Different Types of Prostate Biopsies

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Comments

  • Oldernow
    Oldernow Member Posts: 47 Member
    #22

    Sounds like the next step should be a PSMA PET Scan to determine if there is any spread outside the prostate...

  • centralPA
    centralPA Member Posts: 322 Member
    edited February 13 #23

    You do have PCa, for sure, sorry you have to find that out. But I don't think it is so bad as you state it.

    You have mostly Gleason 6, with a little bit of Gleason 7, so Grade Group 2 overall. The Perineural Invasion is less than ideal, but is just one factor in the decision making.

    Which side was Target #1 on? Also the right side? If so, having it all on one side is better than on both sides.

    Now you know what your enemy is up to, and you can plan your counter-attack. I didn't see anything suggesting surgery isn't an option. Looks like you have lots of options.

    Good paper with good references cited...

    "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9454778/#B82-cancers-14-04065"

    A quote from it

    In addition, several studies have investigated the role of PNI in clinical decision-making and surgery techniques in PCa. For example, PNI was not a contraindication for bilateral nerve-sparing surgery in a cohort investigated by Loeb et al. In fact, the PNI-positive subgroup of this PCa cohort showed a significantly lower risk of progression after bilateral nerve-sparing surgery [85].

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    edited February 13 #24

    I am sorry this scenario has been so stressful.

    Considering your MRI showed PIRADS 5 lesions, I think that those biopsy results are actually pretty good. Now you can focus on getting treatment.

    I am pretty sure that there will be surgeons who will tell you that surgery is an option,. However, the perineural invasion finding needs to be taken into account.

    You have some time to consider all your options; I recommend you also study the various radiation therapies that are available for cases such as yours.

  • JasonB176
    JasonB176 Member Posts: 42 Member
    #25

    Thanks for the input guys. I'm trying to plan out my visit with my urologist. He is usually running an hour behind and visits with him are brief. I don't know if he will take more time given my diagnosis but I'm ready for him to say his recommendation and be done. I'm thinking it's best to say little until he's finished. At that point I will say that I'd like a second opinion. He's a surgeon but given the perineural invasion, it will be interesting to see if he still recommends that.

    I would think that he would have doctors who specialize in radiation in mind. I get confused about the oncologists. Is this a general type of cancer doctor whom should also be seen?

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #26

    You should get input from a radiation oncologist who specializes in prostate cancer. Preferably one in a well recognized academic center. I would try to get an appointment soon after you have seen the urologist.

    In the meantime, make a list of questions for your urologist. He should answer them all in terms that are understandable to a new patient; otherwise, find another urologist.

  • centralPA
    centralPA Member Posts: 322 Member
    #27

    I would be clear with all parties that you plan to do your research. Second opinions from another Uro, opinions from a radiation guy or two, second evaluation on your pathology, etc. Ge an opinion from someone who does focal treatments, maybe. The sooner that message gets across, the better. What you don’t want is the perception that you don’t like this doctor’s answer so you want another. You are just getting up to speed on your disease. Understanding all options.

  • fjubier
    fjubier Member Posts: 24 Member
    #28

    I have been diagnosed last year in March with Grade Group 2 (3+4) with 3 core positives but low % of grade 4 (less than 10%). All options were presented to me from Active Surveillance (AS) to radical treatment (surgery/radiation). I have seen a lot of doctors and I found 2 doctors saying the same thing that I can be on AS and monitor the disease for few months. My PSA was checked every 3 months and it went from 4,5, 6 to 8. I just have done MRI showing the same lesion in the anterior left but this time it is PIRAD 5. This Friday I am due for a repeat biopsy but this time it is a guided transperineal biospy and I am doing it at MSK instead of my local hospital. This type of biopsy seem to be the new state of the art at Academic center. FYI, the urologist that I have seem at MSK is a specialist of focal treatment as this is something I might be interested in pursuing if I am still eligible after the repeat biopsy.

  • JasonB176
    JasonB176 Member Posts: 42 Member
    #29
    https://csn.cancer.org/discussion/comment/1713241#Comment_1713241

    Thanks for your input. Our cases appear to be similar. I had the PI-RAD 5 score and had the guided transperineal biopsy. It's of note that you were advised that AS was still an option with the 3 + 4 score like I have. The difference with me is that most likely the cancer has already left my prostate so I'm doubting that will be an option for me. Good luck on your biopsy!

  • JasonB176
    JasonB176 Member Posts: 42 Member
    #30

    I have a doctor already lined up for a second opinion. I've been told I need my PSA test, MRI, and the slides of the biopsy sent to his office. Is it okay if I request all this before I even see my current urologist?

  • JasonB176
    JasonB176 Member Posts: 42 Member
    #31

    I just came back from seeing my urologist. He said I'm on the low end of intermediate risk due to having the small percentage of a 4 rating in one of the cores. He said that I have a relatively low level of cancer with only four cores positive and only one having the 4 at less than 5%. He does not do the robotic surgeries so recommended I see a local colleague of his but when I asked if she had done over 1000 of these, he admitted that she has not. He then recommended another colleague farther away but who has done over 1000.

    He said even with the perineural invasions that does not mean that the cancer has left the prostate. He said I do not need a PET scan. He said that I would be a candidate for surgery now but also left open the possibility of some AS with PSA tests and DREs every 3 months. He said his more experienced colleague would know more about the genetic test.

    So I have now have two other urologists lined up for second opinions - one is in the same network and one is in a different one. I got the impression that I have a bit of time to work with.

