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Another new guy trying to understand

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

Greetings everyone - I have been reading here today and I like the attitudes of everyone so I thought I would throw out my question.

I had a Biopsy done back in 2014 when my PSA was 4.6 - a segment of the report is shown below:

Clinical History / Pre-op Diagnosis: Elevated prostate specific antigen (PSA) Specimen(s)Received:

1: Prostate, needle biopsy (Lt. Base)

2: Prostate, needle biopsy (Lt. Mid)

3: Prostate, needle biopsy (Lt. Apex)

4: Prostate, needle biopsy (Rt. Base)

5: Prostate, needle biopsy(Rt. Mid)

6: Prostate, needle biopsy (Rt. Apex)

Gross Description: All containers labeled "xxxxxxx, Thomas".

1. "LT base" Two cores, 13 and 17 mm, and fragments. AP/1c.

2. "LT mid" Two cores, 14 and 16 mm, and fragments. AP/1c.

3. "LT apex" Two cores, 15 and 16 mm, and fragments. AP/1c.

4. "RT base" Two cores, 18 and 22 mm, and fragments. AP/1c.

5. "RT mid" Two cores, 19 and 21 mm, and fragments. AP/1c.

6. "RT apex" Three cores from 9-12 mm and fragments. AP/1c.

 

NL meg/10/22/2014 

PSA was retaken last week and has jumped to 5.7 so the Urologist is recommending an MRI (not sure what kind of MRI though). I should get an appointment call tomorrow I hope.

Anyway - I am wondering what the "AP/1c" portion of the pathology report is all about. I tried to look it up here (http://stedmansonline.com/webFiles/Dict-Stedmans28/APP21.pdf) but it makes about as much sense to me as if I were to try explaining some of my COmputer Network Administrator jargon to a lay person.

Any help is appreciated.

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

Testing 1 2 3 4 5

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

Yes, Tommy, your posts are going out. And welcome to you here.

At first, I did not think that " AP/1c " was a result at all, and it might not be.  I do not know the term within the context of biopsy results.

Someone soon surely will, or ask for an explanation when you go for your pending appointment.  Six cores having exactly the same results is virtually unheard of if there is cancer however.  The closest thing I could find was "Abnormal Prostate," but do not assume this. The article stated that as used it referred to "atypical, unspecifiable cell clusters."  I stress: this may or may not be what the term means on your report.

Good luck with your MRI.

max

 

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

I will be asking for sure the next time I see the Doc - but I just thought there might be an explanation out there. Keep up the great work - maybe someday - I will be able to answer someone elses posts as well. Thanks again!

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

I hope so Tommy, I suspect some guys have already benefitted somehow from what you asked about.

None of us are doctors or medical authorities, just guys sharing what we have been through and learned.

I tell people accurately that I 've had no medical training, I've just had every medical thing.

.

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Hi Thomas, (your name is printed in the report)

I think it better for you to inquire with your doctor regarding the biopsy results. The expression of your question "Activator Protein-1c (AP-1c)" refers to aDNA-binding factor typically found in benign hyperplasia but not in cancer. This may signify that all 12 cores had expressions of AP-1 meaning high probability for negative to cancer. I wonder if you are experiencing any problem regarding urination (frequency, retention, etc) that could be a cause of hyperplasia.

Here is a link of interest to you;

https://www.ncbi.nlm.nih.gov/pubmed/12913698

Best wishes and hope you do not become a member of this club.

VGama

 

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

Good to know about the DNA-binding factor. As far as I can tell though - there were only 6 cores taken as shown in what I posted. I left out nothing except my full name and the doctor's name. BTW - it's been a week now and I still don't have an appointment foe the MRI. If no call by tomorrow I will call the Doc's office. Waiting simply sucks.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Suggest that you ask for a T3 MRI, which provides high resolution, it's an MRI with a Tesla 3.0 magnet. This MRI uses the highest magnet in clinical use, and will be more effective for you than other MRI's.

Generally a 12 core biopsy random biopsy is recommended. You may wish to inquire with the urologist.

