Prostate surgery

LvGuy1 · October 2016

I am a 57 year old male that has Adenocarcinoma cancer in my left lobe i have 5/6 with cancer 3 + 3 =6 and Right side 1 out of 6 cores with 3+3=6. I have a T1c ? also my psa is now 11.8 from 3.4 5 years ago. I am scared that it is going to get worse and want to know if i should get it removed as a friend had a different type of cancer and did radiation and was alsways sick. I have a hard time urinating and also now have ED. Any recomendations or results. Thanks

VascodaGama · October 2016

Definite Clinical Stage is required

LvGuy

Your query regards a treatment but this should be decided after receiving a "definite" clinical stage. I wonder if the (?) mark you display with the T1c stage refers that it is still under investigation (not yet conclusive).
Clinical stages are based on symptoms and findings that provide the location of the cancer. Your urinary problem and ED could be a cause of hyperplasia (not cancer) which is producing part of the high PSA. The biopsy report may provide clues to what the pathologist found in the cores, including the percentage of cancer and zones where it was found.

Have you done a DRE (digital rectum examination)?

How about a image study?

Gleason score 6 is the lowest in risk for extra capsular extensions. It relates also to a low or not aggressive type of cancer. Six positive cores out of twelve indicate to be a voluminous type producing high levels of PSA.

I do understand your worries for spread (we all experience the same at beginning) but prostate cancer, in particular Gleason rate 3 is slow growing and do not spread overnight. I would recommend you to get a definite and proper clinical staging before deciding on an option.

Regarding radiation treatments' outcomes, they all differ depending on the area radiated. You did not share details of your friend's radiation field/location but PCa radiation is done at the lower abdomen so that the area involve the gland together with part of the colon, prostate bed, and localized lymph nodes. The field of attack is limited to the area where cancer exists. Accordingly, patient with problems in the area, such as ulcerative colitis, should try other means of treatment.
Another aspect to be considered is the urinary problem. Radiation may prejudice the situation if the problem relates to protuberances of the gland into the bladder. (Again you need a proper "picture" to certify what is causing the symptom)

Surgery is recommended in contained cases (the whole cancer inside the gland). The whole prostate is dissected therefore eliminating the cancer. Radiation is also feasible in contained cases eliminating the cancer but saving the gland and attached tissues (such as the nerves controlling erection and urethra sphincter). The difference between the two is the side effects so that one can decide what would be acceptable or what one couldn't dispend. I recommend you to investigate on the risks and the side effects published in many sites in the net.

I wonder if you have been taking any medication for the urinary problem; something to counter a BPH case (benign prostatic hyperplasia)?

Welcome to the board.

Best wishes,

VGama

Swingshiftworker · October 2016

The choices you need to consider . . .

Hello:

This is a duplicate of a message I left on another thread for a newly diagnosed PCa patient like you. You have a very low grade cancer and have a lot of time to make a decision.

--------------------------------

People here know me as an outspoken advocate for CK and against surgery of any kind. I was treated w/CK 6 years ago (Gleason 6 and PSA less than 10). You can troll the forum for my many comments on this point. Here are the highlights of what you need to consider:

1) CK (SBRT) currently is the most precise method of delivering radiation externally to treat prostate cancer. Accuracy at the sub-mm level in 360 degrees and can also account for organ/body movement on the fly during treatment. Nothing is better. Accuracy minimizes the risk of collateral tissue damage to almost nil, which means almost no risk of ED, incontinence and bleeding. Treatment is given in 3-4 doses w/in a week time w/no need to take off time from work or other activities.

2) IMRT is the most common form of external radiation now used. Available everythere. Much better accuracy than before but no where near as good as CK. So, it comes with a slightly higher risk of collateral tissue damage resulting in ED, incontienence and bleeding. Unless things have changed, IMRT treatment generally requires 40 treatments -- 5 days a week for 8 weeks -- to be completed. I think some treatment protocols have been reduce to only 20 but I'm not sure. Still much longer and more disruptive to your life than CK but, if CK is not available, you may have no other choice.

