biopsy results

Mozir

Hi everyone...I would like to share the results of my biopsy which I did on April 14th 20025

Biopsy URONAV MRI fusion ultrasound transrectal and I have cancer.

If anybody needs details how biopsy goes… you can ask me

Diagnosis

K Prostate (ROI 1), core biopsy:

Prostatic acinar adenocarcinoma, Grade Group 2, Gleason score 3+4=7Tumor present on two of five cores, involving approximately 10% of overall core length Percentage of Gleason pattern 4: 40%

Cribriform tumor architecture: Present

L Prostate (ROI 2), core biopsy:Prostatic acinar adenocarcinoma, Grade Group 2, Gleason score 3+4=7Tumor present on three of three cores, involving approximately 15% of overall core length Percentage of Gleason pattern 4: 30%

Cribriform tumor architecture: Present

Present A-J Prostate (sites as indicated), core biopsies:

No carcinoma identified

I have follow up appointment with urologist on April 22d and I would like to ask you what important questions should I ask ? What test should I request?

and also : Guys who had same diagnosis…give some advice….what treatment you went and any advice or mistake I should avoid.

Thank You.

Wheel

Mozir,

Saw your post. I am sorry to hear results, but although certainly some concerns, those concerns can guide you. Cribriform pattern is often resistant to radiation, not necessarily but due to that can lean towards surgery. Also in your favor is the Gleason 7, not above. Once you reach Gleason 8 often protocols even with surgery recommend ADT plus additional radiation. Surgery at this point is still a gold standard. However with a Gleason 7 favorable of (3+4), you may very well be offered active surveillance. I would though want more information from Decipher testing and Pet scan before considering that. The decipher will tell you whether its likelihood of being aggressive.

I would say your next steps are to ask your urologist for Decipher testing of your biopsy tissue and for a PSMA Pet scan to confirm for it has not left the capsule, although mine was supposedly intact, during surgery they determined on initial pathology I had positive margin.

Also no need to rush, studies have shown from initial diagnosis (like now from your biopsy) to treatment, a delay of up to six months until treatment has no impact on outcome of treatment. That is if the cancer needs treatment now, if you are a candidate for active surveillance that 6 month window is not relevant.

You are on the bubble at a Gleason 7. I admit I was Gleason 8, only one core and my others were 6 and favorable 7’s, but I so much wanted to do active surveillance for how long as I could, but my Gleason 8 precluded it and fortunately that one core led me to treatment. I was also fortunate that it did, since although scans showed it had not left the capsule, indeed it had.

I am sure the members will offer great questions for you to ask. Best of luck!

swl1956

What was your pre-biopsy MRI results? Gleason 3+4=7 Intermediate favorable sometimes Active Surveillance might be appropriate, but with Cribriform present probably not going to be recommended. Cribriform might be associated with a more aggressive cancer and may be resistant to radiation treatments. In my unprofessional opinion, I would absolutely want a PSMA PET scan before making any decisions. It's currently the best (and easy) test to indicate if there is any spread outside of the prostate gland. If none is found, you'll likely have more options for treatment. There are many factors that can influence the decision process and it can be a difficult task to sort through them. After your doctor recommends a treatment you might want to consider a second opinion and preferably at a center of excellence cancer center. Even at the best places researching who's the highest rated doctors is also wise.

Mozir

Thank You….

I do not know will my urologist send me for PSMA Pet scan with my , Grade Group 2, Gleason score 3+4=7 ???

and how to force him? because before my biopsy I ask him will you send it to Decipher test…answer was depend of biopsy If it high or low not…in the middle may be…

In mine mind to do surgery and only with Jeffrey Bassett…but have to fight with my work hmo insurance to get referral to him or quite and sign with Medicare Part B…will see

Wheel… how long do you wait to get appointment with Jeffrey…did he send you to Decipher test and PSMA pet scan ????

Sorry so many questions…little stress

centralPA

@Mozir , with just 12 samples I am guessing you did not have an MRI. Probably the next step will be to get that MRI, so the urologist can see if signs of extra extension and if there are any obvious lesions. To do so, though, you’ll have to wait for the prostate to heal from the biopsy.

What is your PSA level?

Marlon

What is your age? Just my opinion, but I never liked the idea of AS, because you know something is there, just waiting for it to get bigger.

I thought you could only change insurance during the open enrollment period in the fall.

Mozir

centralPA…

I did MRI..This is my report

MRI report

Lesion 1: Left lateral apex 2-3 o'clock
Moderate increased signal on the high b-value sequence. Average ADC value 883. Early focal enhancement is present. On corresponding axial T2-weighted image 23 there is amorphous hypointense signal 1.3 cm in diameter. PI-RADS 4

Lesion 2: Right mid gland and apex 7-8:00 Moderate increased signal on the high b-value sequence. Average ADC value 958. Early focal enhancement is present. On corresponding axial T2-weighted image 21 there is non-circumscribed hypointense signal 1.2 x 0.7 cm. PI-RADS 4 Prostate: Calculated Volume: 37 cc  PSA density: 0.16, elevated.

Image quality is partially degraded by motion related artifact.

Transition Zone: Mild stromal and glandular hyperplastic changes with mild median lobe indentation of the bladder neck.PIRADS 4:  Suspicious MRI findings, <15 mm in size. Biopsy recommended.

My last PSA on 1/12/25 was 5.9…than my doctor send me for MRI

KittySlayer

Surgery is a big decision. The DaVinci surgery while referred to as “major” surgery is really not so scary. I was walking the same afternoon and required no pain medicine post surgery. You do need to read posts in this forum of post surgery consequences regarding continence and erections.