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

Thanks for all that detail on the cores.   Any experiences to share on billing, costs and claims ? 

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Thomas,

Your list above specifies 13 (5x2+1x3) cores. I counted 12 because it is the typical template used in biopsies. In my times Sextants were typical but these are out-of-mode now. The third core from the Right Lobe Apex (RT apex) could have been added by the urologist when shooting the gun if he has seen on the ultrasound screen something obscure in the area. Tissue at each core is measured in length and multiplied by the cores diameter of <1 mm to obtain the volume of found cancer, if any. These measurements are indicated in the list.
LT=Left Lobe; RT= Right Lobe; The zones of the prostate: Base (just under the bladder), Mid (middle zones) and Apex (the lower zone where most cancers are found, therefore a good justification for the three cores taken).

Pathologists identify all types of existing tissues as well as conditions (such as hyperplasia, calculi, etc) and report on findings, but it only analysis what has been requested by the urologist. Longer analysis with more staining mean higher charges. The report you typed above is short in its description and only indicates investigations on the cells. I wonder if the examination of 2014 had a different purpose instead of looking for cancer.

Can you tell us what made you to have the biopsy back in 2014?

Were you experiencing any urination problem leading to suspicious case of hyperplasia?

Was there any symptom apart from the PSA= 4.6 ng/ml?

The above report does not identify the type of tissue (benign or cancer). Either the urologist at that time placed an order for analysis on hyperplasia (making it simple) or this report has a complementary attachment with the details which copy was not given to you.
I think it better for you to inquire on the above in your next consultation. The MRI will add more information on the area and it is good in having a picture that can be useful for judgments now and serve as comparison data for future needs.

Waiting is terrible when we are imagining the worse. However, you have not been declared a PCa patient yet (no report and no picture) and the high PSA could be a cause of hyperplasia, sex, riding a bike, etc. A positive diagnosis would not mean the end of the world. There are many ways to deal with the bandit.

Take each day at a time and enjoy the beauty of life with quality and less worries.

Best wishes,

VGama

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

No other symptons to my knowledge - I do urinate frequently (3-4 times nightly). Last year PSA was 4.8 so the jump to 5.7 is prompting him to go for the MRI. He said it was a very strong MRI. After reading so many other stories here - I am seeing some of you with 26 psa or higher - makes me wonder if we are getting too excited too early over this. Any thoughts? And again - thanks to everyone for the input. (IRL Details - - all was covered by insurance so I don't know from two years ago.)

Charlesaw57
Posts: 1
Joined: Dec 2016

My doctor tells me I need harmond shots, after taking out 11 Lymnos 1 had 2.3 cm of cancer on it out of the 11, he wanted me to start the shots right away. I never got a test to show the cancer had spread, after prostrate Surgery my PSA is now undetectable, but after sending it to the lab the doctor wants me to have harmone shots for 2 years, but tells me more poeple live longer that get the shots and it's small now, it's best to get the shots now while it's jsut 2.3 cm then to fight it later.  HELP ME PLEASE THIS IS MY FIRST EVER AND I'M TRYING TO BE BRAVE IN FRONT OF MY WIFE BUT I'M WORRIED, i DON'T KNOW WHATS BEST AND WHAT TO DO, I DO WANT TO GET ANOTHER OPINION, ANY HELP OR INFOR WOULD BE APPRECIATED.

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Charles

It is better to start your own thread. Many here will help you understanding the facts involving your concerns. However, you need to share more details of your case/story for us to understand your status.
Hormonal shots/treatments (HT) are typical in prostate cancer but one should take them if in fact it improves the situation. HT causes side effects that may be unpleasant to many. Please tell us your age, symptoms, PSA histology, Gleason grade, results of image studies (bone scan, CT, MRI, etc).

Do not panic. Things can be solved. You do not need to follow your doctor's suggestion if not confident with his advice. HT can be started at any time.

Best wishes,

VG

 

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

You can inquire on details in your next consultation. I just wonder if some other test/examination was done in 2014 to trigger the biopsy. Did you get a DRE or any CT with suspicious findings?

