Second Opinion On Biopsy

Just got an email from Johns Hopkins Lab, Dr. Jonathan Epstein and the only (3+5)8 Gleason with 76 % was changed to a (4+3) 7 with 80% so my question is does this since I do not have an 8 now but 4-7's and a 6 and 3 benign does this change the type of treatment? As I was told before with the 8 I could not do the beads and Cryo was OUT? Your thoughts? Thanks in advance for your response!

 I would say that's good news!  Armed with this information, I would consult with a medical oncologist, a surgeon, and a radiation oncologist to determine what's best for you.  I would think you would be a good canidate for any of the standard treatments.  Good luck!

The fact you had a Gleason 8 should not have eliminated seeds. They ave been proven very effective in higher risk cases with a slightly better cure rate than surgery. See Grimm's study, the Prostate Cancer Study group to see comparative cure rates of all options by risk class.

In reviewing the email from Johns Hopkins Lab, Dr. Jonathan Epstein has changed the 3 + 5 to a 4 + 3. For some reason the lab only sent him five of the 12 slides. I have requested his opinion of all 12. Here is what I received so far:

Gleason Score 4 + 3 = 7 involving 10% of one core, 80% pattern 4.

Gleason Score 4 + 3 = 7 discontinuously involving 50% of one core, 50% pattern 4.

Gleason Score 3 + 4 = 7 involving 80% of one core, extraprostatic extension identified. 40% pattern 4.

Gleason Score 4 + 3 = 7 involving 80% of one core, 30% pattern 4. Perineural Invasion Identified in this case.

Gleason Score 3 + 3 = 6 involving 40% of one core.

It appears the extraprostatic extension identified means the cancer is outside of the prostate?
The perineural invasion identified means the cancer has invaded my nerves?

Any feedback is most appreciated!

Just to give an update. I have been to see the oncologist, the surgeon and my urologist. I have decided to do five weeks of external radiation with the internal seeds. I have had the dye injected in my prostate have another MRI tomorrow and will have the markings done the 11th for external radiation. They plan to start the external radiation in a couple of weeks and then inject the seeds.

I will keep you posted as to how I am doing in my journey.

Thanks everyone for your support and concerns.

A down grade from a 8 to a 7 is big news, congratulations. Especially coming from Hopkins. All primary treatments should be available to you.

David

Good morning,

I must say the process so far has been difficult. I have had so many test run on me and procedures that it seems as if there is no end to all of this. Last week I went in for a volume test so they could determine how many seeds I would need implanted. They will implant between 75-100. The nurse and doctor talked to me about pretty much isolating myself for 2-3 months following the insertion. We even talked about Church and that it was not a good idea to be in close proximity of anyone while I was radioactive. It was best if I sleep alone or try to remain 3 feet away from people. The big surprise was the recommendation to not allow my dog to sit in my lap or close to me during this time. This is difficult enough without having to be so isolated.

Have any of you experienced this?

He also told me it wasn't too late to have the prostate removed. If I change my mind it must be done before the first radiation treatment. We asked him when the treatment would start and he said in about a week in a half. I am not sure why he doesn't have a set date or even when he will know. My friend who has been with me through this entire process is growing weary and frustrated at the uncertainty of the Radiation Oncologist.

I am trying to keep positive. Any suggestions is appreciated.