3) BT (brachytherapy). There are 2 types: high dose rate (HDR) and low dose rate (LDR). HDR involves the temporary placement of rradioactive seeds in the prostate. CK was modeled on HDR BT. LDR involves the permanent placement of radioactive seens in the prostate. 1/2 life of the seeds in 1 year during which time you should not be in close contact w/pregnant women, infants and young children. The seeds can set off metal/radiation detectors and you need to carry an ID card which explains why you've got all of the metal in your body and why you're radioactive. Between HDR and LDR, HDR is the better choice because with LDR, the seeds can move or be expelled from the body. Movement of the seeds can cause side effects due to excess radiation moving to where it shouldn't be causing collateral tissue damage -- ED, incontinence, bleeding, etc. Both HDR and LDR require a precise plan for the placement of the seeds which is done manually. If the seeds are placed improperly or move, it will reduce the effectiveness of the treatment and can cause collateral tissue damage and side effects. An overnight stay in the hospital is required for both. A catheter is inserted in your urethra so that you can pee. You have to go back to have it removed and they won't let you go until you can pee on your own after it's removed.

4) Surgery -- robotic or open. Surgery provides the same potential for cure as radiation (CK, IMRT or BT) but which MUCH GREATER risks of side effects than any method of radiation. Temporary ED and incontinence are common for anywhere from 3-12 months BUT also sometimes permanently, which would require the implantation of an AUS (artificial urinary sphincter) to control urination and a penile implant to simulate an erection to permit penetration (but would not restore ejaculative function). Removal of the prostate by surgery will also cause a retraction of the penile shaft about 1-2" into the body due to the remove of the prostate which sits between the interior end of the penis and the bladder. Doctors almost NEVER tell prospective PCa surgical patients about this. A urologist had to nerve to tell me it didn't even happen when I asked about it. Don't trust any urologist/surgeon who tells you otherwise. Between open and robotic, open is much better in terms of avoiding unintended tissue cutting/damage and detection of the spread of the cancer. Robotic requires much more skill and training to perform well; the more procedures a doctor has done the better but unintended injuries can still occur and cancer can be missed because the doctor has to look thru a camera to perform the surgery which obstructs his/her field of vision.

4) You may also want to consder active surveillance (AS), which is considered a form of treatment without actually treating the cancer. You just have to get regular PSA testing (usually quarterly) and biopsies (every 1-2 years, I believe) and keep an eye out for any acceleration in the growth of the cancer. Hopeful and Optimistic (who has already posted above) has already mentioned this and is your best source of info on this forum about it.

I personally could not live w/the need to constantly monitor the cancer in my body. Like most other men, I just wanted it delt with. Some men gravitate to surgery for this reason, thinking that the only way to be rid of it is to cut it out, but I did not like the risks presents by surgery and opted for CK, which is a choice I have NEVER regretted. I am cancer free, there is no indication of remission, there were no side effects and my quality of life was never adversely affected. Other men on this forum have reported similiar results.

So, for obvious reasons, I highly recommend that you consder CK as your choice of treatment. The choice seems obvious when you consider the alternatives but you'll have to decide that for yourself.

Good luck!

Clevelandguy · October 2016

Hi,

Hi,

I had a 3+4 and mine was contained inside the gland, I had my prostate removed by robotic surgery. Some people choose radiation(seeds, cyberknife, ect.) Both radiation & surgery have different side effects. I have slight leakage(less than one pad/day and no ED after two years). )Do your home work and read, read, read, talk with both your urologist & oncologist. The American Cancer Society has a good section on their webssite about the different types of treaments and their side effects. No matter what treatment you choose get the best doctors you can afford. Good luck on your path.................

Old Salt · October 2016

Three useful responses so far

I will add some thoughts as well.

Forget about the friend's experiences. Let's focus on your situation.

What is the size of your prostate? These urinary and ED problems could well be related to an oversized prostate and/or an infection (prostatitis)

And yes, you do have cancer in your prostate, but it appears to be relatively non-aggressive. Swingshiftworker has presented options that are available to you. There is time to study these and make the choice that appears right to you. But you need considerably (!) more info as Vasco already pointed out. Please re-read his advice.

LvGuy1 · October 2016

VascodaGama said:
Definite Clinical Stage is required
LvGuy

Your query regards a treatment but this should be decided after receiving a "definite" clinical stage. I wonder if the (?) mark you display with the T1c stage refers that it is still under investigation (not yet conclusive).
Clinical stages are based on symptoms and findings that provide the location of the cancer. Your urinary problem and ED could be a cause of hyperplasia (not cancer) which is producing part of the high PSA. The biopsy report may provide clues to what the pathologist found in the cores, including the percentage of cancer and zones where it was found.

Have you done a DRE (digital rectum examination)?