The PSA varies with the age of the patient. It also depends on the type of cells (some produce more stuff than others) and the cause. Big size prostates also produce more serum and so do cases of hyperplasia or inflammation. Typically doctors recomment a protocol of UTI medication to try finding a reason for any increase before advancing with a biopsy. Routine biopsy due to PSA=4.6 is not a standard. In any case do not worry so much. Prepare a list of questions while waiting.

Enjoy.

VG

 

Clevelandguy
Posts: 456
Joined: Jun 2015

My general practice MD told me he had a guy with a PSA around 2.5 that was increasing, did the biopsy and found cancer so it's not just about the number.  It's more about the rate of PSA increase that should trigger your doctors.  I was alway told that anything above 4 should be of a concern. Keep an eye on how fast the PSA is increasing(that's what my doctor did) and that could tell you that something might be going on with your prostate. Mine climbed from the general 2 area to just over 6 when my doctor got concerned, it took about 5 years for it to go to the 6 range.

Dave 

3+4

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

I couldn't have the MRI done because I have some stents that could not be verified as to their material. (They are around ten years old or more and no records.) So the Doc had a repeat PSA two days ago and I met with him today. In the last thirty days my PSA has jumped from 5.7 to 6.2 - so he has scheduled a biopsy for Jan. 5th. Dr. told me today that he did the first biopsy when my PSA was at 3.7 (I earlier thought it was @ 4.2 - oops). Nothing was found back then but now I am 2.5 points higher. Getting a little worried - OK - worried. Thanks one and all for being here and all your previous comments. I will keep posting how things go with the next biopsy.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

Welcome back after about a month, Tommy.

Your doctor is correct to do another biopsy now, especially since the MRI cannot be performed.  Your PSA vector warrants further testing.

You mentioned being worried, which is unavoidable. Just don't take the further step into fear.  If cancer is detected this time your cancer is still very likely quite minor.

As has been discussed, there are no absolute PSA thresholds that prove much of anything regarding PCa. What does exists are numbers and trends that reasonably demand follow up. Let us know she results,

max

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

But I guess that's the wonderful part about being human. We worry - sometimes too much. I will watch out for that threshold for fear. Thanks-

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Thomas,

I am pleased of knowing that the doctor confirmed our discussions above regarding the biopsy of 2014. In any case, the latest PSA is suspicious and the trend (constant increases: 3.7/4.2/5.7/6.2 .....) is typical of PCa cases. I absolutely agree with Max suggestions; the biopsy is the way to proceed to verify and recheck the doubts from 2014. I understand yours feelings but I am sorry to say that I see your case to become more complicated if cancer is not detected this time. Without a proper justification on the continuous increase one is never free of the worries.

I sincerely would prefer to tell you for not worrying but I believe it proper to inform you about similar cases of negative biopsies in the presence of unexplained constant PSA increases. These guys had to go through Saturated Biopsies (24 or more cores) to confirm a positive diagnosis. I wonder if you should discuss on such a possibility with your doctor this time because of the negative result of 2014. The info you share in your last post above and your symptomless status seems to confirm that the PSA of 2014 (3.7 ng/ml) was highly suspicious of cancer. Maybe your doctor could/should aim the gun to different regions in the prostate this time (so that you can avoid a saturated biopsy).

Can you share your age and other health issues you have or aspects (medications) that you are taking? Was hyperplasia ever mentioned?

These links explain details on Saturated Biopsies;

https://www.bcidaho.com/providers/medical_policies/sur/mp_701121.asp

http://www.medscape.org/viewarticle/711721_2

No matter what one may think, you are not a member of this unwanted club yet.

Best wishes,

VGama

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

Age 65 - diabetic (insulin and Metformin) - Coronary Artery Disease (6 stents) Plavix, Atorvastatin, Aspirin - High Blood Pressure Losartan, Amlodapine. There has been no discussion of hyperplasia. I just looked at the links you sent and then via our "Patient Portal" asked the Urologist if a "Saturated Biopsy" would be beneficial at this stage.

