Husband just diagnosed with PC

murphy,

Your husband's results are a bit of a mixed bag, but you are correct that the most worrisom issue is the perineural involvement, which CAN be a conduit for the disease to escape the gland.  P.I. means that cancer cells are under the lining of the nerve bundles, but do not at this point prove escape from the gland.  His results also mention positive margins, meaning the tumor is against the wall of the gland, and is also problematic.

His Gleason at 6 suggests non-aggressive disease, but he has a fair amount of volumeric involvement. So, as I said, there is good and bad.

If his first meeting was with a urologist, who will be a surgeon, it is best that his second opinion NOT be a urologist, but rather a radiation oncologist.   Based on this one result, it seems likely that surgery or radiation would be curative in his case; it should be readily beatable.

Vanderbilt is excellent, and a good choice.

max

Murphy549 said:

Husband

Thanks for your comments. The Dr we are seeing is an urologist/Oncologist. They said we would get a tour and get to see the different kinds of medical procedures they offer and speck to different DRs on those prcedures. Do you think we should ask for a PET scan also to see if it’s contained or not? 

 

Murphy 

I will leave it for some of the other guys to give their opinions regarding PET scans.....

max

Murphy,

Welcome to the board. You doing well in getting a second opinion, however, I think it should include questions regarding your first doctor's comments not written in the report.

The diagnosis is all set in the first sentence described by the pathologist; "Adenocarcinoma,Gleason 3+3 =6 (Grade group 1) with perineural invasion". The final comment added by the urologist regards the clinical stage, but he is not precise only assuming it to be T1 or 2. The data used for such a conclusion is based on the results from the predictable Partin tables, results from exams investigating (OC) organ confinement and (EE) extraprostatic extensions and (ISV) invasion of seminal vesicles) and (NM) involvement of lymph nodes or far metastases. I wonder what king of image studies were done.

Sincerely I would recommend you to get a mpMRI or PET before deciding. The described ratio for Positive margins of 25.8 is low but if existent extraprostatic extensions become a high probability that would stage your case as T3. The report doesn't indicate recommended treatment but I believe that the doctor is providing probabilities of recurrence in case you chose surgery. He describes "3 year recurrence - free survival 84%; 5 yr recurrence- free survival. 75%". This is low to assure success. In other words your husband case may need further salvage treatment if he decides in having prostatectomy.

I suggest you to read more about prostate cancer and prepare a List of Questions for your next appointment. You can include all what I suggest above added to other questions you may formulate from these links;

https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/talking-with-doctor.html 

https://www.cancer.net/cancer-types/prostate-cancer/questions-ask-health-care-team

Please note that I am not a doctor. I am a 19 years survivor and continuing patient of PCa with loads of experience acquired from my own researches and treatments.

Best wishes and luck.

VGama

Murphy,

I agree that you should procure the best. Trusting the physician treating us is a good step forward for success. Your husband should be full confident at the timing of the decision.
I am not familiar with the Vanderbilt hospital but Max above recommends it. I also think that second opinions should be obtained from specialists in different fields (Surgery and Radiation) but you need firstly to get additional data/information on your husbands' present status so that doctors will provide you their best recommendation. Contrary to what your first doctor told you, an image study is essential to verify the extent of the disease. The DRE plus the PSA and the Partin Tables do not give a real picture of what is going on. An MRI can identify the involvement of lymph nodes which is not covered by a biopsy or a DRE. Furthermore, a Bone scan would also add info to the decision (most useful in future consultations). A CT does not replace an MRI.

The age of your husband and any illness he has/had can influence the choice of a treatment too. I would recommend you to get the full panel of a blood test (liver, kidneys, thyroid and heart) that will help in the discussions ahead too. You can even get a second opinion on the biopsy slides to verify if a tertiary Gleason grade exists. The gland has a normal size (34cc) so that the PSA corresponds well to the high number of positive needles (5 out of 12). I recommend you to get all data (or copies) into your own file to help you when going around.

Traditionally, none contained cases are spared for radiation from the beginning. EBRT can do the job of surgery covering the whole gland plus surrounding areas if these are identified by the image study. Surgery would remove the whole gland (dissecting the cancer within) but as the doctor comments above the present data shows that it will not be enough requiring addition salvage treatment (IMRT) which would add more risks and side effects to the ones from surgery.

I think that you need to read more about the risks of treatments and how they are chosen. The doctor and the hospital attending your husband will not take part in the final decision process. They will require before the treatment a signed agreement reliving their responsibility from any worse outcome.

Please read the following links;

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

https://www.webmd.com/prostate-cancer/prostate-cancer-treatment-options#1

Can you share more info on your husband? How old is he? Does he have any symptoms? What made him to consult an urologist? Did anybody in his family contract PCa?

Please note that prostate cancer does not spread overnight. The present status would not alter much in two/four mounts. He needs treatment but it should be done coordinately and timely. He may like to participate in this forum and make questions to us survivors directly.

