Leaning cryo seems like only choice

Steve1961

many of you know my story i’ve had a reoccurrence after five years of external beam and a booster. Below is the report of my biopsy, which I am having problems making heads or tails of the bottom line is being told. I have a high risk tumor. The cryotherapy specialist is now telling me that no matter what treatment I choose radiation cryotherapy even surgery I will only have a 50% chance of beating this This is why they suggest cryotherapy because it has the least side effects. Will have to ask the prostate specialist/ surgeon from UCLA Why would surgery only give me a 50% chance specially if the pet scan is showing no external cancer. This is going to be a tough decision because I’m also being told you can only treat the prostrate twice, but maybe a surgery could be a third option Seems like I’m just buying time here since it’s cribform I hope not I will meet with the surgeon today from UCLA who is also an expert. He has done many salvage surgeries, and he has a special interest in high-risk patients so I will have a lot of questions for him and I will get back to you wonderful people, but if anybody can make heads or tails of what the biopsy report means , that would help me out ..looks like to me. There may be more cancer just the one tumor but that’s not what I’m being told. I’ve been told it’s just a single tumor.

FINAL PATHOLOGIC DIAGNOSIS A. Prostate, Right apex, core needle biopsy: Prostatic adenocarcinoma with radiation changes; see comment. B. Prostate, Right mid, core needle biopsy: Prostatic adenocarcinoma with radiation changes; see comment. C. Prostate, Right base, core needle biopsy: Benign prostate tissue with radiation changes. D. Prostate, Right anterior, core needle biopsy: 1. Prostatic adenocarcinoma; Gleason score 4+4=8; see comment. 2. Adjacent benign prostate tissue with radiation changes. E. Prostate, Left apex, core needle biopsy: Prostatic adenocarcinoma with radiation changes; see comment. F. Prostate, Left mid, core needle biopsy: Benign prostate tissue with radiation changes. G. Prostate, Left base, core needle biopsy: Benign prostate tissue with radiation changes. H. Prostate, Left anterior, core needle biopsy: Prostatic adenocarcinoma with radiation changes; see comment . I. Prostate, MRI #1 Right prostatic apex, core needle biopsy: 1. Prostatic adenocarcinoma; Gleason score 4+4=8; see comment. 2. Prostatic adenocarcinoma with radiation changes. COMMENT: In this case we note prostatic adenocarcinoma with no treatment effect in parts D and I for which Gleason score has been provided. In addition there are scattered foci of prostatic adenocarcinoma with radiation changes; this is seen mostly as discontinuous single cells and single glands. Gleason score is not applicable in treated carcinoma, and as such Gleason score is not provided for treated tumor. Lastly, radiation changes are seen in benign prostate tissue. In part I, there is carcinoma with no radiation changes and small scattered foci of prostate carcinoma with radiation changes. In part D, the tumor focus is too small for accurate grading and Gleason score 4+4=8 is favored. Gleason pattern 4 is comprised of expansile cribriform and poorly formed gland types. Slide for part I was also reviewed by Dr Simko at the GU case consensus conference on 10/25/2023 with agreement on the Gleason score and interpretation. Specimen A 1 of 1 core contains carcinoma. The total length of tumor in all of the cores is 5.5 mm (discontinuous). The total length of tissue in all of the cores is 16.2 mm. The percentage of the tissue involved by tumor is 34% (discontinuous). The percentage of tumor greater than Gleason pattern 3 is not applicable. Perineural invasion is not present. No extraprostatic tumor is seen. Specimen B 1 of 2 cores contain carcinoma. The total length of tumor in all of the cores is <0.1 mm. The total length of tissue in all of the cores is 39 mm. The percentage of the tissue involved by tumor is <1%. The percentage of tumor greater than Gleason pattern 3 is not applicable. Perineural invasion is not present. No extraprostatic tumor is seen. Specimen D 1 of 2 cores contain carcinoma. The total length of tumor in all of the cores is 1 mm. The total length of tissue in all of the cores is 22 mm. The percentage of the tissue involved by tumor is 4%. The percentage of tumor greater than Gleason pattern 3 is approximately 100%. Perineural invasion is not present. No extraprostatic tumor is seen. Specimen E 2 of 2 cores contain carcinoma. The total length of tumor in all of the cores is 21 mm (discontinuous). The total length of tissue in all of the cores is 34 mm. The percentage of the tissue involved by tumor is 62% (discontinuous). The percentage of tumor greater than Gleason pattern 3 is not applicable. Perineural invasion