    He said that my case is admittedly in that large gray area of not having an absolutely clear direction. Given my age of only 52, he said radiation and hormonal therapy would not be recommended which I completely agree with.

    I'm going to take a deep breath and wait for my appointments with the other two urologists before getting too stressed about my next step.

  • centralPA
    centralPA Member Posts: 322 Member
    #32
    https://csn.cancer.org/discussion/comment/1713340#Comment_1713340

    Good meeting, it sounds like.

    Even if you don't pursue AS, you at least know you have time to do your diligence, learn as much as possible, and make a best-informed decision. I know its hard to practice patience right now, but patience is absolutely your best friend!

  • Clevelandguy
    Clevelandguy Member Posts: 1,177 Member
    #33

    Hi,

    In my humble non medical opinion the perineurial invasion means the cancer is getting ready to leave the Prostate. I would get with your medical team sooner than later to decide whether surgery or radiation is the proper choice. A PMSA PET scan will show if there is any spread outside of the Prostate. I had Perineurial invasion and doing well(undetectable) ten years later. Find good doctors+good facilities to get the best results. Second opinion might not be a bad idea……….

    Dave 3+4

  • JasonB176
    JasonB176 Member Posts: 42 Member
    #34

    I just got access to the second pathology report of my biopsy that I sent to a different medical institution. I still have to actually see the different urologist to get my second opinion on 3/12/24 but I now have the report that he will be looking at.

    As far as I can tell, it's identical to the one I posted earlier from the first pathology report. The only difference I see is that it makes no mention of perineurial invasions which I find odd. Does anyone else notice anything different? I have a third opinion option for later in the month but am considering canceling that and just going with the two depending upon how my actual visit with the urologist goes on 3/12.

    Here is the second report:

    A. PROSTATE, RIGHT MEDIAL APEX (SB24-01388, A; 01/29/2024):

    Prostatic adenocarcinoma

    Gleason score 3 + 3 = 6/10 (Grade Group 1)

    Number of cores involved: 1 of 1

    Percentage and length of cores involved: <5%, 1 mm


    B. PROSTATE, RIGHT MEDIAL BASE (SB24-01388, B: 01/29/2024):

    Prostatic adenocarcinoma

    Gleason score 3 + 4 = 7/10 (Grade Group 2); Percent Grade 4 (5%):

    Number of cores involved: 1 of 2

    Percentage and length of cores involved: 40%, 9 mm


    C. PROSTATE, RIGHT LATERAL APEX (SB24-01388, C; 01/29/2024):

    Prostatic adenocarcinoma

    Gleason score 3 + 3 = 6/10 (Grade Group 1)

    Number of cores involved: 1 of 1

    Percentage and length of cores involved: 5%, 2 mm


    D. PROSTATE, RIGHT LATERAL BASE (SB24-01388, D; 01/29/2024):

    Benign prostatic tissue.


    E. PROSTATE, RIGHT LATERAL (SB24-01388, E; 01/29/2024):

    Benign prostatic tissue.


    F. PROSTATE, RIGHT ANTERIOR (SB24-01388, F; 01/29/2024):

    Benign prostatic tissue.


    G. PROSTATE, LEFT MEDIAL APEX (S24-01388, G; 01/29/2024):

    Benign prostatic tissue.


    H. PROSTATE, LEFT LATERAL BASE (S24-01388, H; 01/29/2024):

    Benign prostatic tissue.


    I. PROSTATE, LEFT LATERAL APEX (S24-01388, I; 01/29/2024):

    Benign prostatic tissue.


    J. PROSTATE, LEFT LATERAL BASE (S24-01388, J; 01/29/2024):

    Benign prostatic tissue.


    K. PROSTATE, LEFT LATERAL (S24- 01388, K; 01/29/2024):

    Benign prostatic tissue.


    L. PROSTATE, LEFT ANTERIOR (S24-01388, L; 01/29/2024):

    Benign prostatic tissue.


    M. PROSTATE, TARGET #1 (S24-01388, M; 01/29/2024):

    Prostatic adenocarcinoma

    Gleason score 3 + 3 = 6/10 (Grade Group 1)

    Number of cores involved: 2 of 4

    Percentage and length of cores involved: 5%, 2 mm; <5%, <1 mm

    CLINICAL HISTORY

    Prostate Cancer


    SPECIMENS SUBMITTED:

    A: PROSTATE, RIGHT MEDIAL APEX (SB24-01388, A; 01/29/2024)

    B: PROSTATE, RIGHT MEDIAL BASE (SB24-01388, B: 01/29/2024)

    C: PROSTATE, RIGHT LATERAL APEX (SB24-01388, C; 01/29/2024)

    D: PROSTATE, RIGHT LATERAL BASE (SB24-01388, D; 01/29/2024)

    E: PROSTATE, RIGHT LATERAL (SB24-01388, E; 01/29/2024)

    F: PROSTATE, RIGHT ANTERIOR (SB24-01388, F; 01/29/2024)

    G: PROSTATE, LEFT MEDIAL APEX (S24-01388, G; 01/29/2024)

    H: PROSTATE, LEFT LATERAL BASE (S24-01388, H; 01/29/2024)

    I: PROSTATE, LEFT LATERAL APEX (S24-01388, I; 01/29/2024)

    J: PROSTATE, LEFT LATERAL BASE (S24-01388, J; 01/29/2024)

    K: PROSTATE, LEFT LATERAL (S24- 01388, K; 01/29/2024)

    L: PROSTATE, LEFT ANTERIOR (S24-01388, L; 01/29/2024)

    M: PROSTATE, TARGET #1 (S24-01388, M; 01/29/2024)

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