How about a image study?

Gleason score 6 is the lowest in risk for extra capsular extensions. It relates also to a low or not aggressive type of cancer. Six positive cores out of twelve indicate to be a voluminous type producing high levels of PSA.

I do understand your worries for spread (we all experience the same at beginning) but prostate cancer, in particular Gleason rate 3 is slow growing and do not spread overnight. I would recommend you to get a definite and proper clinical staging before deciding on an option.

Regarding radiation treatments' outcomes, they all differ depending on the area radiated. You did not share details of your friend's radiation field/location but PCa radiation is done at the lower abdomen so that the area involve the gland together with part of the colon, prostate bed, and localized lymph nodes. The field of attack is limited to the area where cancer exists. Accordingly, patient with problems in the area, such as ulcerative colitis, should try other means of treatment.
Another aspect to be considered is the urinary problem. Radiation may prejudice the situation if the problem relates to protuberances of the gland into the bladder. (Again you need a proper "picture" to certify what is causing the symptom)

Surgery is recommended in contained cases (the whole cancer inside the gland). The whole prostate is dissected therefore eliminating the cancer. Radiation is also feasible in contained cases eliminating the cancer but saving the gland and attached tissues (such as the nerves controlling erection and urethra sphincter). The difference between the two is the side effects so that one can decide what would be acceptable or what one couldn't dispend. I recommend you to investigate on the risks and the side effects published in many sites in the net.

I wonder if you have been taking any medication for the urinary problem; something to counter a BPH case (benign prostatic hyperplasia)?

Welcome to the board.

Best wishes,

VGama

THanks VascodeGama to answer

THanks VascodeGama to answer your questions. as far as th question mark i didnt know if that was a 1 or and i, I have had a DRE done after the biopsy. here aer a few notes the Dr wrote " in medical decision-making. This 57-year-old white male has a fairly long history of an elevated PSA with previously negative prostate biopsy. His PSA rose and he was seen by Dr. Manuel. A repeat biopsy showed a volume of 36.1 cc and on the left, 5 of 6 cores were positive for Gleason score 6 malignancy, with 1 of 6 cores positive on the right. There was no perineural invasion" "I therefore went through the explanation of Gleason grade, score, stage, etc. in detail. I then discussed how he was not a candidate for active surveillance but that intervention was necessary. I explained radical prostatectomy versus radiation, specifically brachy therapy." "This is a 57-year-old male who had prostate biopsy under ultrasound guidance couple of weeks ago and pathology report came back as adenocarcinoma of the prostate on the left lobe 5 of 6 cores were positive with a Gleason score 3+3. On the right side 1 out of 6 cores was positive, Gleason 3+3. Diagnosis was discussed with the patient and the options for treatment with risks and complications and this included radical prostatectomy, open or robotic, radiotherapy-brachytherapy or external radiation or both, and hormonal therapy. Patient wanted to discuss options with his wife and is leaning more towards radiation therapy. Diagnosis-adenocarcinoma of the prostate, stage TIc"

LvGuy1 · October 2016

Clevelandguy said:
Hi,
Hi,

I had a 3+4 and mine was contained inside the gland, I had my prostate removed by robotic surgery. Some people choose radiation(seeds, cyberknife, ect.) Both radiation & surgery have different side effects. I have slight leakage(less than one pad/day and no ED after two years). )Do your home work and read, read, read, talk with both your urologist & oncologist. The American Cancer Society has a good section on their webssite about the different types of treaments and their side effects. No matter what treatment you choose get the best doctors you can afford. Good luck on your path.................

Thanks Cleveland guy, I have

Thanks Cleveland guy, I have VA and am using the Choice program that has me using outside Drs. and before they have been the best in their field and i do have the options o0f changing Drs. I have been reading up on all the sites i can since the biopsy as i thought i had it 2 years ago and my Dr kept pushing me to get it done. so instead of asking again he just set me up for an appt. He hass been my Dr. for over 10 years and since i trust his judgement i did it. call it fate or Drs intuition. I have recently had my galbladder taken out and have been having problems with that but this cancer has me more scared that the problems with the gallbladder.

LvGuy1 · October 2016

i have posted everything up

i have posted everything up to this date under Vascodagama's comment

Thanks and so far everyone has been very useful in their answers/

VascodaGama · October 2016

This cancer has me more scared................

