Biopsy results

miabarry

Hello:

Received results this morning. Any informed comments would be appreciated.

Final Diagnosis

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A. Prostate, right posterior medial, needle core biopsy:

• Prostatic tissue, negative for carcinoma

 B. Prostate, right posterior lateral, needle core biopsy:

• Prostatic tissue, negative for carcinoma

 C. Prostate, right base, needle core biopsy:

• Prostatic tissue, negative for carcinoma

 D. Prostate, right anterior medial, needle core biopsy:

• Prostatic tissue, negative for carcinoma

 E. Prostate, right anterior lateral, needle core biopsy:

• Prostatic tissue, negative for carcinoma

 F. Prostate, left posterior medial, needle core biopsy:

• Prostatic acinar adenocarcinoma, Grade group 1 (Gleason score 3+3 = 6)
• Tumor involves 1 of 1 tissue core
• The linear amount of tissue with carcinoma is 0.4 mm in aggregate length
• Tumor volume is 5% of the involved core

 G. Prostate, left posterior lateral, needle core biopsy:

• Prostatic tissue, negative for carcinoma

 H. Prostate, left base, needle core biopsy:

• Atypical small acinar proliferation

 I. Prostate, left anterior medial, needle core biopsy:

• Prostatic acinar adenocarcinoma, Grade group 1 (Gleason score 3+3 = 6)
• Tumor involves 1 of 2 tissue cores
• The linear amount of tissue with carcinoma is 3 mm in aggregate length
• Tumor volume is 45% of the involved core

 J. Prostate, left anterior lateral, needle core biopsy:

• Prostatic acinar adenocarcinoma, Grade group 2 (Gleason score 3+4 = 7)
• Tumor involves 1 of 1 tissue core
• The linear amount of tissue with carcinoma is 6 mm in aggregate length
• Tumor volume is 60% of the involved core
• Percentage of Pattern 4: 15%; cribriform pattern not identified

 K. Prostate, T#1, needle core biopsy:

• Prostatic acinar adenocarcinoma, Grade group 1 (Gleason score 3+3 = 6)
• Tumor involves 1 of 2 tissue cores
• The linear amount of tissue with carcinoma is 1.5 mm in aggregate length
• Tumor volume is 10% of the involved core

Rob.Ski

At gleason 3+4, 60% involved probably looking at treatment. Ask about AS but, i was encouraged to stop with 3+3 because 2 my cores were over 50% and my relatively young age. Meantime get up to speed on treatment options. PCa is not typically fast moving so, don't panic do your research and find best facilities. Also, want to find out if there are indications of metastasis as that affects treatment.

Clevelandguy

Hi,

Age? Is the cancer located in the center of the Prostate or close to the Prostate wall or bladder?

Dave 3+4

Old Salt

Yes, those are wise words.

Time for serious research. Fortunately you have some time to do that and choose what is best for you.

LuckyKYGuy

First of all, just take a deep breath.

Pretty similar to what my initial biopsy showed in 2023. Decided to start "active surveillance" as we did the genetic testing and my cancer was shown to have only a 5% chance of being aggressive. Fast forward 14 months later and my follow up biopsy had Gleason's of 8….so had the RARP on October 22nd. All was contained to the Prostate.

So, just research everything and stay on top of it with your Dr. You have time to figure out what you want to do.

miabarry

I am 66 years old. My doctor is from NWestern. This is his message to me:

Low and favorable intermediate risk prostate cancer found on biopsy - this type of prostate cancer is highly curable, sometimes it can be observed

We will discuss more this week

Ross team - please send a decipher biospy

Clevelandguy

Hi,

If it was me I would look into either surgery or radiation based on the team recommendations of your Urologist and Oncologist. Like Old Salt said you have time to study the methodologies vs side effects and to make a choice. AS might also be something to look into. I have included a link to get you started. Only you can make the choice with the guidance of your doctor team.

https://www.cancer.org/cancer/types/prostate-cancer/treating.html

Dave 3+4

Wheel

Can’t speak for Radiation but if you decide to go the surgery route, just be aware that their are different techniques of Robotic Laparoscopic Radical Prostatectomy surgery that can help with incontinence issues and ED issues.

Old Salt

Good point by Wheel. For instance, there is the one-port DaVinci robot method and one with multiple ports. I don't know whether the 'average' urologist has enough training to do more than one kind. Of course, the patient is a factor too in the sense that he may be better suited to multiple port DaVinci surgery. It also bears repeating that experience (number of surgeries) is of utmost importance.

