New Prostate biopsy results

billblack2692

I’m a couple of months from 65th birthday. Just received results from biopsy:

Gleason 3+3=6, Category 1 cancer - most common, low risk.

• It shows perineural invasion, which may slightly raise the concern for spread, but the overall Gleason 6 cancer is usually considered low risk.

MRI showed PiRads 4 lesion contained within prostate.

Most recent PSA 5.64 (up from 4.1 60 days prior)

Live in Atlanta metro - receiving care at Emory. Great facility and reputation.

Still, seeing the C word is a gut punch. Follow up with my urologist this coming Thursday. Most stuff I’m reading says active surveillance is an option. That seems risky/scary??? Am I playing with fire if I take that route?

Wheel

Sorry to welcome you to our group. The perineural invasion is certainly disconcerting along with the jump in your PSA. It is good news that it is Gleason 6, and you are receiving excellent care at Emory. AS is an option but the elephant in the room is the perineural invasion. That as I understand means it had left the prostate capsule and then the next step is into your lymph nodes. It is always possible you have a higher Gleason in your prostate that was missed in the biopsy that has caused the perineural invasion. Have you had a Decipher test or PSMA PET?With a Gleason 6 I know some insurance doesn’t cover the genomic testing or the PSMA PET, however with the perineural invasion maybe they might. It is unusual I believe to have perineural invasion with Gleason 6. If not for that perineural invasion, AS would be a no brainer with a Gleason 6. You will need to defer to your experts at Emory regarding Gleason 6 and the perineural invasion. If they determine AS is somehow an option, then don’t necessarily feel you are playing with fire. AS is active PSA testing, additional biopsy’s, and MRI’s. Generally it is to catch it before it leaves the capsule which again seems it may have so I am not sure about AS.

Wheel

please post an update with your discussion with your Urologist on Thursday. If it is a recommendation for treatment as opposed to AS please feel free to bounce that off everyone. Again sorry you joined us, but everyone here is more than willing to share with you, and Emory is good. All the best.

billblack2692

Thank you, Wheel. I appreciate the feedback and will update this thread after my doctor’s appointment on Thursday.

JackWest

Now 3 years out after my prostate cancer diagnosis by biopsy, then spaceOAR and having radiation treatment of 27 days. PSA is now low holding at about 0.2 However there is some blood in my ejaculate, my urologist says it is OK. Anyone have this or similar? Thanks all.

Jack

Clevelandguy

Hi,

First of all it’s your choice between you and your doctor team. If it was me I would be concerned with the PNI diagnosis. Even at a 3+3 it sound like your cancer is getting ready to leave the Prostate capsule. Not a good thing in my humble non medical opinion. I also had PNI with a 3+4, glad I had mine removed by surgery 11 years ago, still undetectable today. If the cancer is a small percentage of the gland then possibly some form of external beam radiation would work. Remember the best doctors with the best facilities yields the best results. Have you had a PMSA PET scan looking for spread outside of the PNI area?
Dave 3+4

billblack2692

Cleveland, no PMSA pet scan yet. That might be a next step by my doc. I’ll know on Thursday. The MRI did not detect any spread outside the gland. So, I believe we caught this early. More to come.

swl1956

Tell your doctor that you insist on a PSMA Pet scan! Although not perfect it is the best test to determine Pca spread. It's also a very easy procedure. I would not make any treatment decisions without first having one.

Old Salt

https://csn.cancer.org/discussion/comment/1723512#Comment_1723512

Jack, with all due respect, you should start a new thread because your concern has nothing to to with the topic of this thread.

Wheel

I believe the MRI of the prostate focuses on the prostate gland looking for abnormalities and lesions. Not sure the MRI really catches things outside. That is the importance of the PSMA PET scan. The PNI involvement is concerning and I believe increases risk, even with a Gleason 6. Speaking to your Urologist you really want to focus on what the PNI in your specific case is means and the likelihood of further spread and I would imagine the importance of a PET scan to ensure it has not left.

Old Salt

Those are good comments from Wheel, Clevelandguy and sw1956. I don't have much to add except for the following:

You should ask for another evaluation of your biopsy, especially because of the perineural invasion finding. The prostate pathology group at Johns Hopkins is often recommended for such a second opinion. Your urologist should know how to start the process. In the meantime, good luck!

Get a Second Opinion | Johns Hopkins Pathology

centralPA

https://csn.cancer.org/discussion/329496/new-prostate-biopsy-results

Your path so far follows mine. Jump in PSA from around 4 to over 5 in a few months, biopsy showed 3+3=6, PIRADS 4 lesion.

I had a 2nd opinion on the biopsy done by Johns Hopkins, they came back with 3+4=7 with just a wee bit of 4, so recommend get the 2nd opinion. If they agree with each other, that will give you a warm and fuzzy.

Were the positive biopsy samples all in the PIRADS 4 lesion, i.e., localized?

What is the size of your prostate from the MRI? Do you have BPH symptoms?

FYI, I'm 3 years into active surveillance. Just had a round of imaging diagnostics this past winter to confirm AS is still OK to pursue. It is absolutely a risk game to play, you have to be comfortable with getting up each morning and thinking, "Gosh, I have cancer." 😐️

Welcome to the club that I'm pretty sure no one wants to join.

LuckyKYGuy

It's different for everyone.

I was diagnosed in 2023 and had similar biopsy results to you. I chose Active Surveillance. The advanced genomic testing showed I had a 90% rate of surviving 20 years with my numbers.

Fast forward a year later and a follow up biopsy showed higher numbers and perineal invasion. I went ahead and made the choice to do RARP.

Honestly, I didn't worry about it at all during the year when I was in Active Surveillance. I just lived my life normally and now nearly 9 months post op I'm living my life cancer free but without a prostate as normally as I can. Minor leakage, mainly when I cough or sneeze or strain while working outside in the yard. No sex drive. Small prices to pay.

Shalom2U

https://csn.cancer.org/discussion/comment/1723507#Comment_1723507

My understanding is that perineal invasion only indicates that the biopsy found some cancer on the nerve. It is a prognosticator that there is a good chance the cancer could have spread beyond the prostate through the nerve system. It doesn't mean it did. I had it on my biopsy report but there was nothing to indicate that my cancer had spread beyond the prostate. A PET (or PSMA?) scan could show whether or not it has spread but the scan might not be covered by insurance. I didn't have it done for the reason. I had a bone and pelvic scan and both were negative.

Some controversy over this finding. I had a large amount of cancer and that in and of itself is a concern that the cancer has already spread outside the prostate. It makes sense that the larger the tumor the more likely it would be on a nerve. So is cancer more likely to spread because of larger tumor size or that it was on the nerve? No one knows for sure.

Khaffey

I am 5 months out from a radical prostatectomy. My biopsy showed two lesions. One a 3+3=6 and the other 4+3=7 grade grade group 3. After surgery, pathology showed one 3+3=6 and the other 4+4=8 Grade group 4. It also showed Perineural Invasion present. When I questioned my surgeon's PA, she told me that is very common and doesn't mean the cancer has spread outside the prostate. The PET scan will show that.