To Treat or Not To Treat??

dale1k

I just had my consultation with my urologist.. I am borderline active surveillance and treatment based on my biopsy (24 samples) which showed one small tumor in one small area (2 core samples ..25% tissue ) graded 4+3.. Although surgery is his specialty, he ordered a genomic test (Decipher) will wait for results of that test in order to get more info on the potential aggressiveness of that 4+3 graded area.. He also mentioned that because of the size and location of the cancer, if treatment is needed, Radiation and possibly even Focal therapy may be the best options.. My question: Wouldn't a PSMA Pet scan be necessary first if the Decipher result indicates a high potential for aggressive cancer?? Also wondering how reliable is the Decipher test??

centralPA

Curious...your last post in your other thread said that most of your 24 samples were 3+3. Is this true? If so, by NCCN guidelines, if most of your cores were positive (over 50%), this would suggest you are Unfavorable Intermediate just due to having over 50% of the cores positive, whether 3+3 or higher.

If instead you only have a small sample of positive cores but they are 4+3, that would push you into Grade Group 3, which makes you Unfavorable Intermediate for that reason.

What was your PSA?

It sure sounds like treatment is in your future. Can you post the full biopsy pathology report?

dale1k

https://csn.cancer.org/discussion/comment/1697894#Comment_1697894

Here is the actual report... I guess I should have stated that most of the cancer found was 3+3.. As you can see, there were also benign samples... I thought that 3+3 was normally classified as lower risk?? I am still learning as much as I can ... I'm thinking the presence of any 4+3 will likely trigger some type of treatment but crossing fingers maybe not...

DIAGNOSIS:

Prostate, right posterior medial, needle biopsy:

- Adenocarcinoma, Gleason grade 3+3 = score 6, in one of two cores, measuring 1 mm in length, and involving approximately 7% of the needle core tissue

Prostate, left posterior medial, needle biopsy:

-Adenocarcinoma, Gleason grade 3+3 = score 6, in three of multiple core fragments, measuring 7 mm in length and involving approximately 37% of the needle core tissue

Prostate, left posterior lateral, needle biopsy:

- Atypical small acinar proliferation

Prostate, left base, needle biopsy:

- Benign prostatic tissue

Prostate, left anterior medial, needle biopsy:

- Adenocarcinoma, Gleason grade 3+3 = score 6, in two of two cores, measuring 4 mm in length, and involving approximately 17% of the needle core tissue

Prostate, left anterior lateral, needle biopsy:

- Adenocarcinoma, Gleason grade 4+3 = score of 7, in two of two cores, measuring 4 mm in length, and involving approximately 25% of the needle core tissue

Prostate, right posterior lateral, needle biopsy:

- Benign prostatic tissue

Prostate, right base, needle biopsy:

- Benign prostatic tissue

Prostate, right anterior medial, needle biopsy:

- Benign prostatic tissue

Prostate, right anterior lateral, needle biopsy:

- Benign prostatic tissue

lkb/6/7/2022 15:50

centralPA

So I read your pathology as having cancer in both sides of the prostate so you are T2c, and you are GG3 because of the 4+3 score. Definitely at least GG2 since you have some 4 cancer there. Either way, those are two intermediate risk factors, which means you are Unfavorable Intermediate scored.

Since the cancer is on both sides and seems spread out, focal therapy doesn’t jump to mind as a course of action.

How old are you? Expected life span?

Worth signing up and reading these guidelines. Ultimately it’s between you are your doctor, but the guidelines are empirically derived.

https://www.nccn.org/

Clevelandguy

Hi,

You are right, you are in my non medical opinion borderline active surveillance. The grade 4 was in two samples, most of your cancer was on the left side. The PET scan could tell you whether the grade 4 was deep inside or near the edge of the gland? If you wait too long a grade 4 near the edge of your gland could be a problem that could escape to other parts of your body, not good. Was a bone scan done to determine if the cancer has escaped the gland?

It’s really up to your team of doctor’s (Oncologist+Urologist) to determine your next step. Radiation or Surgery would be good choices, study the risks of both and decide.

Dave 3+4

dale1k

https://csn.cancer.org/discussion/comment/1697902#Comment_1697902

https://csn.cancer.org/discussion/comment/1697898#Comment_1697898

I'll be 68 in a month... I do have some other conditions that need to be taken into consideration... That was also a part of the conversation I had with my urologist.. One requires me to take Hydroxyurea(a chemo drug) in capsule form to combat a rare blood disease(Polycythemia Vera).. I've never heard of it before I was diagnosed... Life expectancy: that's unknown... 15 years if I'm really lucky... ?? For now, I feel really good and am very active despite the nasty medication I am taking... My Oncologist and Urologist both are affiliated with the Washington University School of Medicine and the Siteman Cancer Center outside of St louis which happens to be a member institution of the NCCN..

dale1k

Thanks for your comment Dave... I actually brought up the PSMA Pet Scan and my urologist said that would be premature at this time.. He stated that the 4+3 cancer was in a localized area that it was contained within the gland... So I am waiting for the Decipher genomic test results he ordered and should have those in another week.. No bone scan has been done... I think my urologist is using the MRI as well as the biopsy results ...He set me up with a radiation oncologist who I will see in early August for consultation.. If a treatment regimen is recommended, my thinking is that should include a PSMA Pet Scan so I can make the best decision as to what treatment direction would be best for me...

MK1965

dale1k,

First, I would like to confirm presence oh GL 4 % in 4+3. Secondly, I would send biopsy samples to John Hopkins to make sure it is 4+3. If it gets downgraded to 3+4 or 3+3 that gives you different prospective on your treatment or staying on AC.

I had same situation 4+3 In 1 sample with 55% of 4. My urologist sale pitch was 4+3 could easily turn to 4+4 and least likely to be downgraded to 3+3. Fortunately, after RP I was downgraded to 3+4 but with still 40% of 4. Cancer was present in both sides of prostate. I was 51 y/o. Unfortunately, after RP (5+ years ago), I never recovered my sexual function, still having stress incontinece and lost 2+ inches of my penis length with also total anorgasmia.

So, you can see; choosing surgery was terrible mistake for me.

i wish you good outcome with whatever you choose.

MK

dale1k

https://csn.cancer.org/discussion/comment/1697939#Comment_1697939

Thanks for your comment... I have read enough from a number of sources to know I need to be very careful with any decision ... That would include a 2nd opinion on the biopsy results... Because of my other medical condition, if treatment really is necessary, surgery would be a last resort... I don't need that kind of trauma while facing a blood disease that currently has no cure.. One thing I have learned is that when it comes to prostate cancer, there are cases being undertreated and overtreated.. I am going to do my best to avoid being in either of those groups... I know the best way to increase the odds of a good outcome is to get as much verified information as possible... I'm still not sure how much credence to put on the Decipher genomic test.. Nobody in the group has commented on that yet.. I really appreciate your post and feel bad you didn't have a better outcome..

Dale

centralPA

On the decipher test, I had a similar test for me, the Prolaris. They can only refine the distribution of outcomes, not tell you yes or no. In my decision to pursue AS, it was another ingredient in the stew of doctor opinion, biopsy result, MRI result, etc., etc. The prolaris test suggested AS was a reasonable choice, which was confirmatory with my gut feeling.

One way to look at it is if the decision is hard, if it appears that there is no clear winner of a choice, then in some ways the decision is easy. If all choices are reasonable, then any of them will do. Pick the one that is your gut feel.

Your preexisting condition is an important element of this. You’re on it.

Best of luck, Dale!