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Biopsy Results

Rob.Ski
Posts: 35
Joined: Feb 2021

Just got results from my second biopsy.  6 of 12 cores showed 3+3 Gleason.  One of the cores was 100% and another 70% in right posterior.  My question is, what is the significance of the involvement.  The rest of the cores that were positive were in the 30% or less.  Realize this is a question for my doctor just, don't have the follow up scheduled yet.   Its been 10 months since the first biopsy, this biopsy was a "confirmatory" biopsy.  

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3662
Joined: May 2012

A core with '100% volume' means that the disease has taken possession of all of the area within that core.  It is one indication among many as to how widespread and/or old your disease is.  Your biopsy is 'unfavorable' as regards volume, but favorable as regards a more important factor, the Gleason of 6, which indicates non-aggressive disease.  So, you have a mixed bag regarding results.   It will be important for the doctor to compare volumes from the earlier biopsy and this one.   Also, how your PSA has changed (if any) is of importance.  I am not 'expert' at Active Survellance,' but I strongly suspect that you are beyond the parameters that would recommend A/S in your case.   That is, the doc will undoubtedly recommend curative treatment -- either Radiation or surgery.

Rob.Ski
Posts: 35
Joined: Feb 2021

PSA is up about 1.0 in a year 3.5 to 4.5.   MRI Prior to biopsy did come back clean.  I'll be finding out shortly what doc has to say.

 

Thx for the input.

Georges Calvez
Posts: 532
Joined: Sep 2018

Hi there,

This is low level cancer.
It may remain inactive for a long time in which case AV, active surveillance, may be an appropriate response.
In other cases it may progress and slowly grow into other neighbouring tissues.
In your case it seems that it is progressing.
Treatment will depend on your age and personal preferences.
A younger patient may prefer surgery or radiation treatment, an older patient may opt for hormone therapy, etc.
It sounds like it is localised from the MRI results so if you are a younger patient, and you opt for treatment you have a good chance it will be  curative.
Hormone treatment will generally control Grade 6 disease for some time, so that is an option but more orientated towards the older patient.

Best wishes,

Georges

Old Salt
Posts: 808
Joined: Aug 2014

I am also doubtful that Active Surveillance would be a good option for you.

I strongly suggest that you start studying treatment options for Gleason 6 prostate cancer that appears to be contained. According to the table in this link, I think that you are 'low-risk'.

Prostate Cancer: Clinically Localized Guideline - American Urological Association (auanet.org)

BTW, I find it surprising that the MRI didn't show anything. 

VascodaGama's picture
VascodaGama
Posts: 3371
Joined: Nov 2010

Rob,

The results from the last biopsy are worse than the ones from one year ago. The increased number of positive cores (now 6 out of 12) and the identified voluminous case (100% plus 70% involvement) sets the risky level higher. In fact you can see from the link shared above by Old Salt that in contained cases (thought to be yours due to the negative MRI) that you would be considered low risk but not recommended for AS (items of very low risk cases-Table 3).

In my opinion you stand between the lines making the judgment difficult to be set. I was also diagnosed when 50 years old with Gs6 and voluminous case (PSA=22.4). The way practiced at my times (year 2000) in judging risks differ from those established today. There was a consensus that Gs6 could be put on hold independently of the PSA level or number of positive cores but the DRE would rule in lesser or higher risk. Every doctor I visited performed a DRE and all of them considered it smooth (natural touch) setting me with a clinical stage T1c. All image studies (the whole collection) were negative representing a micrometastases case.

I wonder if you are confronting a similar case to that of mine in which our cancerous cells do not form solid tumors (seen on MRI) but dispersed colonies as in the form a mass widely spread. I chosen open surgery but 6 months latter I recurred (Pathological stage: T3a N0Mx) and was in need of further treatment. It seems that micrometastases cases with voluminous diagnosis do badly in surgeries and/or radiation therapies. The cancer can be extraprostatic already. Today the only evidence that I had localized metastases was the high PSA which would have classified me in the above Table 3 as High Risk. 

I think that your case is far away from the case of the survivor Hopeful with who you exchanged posts in your other thread.

You are doing well in investigating further. Chose wisely.

Best,

VG 

hopeful and opt...
Posts: 2331
Joined: Apr 2009

Gleason 6 will not leave the prostate, however when there is a lot of G6, as you,  it is  possible  that significant cancer (7 or above)  exists. Significant can leave the prostate.. 

You may request a second opinion for your prostate pathology by a world class pathologist to confirm the results before considering treatment choices  

 Also if you did not, consider having a t3mri. This test may show extracapsular extension. Will show suspicious lesions in the prostate and the radiologist will rank them by the likelihood of these lesions being a significant cancer. 