LvGuy,

The confusion on (1 or I) may be the type of font used in the report. I would guess it to be 1 (one). The report you share clearly says "stage T1c". He is deciding this category based on his experiences. T1C =Cancer is found by needle biopsy that was done because of an increased PSA. The result of DRE that also weighs in the decision, but you did not comment here, may have been negative otherwise the category would become T2c. A negative image study would also categorize the case as T1c, and the comment "... no perineural invasion", may lead to think in contained cancer, which wouldn't require confirmation by an image exam.
The diagnosis seem consistent but the reason for the size of the gland (36.1 cc ) above normal has not been clarified. Probably the matter is described/understood at the pathologist's report, that may identify existing hyperplasia which could be the cause of the urination problem. The report can also give a clue for the ED you are experiencing.

Can you print out here the contents of that report?

I also would like to know more in regards to the problem with urination and ED. Can you discribe the symptoms? Is there urgency or retention? How about ED, what is the problem: you have the wish but cannot accomplish an erection totally? Are you taking any medication?

I like to know that you trust this doctor for his long relation with you. You may inquire and tell him that you would like to have a MRI as the final information for making a decision on a therapy. Not imperative according the data you share above but the MRI could provide a more comprehensive understanding of the whole situation.

As commented by other survivors above, Gleason grade 3 is not aggressive even producing high levels of PSA. It is active so that it needs treatment but usually its status do not change that soon. You can do your investigations and become well prepared before deciding. You are scared because you are dealing with the unknown. Read, read, read.

Best wishes,

VG

LvGuy1 · October 2016

in anwer to VascodeGama's answer

THanks VascodeGama to answer your questions. as far as th question mark i didnt know if that was a 1 or and i, I have had a DRE done after the biopsy. here aer a few notes the Dr wrote " in medical decision-making. This 57-year-old white male has a fairly long history of an elevated PSA with previously negative prostate biopsy. His PSA rose and he was seen by Dr. Manuel. A repeat biopsy showed a volume of 36.1 cc and on the left, 5 of 6 cores were positive for Gleason score 6 malignancy, with 1 of 6 cores positive on the right. There was no perineural invasion" "I therefore went through the explanation of Gleason grade, score, stage, etc. in detail. I then discussed how he was not a candidate for active surveillance but that intervention was necessary. I explained radical prostatectomy versus radiation, specifically brachy therapy." "This is a 57-year-old male who had prostate biopsy under ultrasound guidance couple of weeks ago and pathology report came back as adenocarcinoma of the prostate on the left lobe 5 of 6 cores were positive with a Gleason score 3+3. On the right side 1 out of 6 cores was positive, Gleason 3+3. Diagnosis was discussed with the patient and the options for treatment with risks and complications and this included radical prostatectomy, open or robotic, radiotherapy-brachytherapy or external radiation or both, and hormonal therapy. Patient wanted to discuss options with his wife and is leaning more towards radiation therapy. Diagnosis-adenocarcinoma of the prostate, stage TIc. I do have a enlarge prostate bit he said it was not that enlarged. as far as the Ed that has been going downhill for the last 4 years, I can still get an eriction but it is a soft one and not hard like it used to be and the urinatin problems are slow drips before strea of urine and also getting up every hour or so to go to the bathroom. dont do bad during the day.

VascodaGama · October 2016

Biopsy Report

LvGuy,

You have reapeted the urologist's comments/report, but I would like to read the biopsy report which document is at the doctor's office. Can you ask for a copy and print it here?

Your symptoms relate to urgency meaning that something is pressing the bladder's wall muscle. Radiation of this area would not solve the problem. ED may be due to other causes, probably affecting the nerves surrounding the gland. I think it better you request an MRI because these items can put your wish of radiotherapy into jeopardy. You need to get more details on the problem.

Best wishes.