is not present. No extraprostatic tumor is seen. Specimen H 1 of 1 core contains carcinoma. The total length of tumor in all of the cores is 0.5 mm. The total length of tissue in all of the cores is 20 mm. The percentage of the tissue involved by tumor is 2.5%. The percentage of tumor greater than Gleason pattern 3 is not applicable. Perineural invasion is not present. No extraprostatic tumor is seen. Specimen I 2 of 4 cores contain carcinoma. The total length of tumor in all of the cores is 6.3 mm. The total length of tissue in all of the cores is 53 mm. The percentage of the tissue involved by tumor is 12%. The percentage of tumor greater than Gleason pattern 3 is approximately 100%. Perineural invasion is not present. No extraprostatic tumor is seen. Specimen(s) Received A:Right apex B:Right mid C:Right base D:Right anterior E:Left apex F:Left mid G:Left base H:Left anterior I:MRI #1 Right prostatic apex Clinical History Relevant History: 62 y.o. with clinically localized prostate cancer (PSA 8.1, Gleason3+4, stage T1cNM) prostate cancer s/p definitive radiation therapy. -MRI LESION #1: RIGHT PROSTATIC APEX Submitting Diagnosis: ICD-10-CM:C61:Malignant neoplasm of prostate (CMS code) Gross Description The case is received in nine parts, each labeled with the patient's name and medical record number. Part A is received in formalin and additionally labeled "right apex," consists of a single 0.1 cm-thick cores of soft tan-white tissue. The cores each have a length of 1.3 cm. All into cassette A1. (lds) Part B is received in formalin and additionally labeled "right mid," consists of three 0.1 cm-thick cores of soft tan-white tissue. The cores each have a length of 1.4 cm, 1.9 cm and 0.4 cm. All into cassette B1. (lds) Part C is received in formalin and additionally labeled "right base," consists of two 0.1 cm-thick cores of soft tan-white tissue. The cores each have a length of 1.3 cm and 1.6 cm. All into cassette C1. (lds) Part D is received in formalin and additionally labeled "right anterior," consists of a single 0.1 cm-thick core of soft tan-white tissue. The core has a length of 2 cm. All into cassette D1. (lds) Part E is received in formalin and additionally labeled "left apex," consists of two 0.1 cm-thick cores of soft tan-white tissue. The cores each have a length of 2 cm and 1.5 cm. All into cassette E1. (lds) Part F is received in formalin and additionally labeled "left mid," consists of two 0.1 cm-thick cores of soft tan-white tissue. The cores each have a length of 1.8 cm and 2 cm. All into cassette F1. (lds) Part G is received in formalin and additionally labeled "left base," consists of two 0.1 cm-thick cores of soft tan-white tissue. The cores each have a length of 1.4 cm and 2.1 cm. All into cassette G1. (lds) Part H is received in formalin and additionally labeled "left anterior," consists of a single 0.1 cm-thick core of soft tan-white tissue. The core has a length of 1.8 cm. All into cassette H1. (lds) Part I is received in formalin and additionally labeled "MRI lesion #1 right prostatic apex," consists of four 0.1 cm-thick cores of soft tan-white tissue. The cores each have a length of 1.3 cm, 1.3 cm, 1.6 cm and 0.6 cm. All into cassette I1. (lds) The diagnosis may have been rendered in whole, or in part, using whole slide digital images of the glass slides on Philips’ FDA-approved (21 CFR 864.3700) PIPS-based platform validated at UCSF. If immunofluorescence, immunohistochemistry or in-situ hybridization was performed and evaluated at UCSF in the above report, all controls performed with the stains reported above reacted appropriately. These stains were developed and their performance characteristics determined by the UCSF Medical Center Department of Pathology. They have not been cleared or approved by the U. S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. These tests are used for clinical purposes. They should not be regarded as investigational or for research. This laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 ("CLIA") as qualified to perform high-complexity clinical testing.

Steve1961

In part I, there is carcinoma with no radiation changes and small scattered foci of prostate carcinoma with radiation changes. In part D, the tumor focus is too small for accurate grading and Gleason score 4+4=8 is favored. Gleason pattern 4 is comprised of expansile cribriform and poorly formed gland types. 

this where I’m confused if it’s too small to get an accurate reading, how can they determine 4+4 and a cribiform features

centralPA

They say that you have 4+4 in Part I. For Part D they say “4+4 is favored” so that is what they are placing their bet on for Part D. But in Part I, it is 4+4.

Thats how I read it. But send a note to the pathologist and ask them to clarify. I did on a report, and he got right back to me.