Biopsy Results

A core with '100% volume' means that the disease has taken possession of all of the area within that core.  It is one indication among many as to how widespread and/or old your disease is.  Your biopsy is 'unfavorable' as regards volume, but favorable as regards a more important factor, the Gleason of 6, which indicates non-aggressive disease.  So, you have a mixed bag regarding results.   It will be important for the doctor to compare volumes from the earlier biopsy and this one.   Also, how your PSA has changed (if any) is of importance.  I am not 'expert' at Active Survellance,' but I strongly suspect that you are beyond the parameters that would recommend A/S in your case.   That is, the doc will undoubtedly recommend curative treatment -- either Radiation or surgery.

Hi there,

This is low level cancer.
It may remain inactive for a long time in which case AV, active surveillance, may be an appropriate response.
In other cases it may progress and slowly grow into other neighbouring tissues.
In your case it seems that it is progressing.
Treatment will depend on your age and personal preferences.
A younger patient may prefer surgery or radiation treatment, an older patient may opt for hormone therapy, etc.
It sounds like it is localised from the MRI results so if you are a younger patient, and you opt for treatment you have a good chance it will be  curative.
Hormone treatment will generally control Grade 6 disease for some time, so that is an option but more orientated towards the older patient.

Best wishes,

Georges

Rob,

The results from the last biopsy are worse than the ones from one year ago. The increased number of positive cores (now 6 out of 12) and the identified voluminous case (100% plus 70% involvement) sets the risky level higher. In fact you can see from the link shared above by Old Salt that in contained cases (thought to be yours due to the negative MRI) that you would be considered low risk but not recommended for AS (items of very low risk cases-Table 3).

In my opinion you stand between the lines making the judgment difficult to be set. I was also diagnosed when 50 years old with Gs6 and voluminous case (PSA=22.4). The way practiced at my times (year 2000) in judging risks differ from those established today. There was a consensus that Gs6 could be put on hold independently of the PSA level or number of positive cores but the DRE would rule in lesser or higher risk. Every doctor I visited performed a DRE and all of them considered it smooth (natural touch) setting me with a clinical stage T1c. All image studies (the whole collection) were negative representing a micrometastases case.

I wonder if you are confronting a similar case to that of mine in which our cancerous cells do not form solid tumors (seen on MRI) but dispersed colonies as in the form a mass widely spread. I chosen open surgery but 6 months latter I recurred (Pathological stage: T3a N0Mx) and was in need of further treatment. It seems that micrometastases cases with voluminous diagnosis do badly in surgeries and/or radiation therapies. The cancer can be extraprostatic already. Today the only evidence that I had localized metastases was the high PSA which would have classified me in the above Table 3 as High Risk. 

I think that your case is far away from the case of the survivor Hopeful with who you exchanged posts in your other thread.

You are doing well in investigating further. Chose wisely.

Best,

VG 

You may wish to ask your doc if he/she believes that a biomarker test is appropriate. 

Rob.Ski said:

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If AS Advoicate is advising against AS, got to be a sign.  LOL.   34 treatments just makes the decision harder although, I'm pretty sure which way I'm headed.

Thx for input.

Rob

For a case like yours, there are options other than IMRT. For instance, brachytherapy (there are two kinds) and SBRT (Stereotactic Body Radiation Therapy).

You should look into those, in combination with one or more competent radiation oncologists. The latter tend to specialize, so you may have to talk to several.

Yes, it's a process, but there will be light at the end of the tunnel.

Hi,

I would want to know on the 100% and 70% sample how much more cancer is in that area.  I would do a MRI or PET scan to determine how much the cancer has invaded my Prostate.  Could be the doctor just hit it right with his biopsy needle or is that section 100% involved?  Like most of the other cancer survivors I feel you are past the time of AS and need to do your research on whether it's radiation or surgery.  A grade 3 tumor is still cancer and cancer does spread and grow but slower than a grade 4 or 5.  Like I always say great doctors+great facilities = great results.  You still have time to do your research, looking at the pro and cons of various treatments.

Dave 3+4

Rob.Ski said:

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Well finally was able to speak to my doctor.  He said high volume 2 cores all Gs6 does not exclude me from AS.  He said a few years ago it would have but, not so much now.  Of course the risk goes up, 60% chance of finding higher grade in next three years.  Risk of escaping prostate is low.  He said AS is not an unreasonable choice. 

Was your call with Dr. Pavlovich, or another AS specialist?

I know that they have been looking at relaxing some of JH's strict requirements.

Still, while any extra day safely living a normal life is a great goal, that much of a cancer load is going to need frequent testing, IMHO.