VG

LvGuy1 · October 2016

Copy of Pathology (Biopsy) Report

Type of Report: Surgical Pathology Specimen:

A-PNBX, RIGHT SIDE, 1 CORE B-PNBX, RIGHT SIDE, 1 CORE C-PNBX, RIGHT SIDE, 1 CORE D-PNBX, RIGHT SIDE, 1 CORE E-PNBX, RIGHT SIDE, 1 CORE F-PNBX, RIGHT SIDE, 1 CORE Date Obtained: 28 Sep 2016

Performing Location: VA Southrn Nevada Hlthcare Sys

Date Completed: 03 Oct 2016

SURGICAL PATHOLOGY REPORT LOCAL TITLE: LR SURGICAL PATHOLOGY REPORT DATE OF NOTE: OCT 03, 2016@07:35:07

ENTRY DATE: OCT 03, 2016@07:35:08

AUTHOR: JINADASA,PRIYANTHI EXP COSIGNER: URGENCY: STATUS: COMPLETED $APHDR - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - MEDICAL RECORD | SURGICAL PATHOLOGY - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PATHOLOGY REPORT Accession No. SP 16 3746 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - $TEXT Submitted by: UROLOGY Date obtained: Sep 28, 2016 15:00 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Specimen (Received Sep 29, 2016): A-PNBX, RIGHT SIDE, 1 CORE B-PNBX, RIGHT SIDE, 1 CORE C-PNBX, RIGHT SIDE, 1 CORE D-PNBX, RIGHT SIDE, 1 CORE E-PNBX, RIGHT SIDE, 1 CORE F-PNBX, RIGHT SIDE, 1 CORE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - BRIEF CLINICAL HISTORY: NA CONFIDENTIAL Page 20 of 32 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PREOPERATIVE DIAGNOSIS: NA - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - OPERATIVE FINDINGS: NA - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - POSTOPERATIVE DIAGNOSIS: NA Surgeon/physician: EMMANUEL S MANUEL MD =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PATHOLOGY REPORT Accession No. SP 16 3746 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - GROSS DESCRIPTION: Specimen A is received in formalin and is labeled with the patient's name, identification number, and "Right Prostate". It consists of 2 tan soft tissue fragments, ranging from 0.6 x 0.7 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette A1. Specimen B is received in formalin and is labeled with the patient's name, identification number, and "Right Prostate". It consists of 1 tan soft tissue fragment, measuring 1.5 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette B1. Specimen C is received in formalin and is labeled with the patient's name, identification number, and "Right Prostate". It consists of 1 tan soft tissue fragment, measuring 1.4 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette C1. Specimen D is received in formalin and is labeled with the patient's name, identification number, and "Right Prostate". It consists of 1 tan soft tissue fragment, measuring 2.0 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette D1. Specimen E is received in formalin and is labeled with the patient's name, identification number, and "Right Prostate". It consists of 1 tan soft tissue fragment, measuring 0.9 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette E1. Specimen F is received in formalin and is labeled with the patient's name, identification number, and "Right Prostate". It consists of 1 tan soft tissue fragment, measuring 1.6 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette F1 LB MICROSCOPIC DIAGNOSIS: A. - RIGHT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - BENIGN PROSTATE TISSUE. - NEGATIVE EVIDENCE OF MALIGNANCY. B. - RIGHT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - PROSTATIC ADENOCARCINOMA IN 1 OF 1 CORE. - GLEASON SCORE: 6 of 10, (3+3). - INVOLVING APPROXIMATELY 10% OF THE CORE. - NO EVIDENCE OF PERINEURAL INVASION. C. - RIGHT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - BENIGN PROSTATE TISSUE. - NEGATIVE EVIDENCE OF MALIGNANCY. D. - RIGHT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - BENIGN PROSTATE TISSUE. - NEGATIVE EVIDENCE OF MALIGNANCY. E. - RIGHT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - BENIGN PROSTATE TISSUE. - NEGATIVE EVIDENCE OF MALIGNANCY. F. - RIGHT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) CONFIDENTIAL Page 22 of 32 - BENIGN PROSTATE TISSUE. - NEGATIVE EVIDENCE OF MALIGNANCY. SUMMARY: RIGHT PROSTATE BIOPSY: (TOTAL 6 CORES) - PROSTATIC ADENOCARCINOMA IN 1 OF 6 CORES. - GLEASON SCORE: 6 of 10, (3+3). - INVOLVING APPROXIMATELY 1.6% OF THE CORES. - NEGATIVE EVIDENCE OF PERINEURAL INVASION. NOTE: The diagnosis was discussed with Dr. Helen Housley by Dr. Priyanthi Jinadasa at approximately 3:55 PM on 9/30/2016. Dr. Helen Housley acknowledged the diagnosis. This case is reviewed at pathology conference on 9/30/2016 and with agreement on the above diagnosis. (WN,PJ). /es/ PRIYANTHI M JINADASA MD Signed Oct 03, 2016@07:35 Performing Laboratory: Surgical Pathology Report Performed By: SOUTHERN NEVADA HCS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (End of report) PRIYANTHI M JINADASA MD pmj|

