Biopsy results

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  • Wheel
    Wheel Member Posts: 173 Member
    #22

    Definitely good advice about concern of the Urethra to engage your Urologist in questions regarding Radiation treatment if that is any concern in Radiation treatment as you consider your treatment direction. You are in a good position to have time to thoroughly research the pros and cons to you in deciding on your treatment course. Don’t hesitate obtaining second opinions.

  • Wheel
    Wheel Member Posts: 173 Member
    #23

    one additional consideration on the AS side. If your Doctor feels inevitably sooner than later that you will likely need to go off AS if you continue that route then you want to consider the trade off of quality of life of maybe two additional years without potential Incontinence issues, ED issues, or rectal issues or Proceeding now with Surgery or Radiation out of concern the cancer is growing. It’s important to realize the quality of life side effects are potential, not everyone experiences them or to the same degree as others. Surgery has much improved with nerve sparing, Retzius sparing and puboprostatic ligament sparing, and single port entry reducing or eliminating incontinence issues and diminishing ED effects. ED with radiation often is not as immediate but can begin months later. Rectal issues are also diminished in Radiation with the new spacers put in place prior to Radiation. Radiation can be done and completed in as quick as a week now. At a certain age or one’s health even if younger than 75 Surgery becomes not an option regardless, but if surgery is done, Radiation can more easily come later and it is held as a backup. If Radiation is done first, salvage surgery is considered much more difficult but can still be done, however only certain skilled surgeons will do that.

  • miabarry
    miabarry Member Posts: 13 Member
    #24

    Sent my biopsy results to Johns Hopkins for second opinion pathologist. No longer

    any pattern 4. All 3+3. However, there is perineural invasion noted for the 1st time in J. You thoughts would be appreciated. Am very confused now.

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  • Clevelandguy
    Clevelandguy Member Posts: 1,229 Member
    #25

    Hi,

    If it was me and the cancer by the urethra would be removed with surgery, I would go with that. You can also do AS for a while with additional biopsies until and if the cancer turns more aggressive, then do surgery. Radiation on your urethra could cause scar tissue problems if you choose radiation when the time comes. Just my humble non medical opinion……..

    Dave 3+4

  • Wheel
    Wheel Member Posts: 173 Member
    #26

    Good advice from Dave. You are still a candidate for AS, but I think before I would decide that I would see if you could get a Decipher test and or a ExoDx urine test. These tests can help determine whether your cancer should even be considered for AS. If treatment is needed and Surgery a good option, I am pro Surgery with the right surgeon.

  • miabarry
    miabarry Member Posts: 13 Member
    #27

    Wheel:

    Decipher came in at low risk .24 and I'm proceeding with AS for the time being.

    What really has been bothering me, quite a bit, is the fact that my urologist, when I asked, did not want me to have my biopsy slides reread. I did it anyway through Hopkins, who agreed exactly with all of the NorthWesterns biopsy findings except the one and only core that NW said had pattern 4. It's almost as if the pathologist at NW intentionally upgraded me to push me into Grade 2 and possible treatment. I know this sounds cynical but prostate cancer is a billion dollar business and it would not surprise me if this was the case. I'm a lawyer for 40 years and it sure would be a massive class action if this was true. They always try and lay it off as "subjective interpretation". Have lost a bit of faith and am going to seek out another urologist/department.

  • Clevelandguy
    Clevelandguy Member Posts: 1,229 Member
    edited December 2024 #28

    Hi,

    Glad you went for the second opinion on your biopsy. I too was diagnosed with PNI and I am glad that I had surgery. With PNI the cancer is getting ready to leave the barn so to speak and is nothing to mess with in my humble non medical opinion. Ten years later I am still cancer free. Keep a close watch on your cancer, don’t let it spread outside the Prostate capsule. On your other comment about diagnosis to drum up business, lets hope it’s not that way, get a doctor team with recommendations that you can trust.

    Dave 3+4

  • miabarry
    miabarry Member Posts: 13 Member
    #29

    Clevelandguy:

    What was your grade at biopsy? Does PNI mean the same thing for all risk groups PCa?

  • Wheel
    Wheel Member Posts: 173 Member
    #30

    That is terrific news on your Decipher. Mine was 69. Also I had my slides sent to John Hopkins but my one Gleason 8 did not get lowered, although a 7 was back to a 6. My 8 was lowered after my prostatectomy to a 7, s as although unfavorable 7. AS is the way I would have gone if I was all 6’s and low decipher score. Still Dave’s advice to closely monitor is definitely something you want to keep in mind. I would also agree that I would hope NW would not be playing that game and I doubt it or they would have given you a unfavorable 7 (4+3) as the favorable 7 is still open to AS and they ordered the Decipher to help make a decision on AS.