Again - thanks - it is great having such a suppport forum as this.

Old Salt
Posts: 720
Joined: Aug 2014

I am glad you followed up on Vasco's advice.

As an aside, make sure that all medical people who will be dealing with you are aware of your other health issues, including the drugs you are taking.

Sorry if this is obvious, but preventable medical mistakes do happen

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

Dr. doesn't do "saturated biopsys" he said that he sends patients who want that to another hospital 200 miles south of my home. He said he could do up to 18 samples so I asked him to do that and we kept the appointment. Biopsy was done a week ago. I got the results today - Gleason 3+4=7, involving about 5% of tissue. Tomorrow I will be contacting the Dr. office to schedule next follow up. Follow up was suppposed to be tomorrow - but he has surgery and had to cancel my appointment. 

It seems that now there are many choices for possible treatment. My wonderful wife who went thru breast cancer over the last 18 months (currently in remission) is more worried than I am I think. But we both agree that just like so many other challenges we have faced over the last 42 years - we will get through this just like everything else - - together.

I will try to keep y'all posted on what the next steps are that the Dr. will be recommending. God bless you all for being here to help and listen. Sometimes - just knowing that I have a place to vent is the best personal therapy one could ask for.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

You low volume 3+4=7 makes you a candidate for all treatment types, to include Active Surveillance, that is closely being monitored, and  treatment, only if necessary; if there is progression.

With Active Surveillance you will not have to undergo an Active Treatment, with the possible severe side effects such as ED, INcontinence, RAdiaiton burns, etc.

I have been monitored with Active Surveillance for the last eight years.

I am in a research study where the technology is being made available at various locations where first a man has a T3 MRI, suspecious lesions are ranked, then the results are locked into a three dimenison biopsy machine, and these suspicious lesions are then targeted.

PS Just reread this thread, and I see that the stents that you have preclude you from having an MRI.......you still may be in an Active Surveillance program (speak with an expert that runs an active surveillance program to confirm this), but you will need to be biopsied more frequently. .......at Johns Hopkins, men over 70 with 3+4=7 are in active surveillance programs, I think using standard two deminsional biopsy technology.

 

I am 73 years old, and was diagnosed at age 66. Chick my name to the left to see my medical history. Please feel free to ask questions about what I have been doing, and for information concerning you. 

Old Salt
Posts: 720
Joined: Aug 2014

It appears from your post that only one spot (out of 18) was cancerous? If not, please provide the biopsy details.

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Tommy:

I'm guessing from your screen name that you are 65.   I'm also guessing, based on what you've said previously, that your doctor is a urologist who probably will recommend surgery for treatment. 

If so, you should take a really long pause to consider your options and ask him to tell you about other alternatives.  If he doesn't do that, he is doing you a disservice.   Discussed briefly below are some of the things he should tell you.

Bascially, your choices include surgery, radiation and active surveillance.  Surgery really is the worst choice presenting the greatest risk of side effects such as ED and incontinence.   There are several methods of radiation available -- Cyberknife (CK), IMRT and Brachytherapy.  The best of them IMO is CyberKnife which provides the most precise method of delivery w/a minimum of potential side effect.  I and other men have been treated sucessfully w/CK without any side effects whatsoever.  Active surveillance is a method of monitoring the cancer through regular PSA testing and biopsy sampling without treatment unless the cancer accelerates and grows.  Given the nature of prostate cancer, chances are that your cancer may NEVER require treatment and, if you are willing to engage in the monitoring process w/o active treatment that certainly is an option.

Hormone therapy is an ancillary treatment that you've already been made aware of.  It's only purpose is to reduce testosterone production in order to reduce the growth of the cancer.  The problem w/HT is that it can have horrific side effects.  As a result, some men have chosen castration (aka orchiectomy) as an alternative.  There is a current thread that discusses this option and several others that discuss the awful effects of HT.

