New member question

mwhit2024
mwhit2024 Member Posts: 3 Member
in Prostate Cancer #1

Hi. I'm newly diagnosed. Just hD my biopsy after mri revealed possible lesion. I'm only reading tge test results so I have not talked to my doc yet but looking for some help on what to expect. Some of the samples came back with Acinar Adenocarcinoma. Gleason score of 7. Any idea what treatment I'd usually recommended?

Thank for your support.

Comments

  • mwhit2024
    mwhit2024 Member Posts: 3 Member
    #2

    More info. I am 60 yrs old. Psa went to 5.01 when I had my physical this year. First time it has been out of range

  • Clevelandguy
    Clevelandguy Member Posts: 1,206 Member
    #3

    Hi,

    You and your doctor team should discuss how much of your Prostate is filled with cancer plus the aggressiveness(Gleason score). Depending if the cancer is confined to the Prostate will probably determine what type of treatment that gives you the best options for remission. A PMSA PET scan and possibly a bone scan to check for spread outside of the Prostate might be the next tests you will need. Too early based on your info provided as to what type of treatment is good for your particular situation. If it was me I would have a Oncologist on my team that specializes in Prostate cancer.

    Dave 3+4

  • Wheel
    Wheel Member Posts: 162 Member
    #4

    mhwhit,

    How many cores were taken and Gleason of each core? Was you Gleason 7 favorable (3+4) or a 7 unfavorable (4+3). A Gleason 7 favorable opens up your treatment options. What was your previous PSA and how long ago. Next steps should include a PSMA Pet scan to see if cancer has left prostate capsule and if so where such as lymph nodes, or does it appear contained. Also a genomic test called Decipher to determine the tumor’s genomic markets as to whether it is considered immediate or advanced. It may take a few more diagnostic tests to get to considering treatment options from active surveillance, radiation treatments ( many different types) including new focal radiation treatments to surgery.

  • mwhit2024
    mwhit2024 Member Posts: 3 Member
    #5

    A: Apex left posterior medial (ALPM)Diagnosis: Invasive Prostatic AdenocarcinomaHistologic Type: Acinar AdenocarcinomaGrade Group and Gleason Score: Grade group 3 (Gleason Score 4 + 3 = 7)Architectural Patterns of Gleason Pattern 4: Fused Glands, Poorly Formed GlandsPercentage of Pattern 4/5: 70%Tumor MeasurementLength of Core Involvement: 3.5 mmLength of Core: 13 mmEstimated Percentage of Prostatic Tissue Involved by Tumor for Core: 27%Perineural Invasion: Not Identified

    B: Apex Left posterior lateral (ALPL)Diagnosis: Invasive Prostatic AdenocarcinomaHistologic Type: Acinar AdenocarcinomaGrade Group and Gleason Score: Grade group 3 (Gleason Score 4 + 3 = 7)Architectural Patterns of Gleason Pattern 4: Fused Glands, Poorly Formed GlandsPercentage of Pattern 4/5: 80%Tumor MeasurementLength of Core Involvement: 1.2 mmLength of Core: 14 mmEstimated Percentage of Prostatic Tissue Involved by Tumor: 9%Perineural Invasion: Not identified

    C: Apex Left anterior lateral (ALAL)Diagnosis: Benign Prostatic Tissue

    D: Apex left anterior medial (ALAM)Diagnosis: Benign Prostatic Tissue

    E: Apex Right posterior medial (ARPM)Diagnosis: Invasive Prostatic AdenocarcinomaHistologic Type: Acinar AdenocarcinomaGrade Group and Gleason Score: Grade group 2 (Gleason Score 3 + 4 = 7)Architectural Patterns of Gleason Pattern 4: Fused Glands, Poorly Formed GlandsPercentage of Pattern 4/5: 5%Tumor MeasurementLength of Core Involvement: 8 mmLength of Core: 15 mmEstimated Percentage of Prostatic Tissue Involved by Tumor: 53%Perineural Invasion: Present

    F: Apex Right posterior lateral (ARPL)Diagnosis: Invasive Prostatic AdenocarcinomaHistologic Type: Acinar AdenocarcinomaGrade Group and Gleason Score: Grade group 3 (Gleason Score 4 + 3 = 7)Architectural Patterns of Gleason Pattern 4: Fused Glands, Poorly Formed GlandsPercentage of Pattern 4/5: 80%Tumor MeasurementLength of Core Involvement: 3 mmLength of Core: 12 mmEstimated Percentage of Prostatic Tissue Involved by Tumor for Core: 25%Perineural Invasion: Present