Wheel

As Old Salt points out it definitely always needs repeating the number of surgeries is of utmost importance. Most times Urologist’s are absolutely fine for the biopsies, but when it comes to surgery they may tout their experience, but just by numbers and the need to be up to date on latest technology and techniques they fall short. Actual Surgeons specialized in prostate surgery are likely the best bet. My urologist actually explained this to me and why he stopped doing the surgery. He said a surgeon getting referrals from a number of urologists will stay constantly busy performing surgery while an individual urologist will do far less. I will read about patients getting surgery from their urologist obviously due to them knowing their urologist. I would recommend that they don’t limit themselves to automatically agreeing to have their urologist perform the surgery.

miabarry

Consulted with Dr. Ashley Ross today re: my biopsy. Cryotherapy not feasible due to location of 3/4 near urethra. Referred me to Dr at University of Chicago who specializes in focal, if I want more info on that treatment. Don't want cancer in mt prostate and the uncertainty about recurrence makes me very anxious. I am recently widowed and have two magnificent daughters who I live for. Want to be a healthy grandfather one day—g-d willing.

Don't know what to do. Mind is spinning right now

Wheel

regardless of your treatment approach, look at the the members of just this group with many years of treatments , remissions, recurrence’s, treatments again, and they are here 15 years later. What is important is that life expectancy is very high regardless of numerous treatments when cancer is caught and treated early and was not allowed to metastasize to the bone. You will be here for your daughters and a grandfather one day!

miabarry

Met with my urologist yesterday and these are his notes:

In summary, the patient presents with a new diagnosis of prostate cancer here for high complexity decision making regarding management options.

66 year old with newly diagnosed left sided favorable intermediate risk prostate cancer. Peri-urethral lesion on MRI which did show prostate cancer, this was GG1 only however.

Relatively low volume of disease.

Not a candidate for cryotherapy due to proximity to urethra.

Could be a candidate for other ablative techniques such as IRE, possibly HIFU.

Could be a candidate for surveillance or for radiation or surgical removal. On finasteride, initially for hair loss. Does not have significant LUTS. Very physically active, desire to be sexually active.

PLAN:

Make sure decipher is sent / pending

Refer to Dr. Sidana to consider focal therapy (he is at U of C) [Make sure he gets his MRI on CD to take with him]

Send information about surgery

Refer to Dr. Sachdev to talk about radiation

Offer a follow up appointment with me in a few weeks

JasonB176

I see quite a few similarities with my situation. Gleason 3 + 3 should just about always be AS but Gleason 3 + 4 really is that gray zone where all the options mentioned are brought into play. Radiation was out for me due to other problems. I was thinking to continue AS but the Decipher test changed that. I'm glad that you'll be getting one. It can really be the tie-breaker in 3 + 4 patients. My results showed I was at high risk genetically. That brought an end to continued safe AS and surgery was scheduled ASAP. I had the surgery on 10/21/24 and the pathology showed somewhat more advanced cancer than the initial biopsy indicated though I was still Gleason 3 + 4.

Hopefully you will be low risk and can take your time weighing your choices.

miabarry

Thanks for your thoughts, Jason

Decipher still pending. Here is my issue: One core, low volume 3/4. Three cores 3/3. 7 cores no cancer.

The cancer in the Pirads 4 was 3/3.

Unifocal lesion per MRI.

Approx. 50% patients on AS with known 3/3 actually have low volume 3/4 undetected—just like me.

Any thoughts on seeking HIFU to obliterate that section of prostate instead of more radical treatment?

Dr. Lepor at NYU Langone is very experienced and I am sending my med records to him.

Old Salt

Focal treatment is certainly an option, but you do realize that further treatment down the line is often necessary?

miabarry

Old Salt: Please explain this to me.

Are you saying that all PCa, no matter the grade/volume/genomics will eventually

get worse and inevitably require more radical treatment?

Old Salt

https://csn.cancer.org/discussion/comment/1718896#Comment_1718896

Not really. The thinking is that in addition to the (four) cancerous site that have been identified there may well be other sites where cancer is 'brewing' but that do not show up right now because they are too small to 'see' or have been missed by the biopsy. In due time, these cancers MAY grow and need treatment.

The choice, therefore, is to treat the whole prostate now or just do the focal and follow up with regular PSA tests to see if anything else develops over time. Not a straightforward decision.

miabarry

Old Salt: With my numbers, etc., how would you advise re: surgery or radiation? Pros/Cons

Old Salt

https://csn.cancer.org/discussion/comment/1718909#Comment_1718909

I try to be 'data driven' and I don't have all the data. As many have stated in this thread, you have options and, significantly, some time to decide which one is best for you. The decision process should include the expertise of the specialist. For instance, it wouldn't be wise for me to recommend therapy X if no X specialist is available to you. Insurance may play a role as well. Your overall physical condition is relevant, as is your Decipher score.

As an aside, you could ask for a scan to more definitively rule out metastasis although your urologist may not go along with that because your Gleason scores are relatively low.

I repeat what your urologist wrote:

In summary, the patient presents with a new diagnosis of prostate cancer here for high complexity decision making regarding management options.

Clevelandguy

Hi,

In my humble non medical opinion the cancer close to your urethra is the area of concern and I would think drive your pick on how to deal with your whole Prostate. You want to kill the cancer but not damage the urethra. Not an area to mess with, choose wisely.

Dave 3+4