Best wishes,

VGama

Murphy,

I also think that the previous doctor's judgment was erroneous. The constant increase of the PSA deserved an earlier action to find the reason for the increase. In 2017 the PSA (3.5 ng/ml) was already above the normal level for a 55 years old man with normal DRE.

Regarding the second opinion on the biopsy slides, this is not done by norm when consulting other physician. Your husband does not need to repeat the biopsy procedure but you need to collect the slides at the previous clinic. You have paid for it and they are yours together with the pathologist's report. Then you need to inform Vanderbilt of your intent. Probably they would like to check the slides firstly before the consultation with the doctor. It makes sense in doing so and you can at the same time request to postpone the consultation to a date that would allow to have the results of the biopsy's second opinion in hand for the doctor's review. Call Vanderbilt and inquire what to do. They may contact directly the previous laboratory requesting them to send the slides. (?)

Many guys in this forum (and I) have requested second opinions on the slides before advancing with a decision. Many got upgraded and many got downgraded. There are also those that become confused for the difference in the results. Sincerely, not everybody needs a second opinion on the biopsy results if the first laboratory doing the analysis is a reliable institution. I believe that your previous doctor requested this job at some laboratory which clinic can be investigate for reliability.
As I commented before, trusting the team caring about our case is important.

You are doing well in investigating the details behind PCa. Diagnosis, then Clinical stage, then treatment decision, then follow-up.

Best of lucks to you both.

VGama

Murphy549 said:

Path report

VGama,

We are calling Vanderbilt to see what we need to do on the pathology slides being looked at again. Thanks so much for all your help. God bless everyone on this site for helping newly diagnosed PC. 

 

Murphy 

 

Murphy, Vasco gave you a perfect overview of biopsy review/ Second Opinions.

The great value of a biopsy is in confirmng PCa.  Subjectivity can enter due to the fact that Gleason is determined by the degree of abnormality of the cells.  It is sort of like judging sublte shades of color in a painting, not simple.

PCa biospy and prostate imaging are very given to false negatives, but false positives almost never occur. I have a friend about 80 now.  He had a positive diganosis of PCa about 17 years ago and went on A/S.  He had another biopsy a few years later, and it was negative for PCa.  But a few years ago,a third biopsy again found PCa.   So, he has had PCa the whole time, it is just that the second biopsy missed it, due to the small amount of involvement.  His PSA continues to rise, but as of today he has never received any curative treatments, and most likely never will.

Get the second opinion, but it seems clear that curative response is needed in his case. What that response will be depends on the experts and his choice.  Many people recommend that second opinions not come from another doctor in the same practice as the first doctor, for obvious reasons. Second opiniopns are essentially formal consultations, and not hugely expensive, usually.

Hi,

Being the fact that he has perinueral invasion means to me that the cancer is getting close to leaving the gland, not good.  If the cancer was deep inside the Prostate at a 3+3 then if it was me I would wait.  If it was my choice knowing what the facts are I would want to have my Prostate removed to keep the cancer from spreading outside of the gland.  But, you and your husband need to do what is right for your family. Good luck on your decision for your treatment plan. This is just my opinion based on what I have learned and not a medical diagnosis, I am not a doctor but a 4 yr. cancer survivor.

Dave 3+4

Sorry to hear your family is having to deal with the terrible cancer diagnosis.  You are doing great researching and learning from some of us who have gone through the same experience.  It's ok to get 2nd, 3rd, 4th medical opinions too. I posted my comments that active surveillance would have been bad for me on another discussion board at https://csn.cancer.org/node/320410 so I won't repost my comments here.  I think most of us participate in active surveillance from the first time we get an elevated PSA.  From that point on we have to actively monitor the PSA and if it continues to be elevated or if there are other signs/symptoms, we progress to a MRI or biopsy.   If the biopsy comes back with a GS 6, current medical literature appears to support continued A/S, although other factors have to be taken into consideration as well.  Other survivors have already commented for A/S to be effective, one has to continue to monitor, see the doctor, etc. etc.  It is very important.  All the way up to my elected surgery, my mind tried to convince me to only do A/S which may have been OK except for my GS7 and my family history.  You can see my story at https://csn.cancer.org/node/320408 if interested.  I thought about having a second biopsy done by another facility/doctor because my one core 3+4=7 had an incredibly small percentage of 4 detected.  But I proceeded with treatment and elected surgery and I can't tell you how grateful I did just that (elected treatment) because it identified diffuse cancer throughout over 30% of my prostate.  Either treatment - radiation or prostatectomy probably would have been successful based on current medical listerature but I chose surgery for many reasons I listed in my story.  Everyone's case is different so you are doing an awesome job learning as much as possible.  For me, I just couldn't sit back and take a risk with my extended (generations) positive family history.