  • Clevelandguy
    Clevelandguy Member Posts: 1,229 Member
    #31
    https://csn.cancer.org/discussion/comment/1719315#Comment_1719315

    Hi,

    My Gleason score at biopsy was 3+4 with PNI, PNI means that the cancer has reached the nerve bundles on the wall of the Prostate and can spread along the nerves outside of the Prostate. I don’t think that is a good thing regardless of Gleason score. Like I said earlier, if you can get rid of the cancer close to the urethra and the PNI by removing the Prostate that is what I would be doing. Great doctors+Great facilities =Great results. Good luck in your decision……………..

    Dave 3+4

  • miabarry
    miabarry Member Posts: 13 Member
    #32

    The Journal of Urology

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                Advertisement                    
                                                                                                                                                                                                    
                            Journal of UrologyAdult Urology1 Jan 2023
    Clinical Significance of Perineural Invasion in Men With Grade Group 1 Prostate Cancer on Active Surveillance
       Claire M. de la Calle , Mufaddal M. Mamawala , Patricia Landis , Katarzyna J. Macura , Bruce J. Trock , Jonathan I. Epstein , and Christian P. Pavlovich     View All Author Information
    Full TextPDF                Cite                                Tools                Share      
    Abstract
                      
    Purpose:
          
    We aimed to evaluate the clinical significance of perineural invasion in men on active         surveillance for Grade Group 1 prostate cancer.
                
    Materials and Methods:
          
    We identified 1,969 men with Grade Group 1 prostate cancer and at least 1 follow-up         biopsy. A time-dependent Cox model and a logistic regression model were used to assess         the association between biopsy-detected perineural invasion and grade reclassification         (defined as the detection of Grade Group ≥2 prostate cancer on a surveillance biopsy),         and adverse pathology (defined as Grade Group ≥3 ± seminal vesicle invasion ± lymph         node involvement) at radical prostatectomy, respectively.
                
    Results:
          
    The 198 men with perineural invasion detected during active surveillance had lower         rates of grade reclassification-free survival than those without perineural invasion         (P < .001). On multivariable analysis perineural invasion was significantly associated with         grade reclassification (HR 3.25, 95% CI 2.54-4.16, P < .001); an association that persisted in the multiparametric magnetic resonance imaging         subset. At radical prostatectomy, men with biopsy-detected perineural invasion had         more extraprostatic extension than men without perineural invasion (Relative Risk         1.71, 95% CI 1.15-2.56). However, on multivariable analysis biopsy-detected perineural         invasion was not associated with adverse pathology (OR 0.68, 95% CI 0.27-1.68, P = .40) and these patients did not exhibit more biochemical recurrence at 5 years (P > .05).
                
    Conclusions:
          
    Perineural invasion during active surveillance was associated with grade reclassification.         At radical prostatectomy biopsy-detected perineural invasion patients exhibited more         extraprostatic extension but biopsy-detected perineural invasion was not independently         associated with more adverse pathology. In addition, these patients did not have more         biochemical recurrence during follow-up. Perineural invasion should not preclude Grade         Group 1 patients from active surveillance but they may warrant more stringent monitoring.
       
    https://doi.org/10.1097/JU.0000000000002963
                            
    
                        
        
                        
    
                
    
            
    
        
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                    Clevelandguy                    
                        
    
                        
                                Clevelandguy
                        

                        
                            Member Posts: 1,229 Member                        
                    
    
                    
    
                        
                                                   
                                                #33                    
    
                    
                                                
    
                                                    
    
                                    
    
                
    
                    
    
                        
    
                            
    
    
        https://csn.cancer.org/discussion/comment/1719330#Comment_1719330
    

    

    Hi,
    Typically grade 1 prostate cancer is 3+3 as called out in the paper above.  You can ask a Urologist but yours was a 3+4(1st biopsy evaluation)with PNI and cancer very close to the urethra, that could bump you up to a grade 2?  Might be worth further consultation with a trusted Urologist and Oncologist very knowledgeable on Pca to determine a treatment path.
    
Dave 3+4
                            
    
                        
        
                        
    
                
    
            
    
        
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