late? In general, waiting one month should be OK because adenocarcinoma is slow growing.

In the meantime, you can familiarize yourself with the various treatment options. Not fun, but well worth your time.

vmen70

https://csn.cancer.org/discussion/comment/1696614#Comment_1696614

PSA history has be typically around 1.0 up till 2020, it went to 1.28, end fo 2021 - 3.40 last one jump to 5.3 on March 15. After that reading did the MRI, which showed one lesion, (done in April) and did the biopsy last week. The biopsy stated that cancer cells are adenocarcinoma. The targeted core had the 4+4, 14 other samples in other areas of the prostate were clean. Got an appointment with radiation dr in 2 weeks, surgery urologist in 3 weeks.

Old Salt

Glad you got those appointments coming up soon.

Do make a list of all the questions you have.

As an aside, there are several kinds of radiation therapies, and each has its own set of specialists. Most of them will recommend just the method they are familiar with... You really do need to do your own 'homework'.

Brachytherapy (High Dose Rate and 'seeds').

Conventional radiation, IMRT

Stereotactic Body Radiation Therapy (SBRT)

Proton radiation therapy

J69

vmen70, sorry to see you here. I am also a GL-8 and chose IMRT 28 sessions with ADT added for 18 months. I would have gone with surgery, but a previous TURP procedure made it a hit or miss proposition. Also because of the TURP I couldn’t do the other RA treatments. More than likely you will be put on ADT with either surgery or RA. Think positive and don’t stress out. Please keep us informed of which way you go.