I'm just raising these issues for you now so that you'll be aware of them before you speak w/your doctor again.  In fact, I suggest that you do your own research on the topics that I'm mentioned before such a meeting, so that you will be better able to discuss them w/your doctor at that time.

Good luck!

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Tommy (Thomas)

Unfortunately you became a member of this unwanted club. Gleason 7 (3+4) is of moderate aggressivity and has an intermediate classification in regards to the risk for existing metastases. This is the way used by doctors initially to guess the status of the patient. His follow up will now be based on image studies to verify if such metastases exist, and with the data in hand he will provide a “clinical Stage”. It is then that a treatment is considered.

The results from the biopsy plus the Gleason score plus the PSA histology plus the DRE (digital rectum examination) plus symptoms and the image studies complete the diagnosis. The follow up treatment depends not just on the clinical stage but on your other health issues, your wishes, your family concerns and private financial affairs.
Many of these issues have nothing to do with your doctor so that you will be the one to finally decide on an option based on the recommendations provided by your doctor, provided by second opinions and in discussions with your family.

Old Salt above has requested the details of the biopsy because it matters in the judgment. One core positive with 5% involvement is in fact a very tiny portion of cancer, maybe not in need of a radical treatment (as commented by Hopefull). If cancer has been found in more than one core then the judgment would be for a voluminous cancer case. The location of the positive core also matters. The apex of the prostate is the area where most of PCa are found. This is far from the bladder and far from the sphincter that could lead to risks in incontinence issues. I hope you get a copy of the report and let us know the details.

Surely we PCa patients want to solve the problem the soonest and have peace of mind. Unfortunately as you and your wife already know cancer does not permit us to disregard the matter that easily. You need to maintain one step forward at each of its moves. One needs to know the basics and make due decisions when time requires it.
Prostate and breast cancers are similar cancers but in comparison prostate cancer grows must slower, approximately 4 times slower than breast cancer (source; Invasion of the Prostate Snatchers, by Dr. Mark Scholz).

All treatments have risks and side effects (Swing above reflects the problem well). Radical therapies (surgery and radiation) are the ones that can assure cure. Palliative hormonal therapies are good in controlling the advancement of the bandit during long periods of time but do not cure. AS (active surveillance) permits us to postpone a treatment while under vigilance with a coordinated regimen of tests and exams. One avoids the risks of a therapy and may as well die from other causes without ever treating this cancer. This is a good option if the cancer status permits and if we mentally can accept the idea of sleeping well in the same bed with the bandit. If worried, It is possible to find the aggressivity (growth factor) of one’s cancer via genetic tests.

So far your situation does not seem to be aggressive. I recommend you to read a lot on the matter get second opinions and only decide on a treatment after considering the details.

Here are some links that will help you to understand the facts and provide ideas for your List of Questions for your next consultation;

http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

http://www.lef.org/Protocols/Cancer/Prostate-Cancer-Prevention/Page-01

Best wishes and luck in your journey.

VGama

hopeful and opt...
Posts: 2224
Joined: Apr 2009

The pathology results of your biopsy is a major factor in determining the best treatment option, so you want additional assurance that the Gleason score is accurate. 

Determining Gleason scores are subjective, and there are expert prostate cancer pathologists with better facilities and skills than others. A few of the best that canc be consulted are:

Jon Oppenheimer, Tennessee  888 868-7522, David Bostwick, Virginia 800 214-6628 and Jon Epstein (John Hopkins, Maryland0 410 955-5043

You can contact your doctors office, and ask them to send the slides to one of the above before your appointment.

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

So much great input. Thank you everyone. It is great to read all of what everyone has to add because about 99% of it verifies my  own research.

Actually the 3+4=7 is from two of the samples (see below). My follow up appointment with the Doc is tomorrow. I do not plan to go in tomorrow and just accept whatever is offered. I have several questions to ask regarding various types and methods of treatment along with questions regarding timetables for these things to happen or even if there is a need for treatment at this time. I know that having two samples with a 5% positive is small but I also know that I do not handle a wait and see type of treatment well. To me, surgery to remove a prostate gland is like taking your car to the mechanic because it runs rough only to have him rip out the carburetor so he can diagnose the problem and then not be able to put the carb back. I also feel the same way about taking drugs to lower the PSA - - OMG, let's just put a chemical bandaid on something and make it look better. (Sort of like massaging the unemployment numbers to make things look better - GEESH!)

