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Biopsy Results - Gleason 3+3=6

Will_H
Posts: 2
Joined: May 2018

I just got my biopsy results (below).  I talked with my urologist and he had three options; monitor, radiation or surgery.  I am 64, live in San Rafael, CA (San Francisco Bay Area) and am a member of Kaiser HMO.  The closest radiation treatment center is in Novato, CA. Dr. Joseph Lee of the San Rafael Kaiser office does DaVinci surgery at the San Francisco Kaiser center.

I was wondering if anyone had any experience with either of  those two locations.

Gleason 3+3=6, stage T1c, psa 4.9

FINAL PATHOLOGIC DIAGNOSIS 
A) PROSTATE, LEFT APEX, NEEDLE BIOPSY-NEGATIVE FOR MALIGNANCY. 
  
B) PROSTATE, LEFT MID, NEEDLE BIOPSY-NEGATIVE FOR MALIGNANCY. 
  
C) PROSTATE, LEFT BASE, NEEDLE BIOPSY-NEGATIVE FOR MALIGNANCY. 
  
D) PROSTATE, RIGHT APEX, NEEDLE BIOPSY-NEGATIVE FOR MALIGNANCY. 
  
E) PROSTATE, RIGHT MID, NEEDLE BIOPSY-PROSTATE ADENOCARCINOMA 
GLEASON 6(3+3), INVOLVING ONE CORE. 
     -TUMOR INVOLVES 10% OF TISSUE. 
  
F) PROSTATE, RIGHT BASE, NEEDLE PROSTATE ADENOCARCINOMA GLEASON 6 
(3+3) INVOLVING ONE CORE. 
     -TUMOR INVOLVES 2% OF TISSUE. 

 

 

Thank you.

Old Salt
Posts: 720
Joined: Aug 2014

The three choices that have been given all make sense. But that was not really what you were asking about. 

Regarding (DaVinci) surgery, the most important issue is the experience of the surgeon. Ask Dr Lee about that; many on these forums consider that one needs at least 500 surgeries to become 'expert'. 

As far as radiation is concerned, there are several options. Not all of them may be available within the Kaiser system. Therefore, could you be more specific? Here is a list:

Low-dose brachytherapy ('seeds'), high-dose brachy, Stereotactic Body Radiation Therapy, IMRT/IGRT, proton radiation. Again. expertise is very relevant. 

 

Swingshiftworker
Posts: 1013
Joined: Mar 2010

If you have not been briefed about it yet, I suggest you ask about Cyberknife (CK) treatment for your prostate cancer (PCa) at the NorCal location in South San Francisco.

CK is one of the most accurate methods of radiation delivery (down to the sub-mm level) and can also account for body/organ movement during treatment, which minimizes the risk of side effects caused by damage to non-cancerous tissue.

I was a member of Kaiser Norcal for all my life until I was diagnosed w/PCa in 2010.  The only choices presented to me at the time were surgery (open or robotic) or brachytherapy (in their Roseville BT center.  Kaiser Norcal was treating other cancers (but not PCa) w/CK at that time; they later changed that policy.

I didn't like the choices and after doing my research, chose CyberKnife treatment at UCSF.  Had to swtich from Kaiser to Blue Shield to do this and it delayed my treatment about 6 months but all went well and I have been cancer free for over 7 years.

Have been w/UCSF and Blue Shield ever since but am thinking about returning to Kaiser next year because it's facilities are more convenient to me and I am no longer of need of specialized treatment that Kaiser does not or will not provide.

 

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

Why not active surveillance with NO side effects from active treatments that  can be drastic

I am in year 10 of an active surveillance protocol, that is I have not had any active treatment at all during this time, and have not suffered from any possible side effects from active treatments such as surgery or radiation. I am able to go on with my life.

I am monitored , that is I am closely watched......Active Surveilance for delayed treatment is a very viable treatment decision for low risk prostate cancer, since 97 percent of men with LRPC are likely to die of something other than prostate cancer. The pathologic stage of patients who are closely monitored, is similar to initally treated patients with LRPC, so the treatment decisions will be very similar. I selected Active Surveilance as my treatment decision in March, 09 . I plan to continue with this treatment option for the rest of my life if I can. If not I feel that I will still be able to seek any necessary treatment. 

With low volume, low aggressive cancer as you have, you are a prime candidate for active surveillance; that is simply being monitored.

Any other diagnostic tests? 

Active surveillance (monitoring) is indicated as the treatment choice by the American Urological Association for those who qualify.

 

Tech70
Posts: 53
Joined: Nov 2017

Given the information you provided, I agree with H&O that you are a potential candidate for active surveillance.  Before making a final decision, I would seek a 3T MRI and Oncotype DX testing of the biopsy.  The MRI will show the extent of the cancer and the Oncotype testing will show how aggressive the cancer is.  I am on AS, not only to avoid the side effects of active treatment but also reasoning that if I should eventually need more aggressive treatment, more and more treatment options and technologys become available.

Will_H
Posts: 2
Joined: May 2018

Thanks for all the replies.  Right now I am trying to gather information before I make a decision.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3274
Joined: May 2012

You give the best answer, Will:  Take your time.

Be aware that even for a highly educated person, getting familiarized with the multitude of PCa treatment options can take time; easily a month or more, even for a dedicated researcher.  Many guys here have researched and asked questions for many months before arriving at a decision.

Your particulars are similiar to what mine were in 2014, but not identical.  The only early factor that you do not list is your PSA vector, or the rate of change in PSA results over the last few years.  But what you did submit indicates very minor, incipient disease.

What you could do now is begin scheduling meetings with doctors: At least one surgeon, and at least one highly-regarded radiation oncologist.  You would do well to also meet a urologist or medical oncologist who is conversant in Active Survelliance.

Insurance flexibility (or lack thereof) is also highly relevant for most individuals.  Some men jet set around the world for specialists. Most guys use a doctor in their existing hospital or group.  The men here run the full spectrum of those responses.

max

 

Clevelandguy
Posts: 440
Joined: Jun 2015

Hi,

Good advice from Max, do your homework.

Dave 3+4

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