Date Oct 02, 2016 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - STANDARD FORM 515 ID: SEX:M DOB:03/24/1959 AGE: 57 LOC:LAS URO PCP: George B Kaiser, MD /es/ PRIYANTHI M JINADASA MD Signed: 10/03/2016 07:35

Type of Report: Surgical Pathology Specimen: A-PNBX, LEFT SIDE, 1 CORE B-PNBX, LEFT SIDE, 1 CORE C-PNBX, LEFT SIDE, 1 CORE D-PNBX, LEFT SIDE, 1 CORE E-PNBX, LEFT SIDE, 1 CORE F-PNBX, LEFT SIDE, 1 CORE CONFIDENTIAL Page 23 of 32 Date Obtained: 28 Sep 2016 Performing Location: VA Southrn Nevada Hlthcare Sys Date Completed: 03 Oct 2016 SURGICAL PATHOLOGY REPORT LOCAL TITLE: LR SURGICAL PATHOLOGY REPORT DATE OF NOTE: OCT 03, 2016@07:38:23 ENTRY DATE: OCT 03, 2016@07:38:23 AUTHOR: JINADASA,PRIYANTHI EXP COSIGNER: URGENCY: STATUS: COMPLETED $APHDR - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - MEDICAL RECORD | SURGICAL PATHOLOGY - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PATHOLOGY REPORT Accession No. SP 16 3747 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - $TEXT Submitted by: UROLOGY

Date obtained: Sep 28, 2016 15:05 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Specimen (Received Sep 29, 2016): A-PNBX, LEFT SIDE, 1 CORE B-PNBX, LEFT SIDE, 1 CORE C-PNBX, LEFT SIDE, 1 CORE D-PNBX, LEFT SIDE, 1 CORE E-PNBX, LEFT SIDE, 1 CORE F-PNBX, LEFT SIDE, 1 CORE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - BRIEF CLINICAL HISTORY: NA - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PREOPERATIVE DIAGNOSIS: NA - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - OPERATIVE FINDINGS: NA - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - POSTOPERATIVE DIAGNOSIS: NA Surgeon/physician: EMMANUEL S MANUEL MD =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PATHOLOGY REPORT Accession No. SP 16 3747 CONFIDENTIAL Page 24 of 32 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - GROSS DESCRIPTION: Specimen A is received in formalin and is labeled with the patient's name, identification number, and "Left Prostate". It consists of 1 tan soft tissue fragment, measuring 2.2 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette A1. Specimen B is received in formalin and is labeled with the patient's name, identification number, and "Left Prostate". It consists of 1 tan soft tissue fragment, measuring 1.8 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette B1. Specimen C is received in formalin and is labeled with the patient's name, identification number, and "Left Prostate". It consists of 1 tan soft tissue fragment, measuring 1.5 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette C1. Specimen D is received in formalin and is labeled with the patient's name, identification number, and "Left Prostate". It consists of 1 tan soft tissue fragment, measuring 1.6 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette D1. Specimen E is received in formalin and is labeled with the patient's name, identification number, and "Left Prostate". It consists of multiple tan soft tissue fragment, measuring 1.6 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette E1. Specimen F is received in formalin and is labeled with the patient's name, identification number, and "Left Prostate". It consists of 1 tan soft tissue fragment, measuring 1.7 cm in length with an average diameter of <0.1cm. The specimen is entirely submitted in cassette F1. MICROSCOPIC DIAGNOSIS: A. - LEFT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - PROSTATIC ADENOCARCINOMA IN 1 OF 1 CORE. - GLEASON SCORE: 6 of 10, (3+3). CONFIDENTIAL Page 25 of 32 - INVOLVING APPROXIMATELY 30% OF THE CORE. - NO EVIDENCE OF PERINEURAL INVASION. B. - LEFT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - PROSTATIC ADENOCARCINOMA IN 1 OF 1 CORE. - GLEASON SCORE: 6 of 10, (3+3). - INVOLVING APPROXIMATELY 5% OF THE CORE. - NO EVIDENCE OF PERINEURAL INVASION. C. - LEFT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - PROSTATIC ADENOCARCINOMA IN 1 OF 1 CORE. - GLEASON SCORE: 6 of 10, (3+3). - INVOLVING APPROXIMATELY 5% OF THE CORE. - NO EVIDENCE OF PERINEURAL INVASION. D. - LEFT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - BENIGN PROSTATE TISSUE WITH MIXED INFLAMMATION. - NEGATIVE EVIDENCE OF MALIGNANCY. E. - LEFT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - PROSTATIC ADENOCARCINOMA IN 1 OF 1 CORE. - GLEASON SCORE: 6 of 10, (3+3). - INVOLVING APPROXIMATELY 5% OF THE CORE. - NO EVIDENCE OF PERINEURAL INVASION. F. - LEFT SIDE, PROSTATE NEEDLE BIOPSY: (1 CORE) - PROSTATIC ADENOCARCINOMA IN 1 OF 1 CORE. - GLEASON SCORE: 6 of 10, (3+3). - INVOLVING APPROXIMATELY 5% OF THE CORE. - NO EVIDENCE OF PERINEURAL INVASION. SUMMARY: LEFT PROSTATE BIOPSY: (TOTAL 6 CORES) - PROSTATIC ADENOCARCINOMA IN 5 OF 6 CORES. - GLEASON SCORE: 6 of 10, (3+3). - INVOLVING APPROXIMATELY 8.3 % OF THE CORES. - NEGATIVE EVIDENCE OF PERINEURAL INVASION. NOTE: The diagnosis was discussed with Dr. Helen Housley by Dr. Priyanthi Jinadasa at approximately 3:55PM on 9/30/2016. Dr. Helen CONFIDENTIAL Page 26 of 32 Housley acknowledged the diagnosis. This case is reviewed at pathology conference on 9/30/2016 and with agreement on the above diagnosis. (WN,PJ). /es/ PRIYANTHI M JINADASA MD Signed Oct 03, 2016@07:38 Performing Laboratory: Surgical Pathology Report Performed By: SOUTHERN NEVADA HCS [CLIA# 29D2042411] - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (End of report) PRIYANTHI M JINADASA MD pmj| Date Oct 02, 2016 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -ES STANDARD FORM 515