I know that there still needs to be further testing in order to determine a potential "Stage" of things - hence the cat scan and/or bone scan. I do not plan to jump on the first treatment suggested but I also do not like the idea of "Active Surveilance" - but that is just me.

With respect to the Pathology Report:

2. Prostate gland, right mid, biopsies: Adenocarcinoma of the prostate

, Gleason's grade and score 3+4=7, involving about 5% of the tissue  

I also intend to ask the good Doctor tomorrow why he said he was going to get 18 samples for the biopsy and according to the pathology report there were only 13.

Once again thanks to absolutely everyone for their great comments and suggestions. It is good to know that my own feelings, rants, musings and research can be verified by this wonderful and dignified bunch. Thanks guys!

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Source:

a primer on prostate cancer....stephen b. strum, md, facp

cat scan

"At diagnosis, the CT scan can be omitted in men presenting with a validated Gleason score of 2-7, a baseline PSA of less or equal to 15 and a clinical stage of less than or eual to T2b."

"Unfortunately , a CT scan of the pelvis and the abomen is rountinely ordered in virtually all newly diagnosed men with PC. However, it is our contention based on published literature, that this is a serious waste of healthcare dollars while exposing the patient to unneccessary radiation and inonenience."

..................................

bone scan

The American urological Association does not recommend a bone scan for those with a Gleason under 8.

..........................

13 samples

Quite often, when biopsied, the staple gun does not pick up enough tissue for samples...in my case this has occured, but it is generally only one or two that are missed......( are there 18 cores that are referrenced in the pathology with some showing no pathology?)

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

Dr. said he would take 18 - pathology ony shows 13 taken. Thanks for other info - will keep that under advisement. Have a great day (evening or wherever you are)!

hopeful and opt...
Posts: 2224
Joined: Apr 2009

It's evening here in California.

You will be fine

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

This Thursday 3/16, I will be going for Brachytherapy. I have a good feeling about this even though I have already looked at several sites that talk about possible complications. Those will always be there but that doesn't mean that I will have them. It is good to know what they are and such. The most worisome part of all this is the future popssiblilities of a secondary cancer. Like I said, I think everything this week will go just fine and I hope to update again on Friday as I take a day off to extend the weekend a bit so I will do better the following Monday when I return to work. Thanks for being there all you wonderful people. You have been a blessing to have as a sounding board and a place to vent and/or rant. I love you all.

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Best wishes for a good outcome. Brachytherapy has many years on the run and many did well. Typically they report about one week of disconfort, in particular regarding stool discharges. You may need to change diet to solve the issues.

Best,

VG

Old Salt
Posts: 720
Joined: Aug 2014

Is your doctor doing High Dose brachy (two sessions and the radioactive source is removed right away) or the slowly decaying seeds?

Steelchuggin26
Posts: 36
Joined: Mar 2013

Appears you have a very small.amount of cancer thst was found in only one core. This would likely be measured on millimeters, and not centumeters. Therefore, i would yhink you can expect excellent results with your treatment. Gleason 7 is more aggressive than the commonly diagnosed gleason 6, but is far from being the worst you can get. In fact, the 3+4 isnt even the worse of the two 7 variants. Predominantly the cancer is comprised of mostly pattern 3, with lesser pattern 4 in an already very small focus. I think with such low volume disease, brachytherapy is an excellent choice. You get to avoid the rigors of surgery, and success rates are pretty much equivalent.  There are seeds that stay in there permanently, these are low dose, and then there is the high dose. Which one will you be getti g?

tommyg1951's picture
tommyg1951
Posts: 13
Joined: Oct 2016

I will be getting the low dose seeds that stay in. Pretty high degrree of confidence from me and the Doctor. I will try to post at the end of the week when all is done.

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