New To This Group

Hi,

The MRI will pinpoint areas to sample on your biopsy. The biopsy samples will be reviewed and checked for cancer, only the biopsy can determine if you have cancer. The samples will be graded from a 3 to a 5 with a 3 not being very aggressive to a 5 being aggressive. The first number will be the majority of cancer cells seen in the sample and the second number is the least amount of cells in the sample, ex: 3+4. A 5+3 is far more aggressive than a 3+4. Good luck on your biopsy………..

Dave 3+4

Hi,

As Dave above comments Gleason score 7 (4÷3) is more aggressive than 7 (3+4). In fact yours (4+3) could have the risks associated with Gleason score 8 (4+4) if it refers to a voluminous case.

Can you describe the details on the pathologist report. How many positive needles, location and volume (%) in each sample.

Also any other detail regarding the type of cancerous cells.

Your wish in radiotherapy may be correct but I recommend you to research on the various options in RT treatments as some are prefered to others depending on the information gathered from the biopsy and MRI.

I would think that the field for radiation will take into consideration the lymph nodes identified in the MRI. Probably a combination of two modalities would be a better choice. For instance, HDR + IMRT.

Prepare a list of questions for your meeting on the 27th, and get second opinions on the suggestions given by your doctor.

Best wishes and luck in this journey.

VGama

Hi again,

I wonder the reason that took you to do the initial MRI. Did you experience pain or was it urination issues. What is the PSA histology?

From the info you provide, your case should be dealt as Gleason score 8. There are 9 positive cores out of 15 (voluminous) with high expression of rate 4 (above 70% of cancerous tissue), all at the right lobe.

I would think that the extra three needles (region of interest) were directed to the lesion identified in the MRI, at the right base (next to the bladder).

In my lay opinion, it seems to be a solid tumor, less prone to micrometastases, with high probabilities for a successful RT treatment. The presence of Perineural invasion at the apex (Ģ-rate4 95%) may suggest high probability of existing extraprostatic extensions. Surgery alone wouldn't do the job.

In your shoes I would try a combination of two radiation modalities. One aggressive for the gland and IMRT for zinping the iliac lymph nodes and the surrounding tissues at the apex (attached to the colon). Check on gels to avoid coleteral damages in the colon walls.

Please note that I am not a doctor. I am curious PCa patient doing researches since 2000 when I was diagnosed with the bandit.

Discuss the matter with your doctor and get second opinions from radiation specialists.

Involve your family in the decision process.

Best,

VGama

Hi again,

Well, your judgment on the PSA was wrong. At 63 anything above2.68 becomes suspicious in asymptomatic situations.

Constant increases, even small ones, are serious. In any case, you doing well in investigating treatment options. Try to reach a concensus in getting cured but keeping quality of life. Even in radiation modalities some present lesser risks in terms of the side effects.

Your inquire on Gleason results, is no more important as your diagnosis has ended. Surely higher rates of 4 and 5 represent a worse scenario as these cells tend to be more aggressive (alive and kicking) but producing lesser amounts of PSA serum.

One note for discussion with your doctor is the incorporation of ADT (hormonal treatment) in the RT procedure of your choice. ADT helps the job of the RT in the killing process. Typically it starts 2 months in advance of the RT, and continues for a period that can last more than one year.

ADT will add more side effects so you should be prepared regarding other health issues. Total panel blood tests is recommended in advance (liver, kidneys, heart, etc). In my case I also checked the testosterone which proved to be helpful when on ADT.

Some guys with high risk cases do dexa scans to check bone health. At 60 I was found with osteopenia.

I recommend you to research the matter and prepare a long list of questions to the doctor, for your next meeting.

We all experience that freaking out period. However, has you advance in your research the fear attenuates. Do not rush. Do things coordinatly.

Best wishes and luck in this journey.

VGama

Hi,

If it was me I would ask the doctor(s) about doing a Pet scan to better define the location of the cancer which could help you decide on which radiation treatment to choose. I have included a link which can help you understand the various treatments plus their side effects.

Dave 3+4

I am new as well. I am an Ortho Surgeon. healthy and fit my whole life. PSA jumped 2.7 to 4 over 2 yrs and no symptoms of any kind (urinary nor ED) MRI PIRAD -4 Fusion biopsy 9/16 cores + 4 were GS6, 3 were GS 7 (3+4) and 1 was GS7 (4+3). The higher ones in the target while GS 6 and 5% GS 7 (3+4) on other side. Needless to say being a surgeon I know too much. Went to USC - after discussion chose RRP over other because diffuse disease AND the experience at USC (over 15000+ among their docs) is that after radiation, HIFU etc IF there is recurrence and surgery needed, it can be a mess- from fistulas to secondary cancer of bladder, colon etc. Frankly the decision is the most difficult of my life and I make complicated medical decisions regularly. My docs always to PSMA PET ahead of time to help them decide how far up the lymph node chain they need to dissect. Surgery in DEC and anxiety is palpable. Very glad I found this forum and the wise words by so many. God Bless

Given my experience in healthcare, I suggest finding the absolute BEST to treat if you can do that. I live out of town but traveling to USC because they are a high level tertiary facility and handle many complications seen by the less skilled surgeons AND complications from Radiation etc. I would STRONGLY suggest meeting with UROLOGY at MAYO if in WI or take a trip to MD Anderson in Houston or USC KECK Medical Center in LA. They have tons of data and while there are always successful outcomes with every time of treatment, GS9 is nothing to play around with. A skilled surgeon can debulk the tumor and avoid or handle injury to surrounding structures and perhaps then, with less tumor burden, adjuvant treatment can be more successful. No question it can get confusing. Pick an expert and then TRUST that expert. Hindsight is always 20/20 and this disease will play with your mind. stay focused!! I look forward to hearing the good news from you soon!