SEX:M DOB:03/24/1959 AGE: 57 LOC:LAS URO PCP: George B Kaiser, MD /es/ PRIYANTHI M JINADASA MD Signed: 10/03/2016 07:38

I did take out my personal info like name and ssn as this was done thru the VA

LvGuy1 · October 2016

VascodaGama said:
Biopsy Report
LvGuy,

You have reapeted the urologist's comments/report, but I would like to read the biopsy report which document is at the doctor's office. Can you ask for a copy and print it here?

Your symptoms relate to urgency meaning that something is pressing the bladder's wall muscle. Radiation of this area would not solve the problem. ED may be due to other causes, probably affecting the nerves surrounding the gland. I think it better you request an MRI because these items can put your wish of radiotherapy into jeopardy. You need to get more details on the problem.

Best wishes.

VG

biopsy report

the post is being reviewed and will be posted afterwards

VascodaGama · October 2016

Another system glitch attack

Please wait. You and I and many here have been attacked by this forum software gitch. They will post it once Simone, CSN support team, is alerted to the occurence.

I will wait and comment latter.

Best,

T3rri · October 2016

An important factor is to

An important factor is to consider how much the delta is between Testings and doubling time. I would have to reach back into research but it seemed like 0.7 change might also be a marker but this could be incorrect, check with a urologist. My husband's psa tests did not raise a flag because of the psa totals were under the limit but had we been looking at the change at each testing we would have had a 3 year jump on it. He did have prostate cancer which was only detected because we pushed for the most advanced psa tests available in spite of the doctor saying it was not necessary. Good luck, be your own advocate and insist on what you want to answer your questions and concerns.

VascodaGama · October 2016

Prostate zones not specified

LvGuy,

Please note that I am not a doctor. My comments are based on my experience and researches done along my 16 years as survivor.