 

 

 

 

Rob.Ski
Posts: 35
Joined: Feb 2021

I guess I fall into,

  1. Clinicians should offer definitive treatment to localized prostate cancer patients undergoing active surveillance who develop adverse reclassification. (Moderate Recommendation; Evidence Level: Grade B)

where increased volume is a condition of adverse reclassification.   

Thanks for the insight.   Will post doc recommendation after I talk to him.

 

ASAdvocate
Posts: 160
Joined: Apr 2017

The experiences at johns Hopkins and other long term AS programs is that more than fifty percent of any core involvement is a predictor of future reclassification.

You have every treatment option available to you. I have a list of all the primary treatments for prostate cancer that I occasionally post on various sites for feedback, and there are currently 34 treatments!

Take your time, ask, resesrch, consult, and choose what is best for you.

 

hopeful and opt...
Posts: 2331
Joined: Apr 2009

You may wish to ask your doc if he/she believes that a biomarker test is appropriate. 

Rob.Ski
Posts: 35
Joined: Feb 2021

If AS Advoicate is advising against AS, got to be a sign.  LOL.   34 treatments just makes the decision harder although, I'm pretty sure which way I'm headed.

Thx for input.

Rob

Old Salt
Posts: 808
Joined: Aug 2014

For a case like yours, there are options other than IMRT. For instance, brachytherapy (there are two kinds) and SBRT (Stereotactic Body Radiation Therapy).

You should look into those, in combination with one or more competent radiation oncologists. The latter tend to specialize, so you may have to talk to several.

Yes, it's a process, but there will be light at the end of the tunnel.

Rob.Ski
Posts: 35
Joined: Feb 2021

I'm 50 years old and have been given the standard push for surgery by both surgeons and a radioliogist.  Mainly because of age and the idea that radiation after surgery is more viable than the other way around.   I've seen advice against surgery and for it.  I am leaning toward surgery when the time comes.

MK1965
Posts: 223
Joined: Jun 2016

Gleson 6 does not metastasize and that was proven in many peer reviewed journals.

Just monitoring it, is the best option for everyone with same stats.

While being monitored, you wont miss window od opportunity if treatment becomes necessary.

Enjoyong years as is, is the best choice,  because years lost do to treatment SE will never repeat.

Anything that preserves current state is better then being victim of unnecessary radical treaTrent like RP  is.

 

 

MK

Rob.Ski
Posts: 35
Joined: Feb 2021

I'm all for the idea of putting off treatment and avoiding side effects but, there are risks and I feel they are getting higher.  I know there is possiblility with negative side effects with treatment.  There is also the possibility of waiting too long and dealing with metatasis.  I do appreciate the input.  Decisision on treatment is difficult with lots of options and risks.  It weights heavily on the mind.

Clevelandguy
Posts: 693
Joined: Jun 2015

Hi,

I would want to know on the 100% and 70% sample how much more cancer is in that area.  I would do a MRI or PET scan to determine how much the cancer has invaded my Prostate.  Could be the doctor just hit it right with his biopsy needle or is that section 100% involved?  Like most of the other cancer survivors I feel you are past the time of AS and need to do your research on whether it's radiation or surgery.  A grade 3 tumor is still cancer and cancer does spread and grow but slower than a grade 4 or 5.  Like I always say great doctors+great facilities = great results.  You still have time to do your research, looking at the pro and cons of various treatments.

Dave 3+4

Rob.Ski
Posts: 35
Joined: Feb 2021

MRI was clean.  Guess I could inquire about T3 MRI.  I've been to 3 different facilities, at Hopkins now.   Still waiting on follow up call from doctor on latest biopsy results.  

Rob.Ski
Posts: 35
Joined: Feb 2021

Well finally was able to speak to my doctor.  He said high volume 2 cores all Gs6 does not exclude me from AS.  He said a few years ago it would have but, not so much now.  Of course the risk goes up, 60% chance of finding higher grade in next three years.  Risk of escaping prostate is low.  He said AS is not an unreasonable choice. 

Rob.Ski
Posts: 35
Joined: Feb 2021

Well finally was able to speak to my doctor.  He said high volume 2 cores all Gs6 does not exclude me from AS.  He said a few years ago it would have but, not so much now.  Of course the risk goes up, 60% chance of finding higher grade in next three years.  Risk of escaping prostate is low.  He said AS is not an unreasonable choice. 

ASAdvocate
Posts: 160
Joined: Apr 2017

Was your call with Dr. Pavlovich, or another AS specialist?

I know that they have been looking at relaxing some of JH's strict requirements.

Still, while any extra day safely living a normal life is a great goal, that much of a cancer load is going to need frequent testing, IMHO.

Rob.Ski
Posts: 35
Joined: Feb 2021

Another specialist at Hopkins

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