I am three months post surgery and happy with my decision and relieved that I no longer stress about my next PSA/biopsy. I did Active Surveillance for two years before deciding. One reason I waited was I was retiring and wanted to hike the AT in 2024.

My wife’s insurance plan I was on did not include the Pro from Dover I wanted to do my surgery. So January 1st I enrolled in a Marketplace Plan that covered the surgeon I wanted. I was able to pay premiums for a couple months to cover the surgery and will be able to cancel the plan shortly.

During this time while you are making your decision or waiting for surgery to be scheduled focus on your overall physical fitness. I feel it made my surgery and recovery go much better. The year I had my appendix out with laparoscopic surgery I was bike racing and riding 6,000 miles a year. My robot assisted prostatectomy was after a summer hiking 2,000 miles. Both times going into surgery I was at peak fitness and feel it really benefited my recovery. Also pre-surgery begin some pelvic/Kegal exercises, ask your urologist for recommendations.

Mozir

Marlon,

I am 65.5 in October 66

What is abbreviation AS mean?

I am already signed with Medicare part A and if I sign with Original Medicare part B plus Medigap plan

cover out-of-pocket costs..I can go to any doctor in USA

Google it for dropping my employer insurance

• Working and Employer Coverage:If you're still working and have employer-sponsored health insurance, you can delay enrolling in Medicare Part B (the outpatient part) without a penalty. You can enroll during your Initial Enrollment Period (IEP) or during the Special Enrollment Period (SEP) that begins when your employment or employer coverage ends
• Dropping Employer Insurance:You can choose to drop your employer-sponsored plan and enroll in Medicare, either Original Medicare (Parts A and B)

• Special Enrollment Period (SEP):If you drop your employer coverage, you'll have an eight-month SEP to enroll in Medicare Part B to avoid a late enrollment penalty. 

centralPA

https://csn.cancer.org/discussion/comment/1722326#Comment_1722326

Ahhh, I see now. You had 10 samples on the grid (A-J) that were clear, and then a bunch in each region of interest that were positive.

Both positive samples have a pretty decent amount of G4 (30% and 40%) and you are positive on both sides. Hope you get the genomic testing too, to help make your decision.

Mozir

KittySlayer,

Thanks for your comment and advice… Admire your physical fitness

I am trying to be feet…I was a pro athlete in my youngest years, I am 6.1 and 188 pound not overweight, swim 3 times a week, trying to have right diet…

I will see what my urologist tell me on Tuesday 22d…

Marlon

Mozir, AS = Active Surveillance. That is when you postpone treatment to see how slowly the cancer is growing. Age is important in determining which treatment option is appropriate.

Mozir

Thank You all

I will see what my urologist tell me on Tuesday 22d and first I will ask him to get PSMA PET scan and Decipher tests

and will see….hope he will say no

Old Salt

Just to add to the AS protocol. There are many different AS protocols; some are more ACTIVE than others. They typically involve frequent PSA tests, biopsies and MRIs. One also has to have the proper 'mentality' or you will be a constant nervous wreck 😒

Mozir

Old Salt, Thank You

Help a lot all of yours support

Tomorrow at 12.00 noon have app with urologist who did biopsy, will see what he is going say but first want to ask him for Decipher test and PSMA PET scan…

Mozir

Want to update after my app with urologist..

He confirm I have cancer…clinical tumor stage T2c….cancer inside of prostate..I ask him to order Decipher test and PSMA Pet Scan…it looked like he didn't read my report carefully because when I mention I have Cribriform tumor architecture…his reaction was like..or you have it and he open my report to check it and after

He agree to send those tests to my insurance, but I got a feeling he doubts that I will be approved for its…he said i have to fight the insurance.

I was told that I have time to make a decision on the choice of treatment, look like i have time for AS but he is leaning towards surgery and mention that they will also soon have a new procedure called High-Intensity Focused Ultrasound (HIFU)

It's often considered an alternative to traditional prostatectomy.

Hope my insurance approve test…next App on May 20th

I don not why but have little depression after appointment

Old Salt

Your doctor said something like "Soon have a new procedure". Do you really want to be a test piggy?

swl1956

Yeah! I think I'd run from anyone suggesting they will "Soon have a new procedure". No matter which treatment you choose whether it be standard of care or one of several alternative treatments, you definitely want a highly experienced team in specifically that treatment doing the job.

Mozir

I am agree with you both…that why I feel little depress after my appointment…I already new I have cancer and was waiting for some specific proposal from urologist…but its look like he even didn't read my report carefully because when I mention I have Cribriform tumor architecture…ouch you do and start looking thru my report.

I put pressure on him to get those 2 tests Decipher and PSMA PET SCAN..he did not offer but at least he agree to ordered its and I am already scheduled for PSMA PET SCAN on May 14th

I am working right now to get appointment with highly experienced surgeon to see what he is going to say

Old Salt

You are doing the right 'thing'. Keep going.

Also get an appointment with a highly rated radiologist, or radiology center of excellence to get more info, especially about the cribriform finding.

This is what Copilot (AI) had to 'say' about your cribriform pattern finding:

If you or someone you know is dealing with this diagnosis, consulting with a highly experienced medical team and considering genomic testing can provide valuable insights for personalized treatment planning.

swl1956

Yeah! I understand completely. Frustration, stress and depression will do a number on you if you let it. Try to stay focused on learning as much as you can. The more you know, the better you will be at determining if you have a good doctor / doctors and ultimately making the best choices. I found the videos that Dr. Mark Scholz from PCRI (Prostate Cancer Research Institute) very informative. He's gifted at explaining complicated issues in an easy to understand format.

https://www.youtube.com/watch?v=cktFJdT7mow