From your post above, I noticed that the biopsy and the report were done simple. It doesn't specify particulars apart from benign or cancerous. It doesn't comment on any type of tissues like calculi which may have not been investigated. There is a comment (D. - LEFT SIDE......MIXED INFLAMMATION) which could justify the slight larger size of the prostate at 36 cc. The template of the 12 cores do not specify location/zone of prostate from where each core were taken. The only information is right or left side (lobe) and each needle (PNBX) is identified with letters; A to F. The American Urological Association AUA has no guideline for indentifying biopsy cores, however, there is a tendency by the doctors in starting the lettering from the top (base to apex of prostate). Please refer to the link below figure B. I would guess that the needles: A and B are from the base; C and D from mid zone; E and F from the apex. Apex is the zone where most of PCa cancers are found even those that were missed in previous biopsy.

https://www.auanet.org/common/pdf/education/clinical-guidance/Prostate-Biopsy-WhitePaper.pdf

Accordingly, the cancer was found at the base (lust bellow the bladder) in both lobes and in all zones of the left lobe. The inflammation exist at the mid zone which could be pressing the urethra causing restriction in urine flow. Cancer at the base could also press upwards probably affecting the nerves surrounding the bladder.

In in your shoes I would request an MRI for added information, particularly to verify details of the base of the prostate (next to the bladder) and the extent of the cancer. This is a delicate area where the sphincter is located. Cutting too much could leave you with a case of incontinence. The treatment option should be decided according to probable risks and the side effects. There is always something we would not give up. Radiation is linked to cases of proctitis and colitis. Surgery may cause incontinence, ED and buried penis.

You were diagnosed with low risk cancer so that you can take time to decide.

Best wishes,

VG

Max Former Hodgkins Stage 3 · October 2016

Exactly

LvGuy,

Vasco's summation is superb. 1. You have non-aggressive disease; 2. You have time to sort this out, and should request the additional imaging he described.

Also, you mentioned above that you use the VA, but with "Choice." Where I live, the VA ALWAYS outsources oncology patients -- sends them to civilians. Do request appointments with other MDs in the specialization, and definitely at least one Radiation Oncologist.

max

LvGuy1 · October 2016

Thanks Guys

THanks Guys for your comments and will certainly got 2nd and third opinions along with the tests recomended. Will post again when i get more answers.

mdo53 · October 2016

I'm 63 and watched my PSA's

I'm 63 and watched my PSA's rise from 3-9 over the past 15 years. I had a Artemus biopsy procedure and then met with the radiologist and urologist/surgeon to discuss treatment options. My Gleason score was 4+3. My federal insurance didn't offer proton therapy as an option. I chose robotic surgery on Sep 6, 2016. Checked in the hospital on the day of surgery and checked out 24 hours later. Catheter was removed 7 days after surgery. Incontenence for first few days then progressing to wearing a single light pad app. 21 days after surgery. It's been 42 days since surgery and I have 99% bladder control. I sleep better believing that the cancer isn't spreading. Just got my my first PSA result today 0.04. I hope this is good!

VascodaGama · October 2016

mdo53; Great news

It is very good indeed. PSA=0.04 ng/ml verifies the success of surgery.

Let's celebrate with a full glass of my lovely red Esporao.

Best wishes for continuing remission.

VG

Max Former Hodgkins Stage 3 · October 2016

mdo53 said:
I'm 63 and watched my PSA's
I'm 63 and watched my PSA's rise from 3-9 over the past 15 years. I had a Artemus biopsy procedure and then met with the radiologist and urologist/surgeon to discuss treatment options. My Gleason score was 4+3. My federal insurance didn't offer proton therapy as an option. I chose robotic surgery on Sep 6, 2016. Checked in the hospital on the day of surgery and checked out 24 hours later. Catheter was removed 7 days after surgery. Incontenence for first few days then progressing to wearing a single light pad app. 21 days after surgery. It's been 42 days since surgery and I have 99% bladder control. I sleep better believing that the cancer isn't spreading. Just got my my first PSA result today 0.04. I hope this is good!

Great

It sounds like your treatment was well chosen and went well.

Your timeline was identical to mine: cath for a week, rapid regaining of urinary control, etc.

Regarding proton treatment: know that it has limited availability except in a few areas, and indeed is not easily paid for by the insurance carriers, so your experience in that regard is not unusual. It's popularity is increasing, but only very slowly, and only because of the marketing of the sites that own the equipment.

Sloan-Kettering in NYC defines "undetectable" at .05 . .04 is significantly below that, and at only around 40 days post-surgery, it is possible that your number will drop even lower over time.

The Director of Surgery at Sloan-Kettering also writes that "some certified labs" define "undetectable" as high as 0.1 ng/ml (Dr Peter Scardino's Prostate Book , p .320)

What matters is that your result does indeed count as "undetectable," by everyone's standards. I think my first PSA result post-DaVinci was similiar to yours.

max

Prostate surgery

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