    G: Apex Right anterior lateral (ARAL)Diagnosis: Benign Prostatic Tissue

    H: Apex Right anterior medial (ARAM)Diagnosis: Benign Prostatic Tissue

    I: ROI1Diagnosis: Invasive Prostatic AdenocarcinomaSite Description: ROI1Histologic Type: Acinar AdenocarcinomaGrade Group and Gleason Score: Grade group 2 (Gleason Score 3 + 4 = 7)Architectural Patterns of Gleason Pattern 4: Cribriform Glands, Fused Glands,Poorly Formed GlandsPercentage of Pattern 4/5: 30%Tumor MeasurementLength of Core Involvement: 15.5 mmLength of Core: 20.5 mmEstimated Percentage of Prostatic Tissue Involved by Tumor for Core: 76%Number of Involved Cores: 4Number of Cores: 4Perineural Invasion: Present

    J: ROI2Diagnosis: Not Applicable

    K: Base left posterior medial (BLPM)Diagnosis: Invasive Prostatic AdenocarcinomaHistologic Type: Acinar AdenocarcinomaGrade Group and Gleason Score: Grade group 3 (Gleason Score 4 + 3 = 7)Architectural Patterns of Gleason Pattern 4: Fused Glands, Poorly Formed GlandsPercentage of Pattern 4/5: 80%Tumor MeasurementLength of Core Involvement: 1 mmLength of Core: 16 mmEstimated Percentage of Prostatic Tissue Involved by Tumorfor Core: 6%Perineural Invasion: Present

    L: Base Left posterior lateral (BLPL)Diagnosis: Invasive Prostatic AdenocarcinomaHistologic Type: Acinar AdenocarcinomaGrade Group and Gleason Score: Grade group 3 (Gleason Score 4 + 3 = 7)Architectural Patterns of Gleason Pattern 4: Fused Glands, Poorly Formed GlandsPercentage of Pattern 4/5: 55%Tumor MeasurementLength of Core Involvement: 11 mmLength of Core: 15 mmEstimated Percentage of Prostatic Tissue Involved by Tumor for Core: 73%Perineural Invasion: Not Identified

    M: Base Left anterior lateral (BLAL)Diagnosis: Benign Prostatic Tissue

    N: Base left anterior medial (BLAM)Diagnosis: Atypical Small Glands

    O: Base Right posterior medial (BRPM)Diagnosis: Invasive Prostatic AdenocarcinomaHistologic Type: Acinar AdenocarcinomaGrade Group and Gleason Score: Grade group 1 (Gleason Score 3 + 3 = 6)Tumor MeasurementLength of Core Involvement: 11 mmLength of Core: 12 mmEstimated Percentage of Prostatic Tissue Involved by Tumor for Core: 92%Perineural Invasion: Not Identified

    P: Base Right posterior lateral (BRPL)Diagnosis: Benign Prostatic Tissue

    Q: Base Right anterior lateral (BRAL)Diagnosis: Benign Prostatic Tissue

    R: Base Right anterior medial (BRAM)Diagnosis: Benign Prostatic Tissue

    S: ROI3Diagnosis: Not Applicable

    T: ROI 4Diagnosis: Not Applicable

    U: Left SVDiagnosis: Not Applicable

    V: Right SVDiagnosis: Not Applicable

  • Wheel
    Wheel Member Posts: 162 Member
    #6

    posting your Biopsy Pathology report was very helpful. Several items to definitely discuss with your Doctor include the cribriform pattern and the perineural invasion. I would think his next step would be the PSMA Pet scan. If the cancer has left the prostate, some of the newer radiation treatments might not be available. Do you live by a major university teaching cancer hospital? You may have a good Doctor, but like Dave recommends, you really do want to see a Prostate cancer Oncologist, not just a general Oncologist. General Oncologist’s will follow standard protocols while specialists will be aware of latest clinical trials that might fit you after your workup is complete. Even Radiation treatments can be speeded called hypofractionation, SBRT and IMRT. SBRT can deliver high doses in a treatment protocol of a week.

  • Old Salt
    Old Salt Member Posts: 1,530 Member
    #7

    In summary, your Gleason score is 4+3 with cribriform pattern and perineural invasion. This means that there are several treatment options available to you. Typically, a patient in your situation would want to discuss these with both a urologist and a radiation oncologist with expertise in prostate cancer. Information from a PSMA, and possibly other, scans will be very helpful, as others have pointed out.

    There are some major cancer centers where one can get an unbiased evaluation. If there is one in your neck of the woods, that would be the one to consult.

    Please note that urologists tend to recommend surgery (their specialty). In the same vein, radiation oncologists should not be discussing surgery options.

  • Marlon
    Marlon Member Posts: 127 Member
    #8

    Both my urologist (a surgeon) and the radiation oncologist (a urologist) said the same thing: I (4+3) could have a good outcome either way. My age (67) was the critical factor. Younger and surgery would be preferred. Older or with other health issues, and radiation would be preferred. Like it or not, you have to consider how much longer you might live, in order to gauge how much of the side-effects of either impact your quality of life.

    I chose surgery, and glad I did. I got the cancer out, and while the recovery is harder than I expected, it's manageable. If it comes back, radiation is still an option for additional treatement.

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