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Biopsy results - trying not to panic

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Posted 7/13/2015 7:53 PM (GMT 0)
We will be requesting that Steve's slides go to Dr Epstein for 2nd opinion & review, but this is what we got from the Cleveland Clinic:

(17 biopsies were done, all were benign except the following)

Right apex - adenocarcinoma, Gleason 3+4=7, involving two of two cores (60%, 40%; 7mm, 4mm)

Target 1-3 - adenocarcinoma, Gleason 3+4=7, involving two of two cores (20%, 10%; 1mm, <1mm)

I am not exactly sure of the location of the target, but I believe it was the suspicious area from the MRI which was described as the mid left lateral peripheral zone.

From what I've gathered in the past week from postings here especially, cancer in the apex is particularly concerning. Is that true?

I can't believe I'm posting this information here even before I've told my husband, but other than the facts of the report, what should I tell him? He is going to take this so very hard and I want to help him deal with it in any way I can.

We are meeting with the doc on 7/22 to discuss treatment options.
Posted 7/13/2015 8:04 PM (GMT 0)
Sorry to hear the results, but its not the worst.
I had a lot more 3+4 cancer and was told I might live 10 year without treatment.
With treatment, your husband has excellent prognosis.
Good luck to you both.
Posted 7/13/2015 8:05 PM (GMT 0)
Welcome to the forum. Sorry you find yourself here.

Others with more experience will be along shortly.

17 cores seems like a lot. That they only got two positive out of 17 is encouraging. It seems likely that you've caught this quite early, and all treatment options are probably on the table for your husband.

Hang in there, and keep us apprised of further results.
Posted 7/13/2015 8:10 PM (GMT 0)
Suzhtz,

Take a moment, relax, breath, and know that this is a very treatable condition. Hate that you have to be here but please be assured that you and your husband both can and will learn much from everyone on here, has made my PCa so much easier to swallo...

Read all the stickies above, and wait until you've talked to the docs next WEDNESDAY before you get too worried.

I am some what confused to why they took or did so many biopsy's?
Most people only have 12 done six on each side?

You also stated that target 1-3 where G7 is that one sample or three that all where the same?

When you have time post a signature profile for your husband it helps others when they know age, location etc. wishing you both the best. Others will chime in with more info soon I am sure...all the best.
Posted 7/13/2015 8:20 PM (GMT 0)
Of course any cancer diagnosis is troubling. This particular diagnosis is sometimes called "favorable intermediate risk" and is treated in much the same way as "low risk" PC. That means that all the same therapies are likely to be as curative as the therapies for low risk PC. Some even do active surveillance with numbers like that, if you have good access to an excellent radiologist trained in reading mpMRIs. Brachytherapy monotherapy (either LDR or HDR) are both good options, as is SBRT, and surgery. Not all are available at Cleveland Clinic, however.
Posted 7/13/2015 8:33 PM (GMT 0)
Man, I'm sorry you and your husband are joining our club. But as far as diagnoses go, his is pretty good. Probably weird to hear "pretty good" and "cancer" in the same sentence, but it's true. Try and take some time to decompress from the news. And keep in mind that time is a luxury you have. Try and take advantage of that to check out all your options.

Most important, good luck to you and your husband and let us know how we can help.
Posted 7/13/2015 8:37 PM (GMT 0)
Thank you all for your reassurances. I am trying to pull myself together before going over the results with Steve. I'll be leaving work shortly and we should be meeting at home in the next couple of hours.

To clarify what and where biopsies were done:

Right base 2
Right mid 2
Right apex 3
Left base 2
Left mid 2
Left apex 3
Target 3

Also no staging on the report. Shouldn't that have been included?

Pathologist was Katherine Watts.
Posted 7/13/2015 8:57 PM (GMT 0)
Hi Suz. Sorry for the news but take that deep breath now. Your husband is likely to be cured with those cancer stats and he has lots of options so you both need to KEEP THAT IN MIND!

Actually, my wife found out before me as well; I had told the doctor to call and talk to either of us and she happened to be home. She told me, seriously but calmly, that my biopsy had come back positive for prostate cancer but that she understood from the doctor that it was very treatable and that the outcome was likely to be very good. Then we went over the details together and went into serious research mode.

Re the 17 samples, it is doctor's choice on that so not to worry. My doctor did 16, which he told me gave him a better perspective than the usual 12; that made sense to me and still does.

OK...now you guys have it so now what? My answer is to get yourselves educated on our disease so that you are very ready to discuss this with your doctor. Read the sticky and the top of our forum. Order two books, "Guide to Surviving Prostate Cancer" by Dr. Walsh (a surgeon) and "Invasion of the Prostate Snatchers" by Dr. Scholz (a medical/prostate oncologist.

Then get prepared to visit multiple doctors with multiples specialties. You urologist may be a surgeon and suggest surgery. Don't bite. You may ultimately choose surgery but....the options listed by TallAllen, i.e. LDR Brachy, HDR Brachy and SBRT should also cure hubby with less onerous side effects. You can't just trust one doctor to give you the answer.

If you need advice on specialists, please ask us. There is a variety of knowledge on this forum and we know great doctors.

Oh...and please follow thru with the second opinion from Epstein or Bostwick.

Stick with us; we are here to help.

Jim

P.S. If your husband is so inclined, you may want to show him or print out some of our comments. That may make him feel better.
Posted 7/13/2015 8:58 PM (GMT 0)
suzhtz, well this is a concern, but a long way from panic. The apex is considered the trouble spot as far a spreading outside the gland is concerned. That being said, with only 2 positive cores out of 17, that's not a bad diagnosis at all. Pretty much any of the standard therapies should offer cure. Note the word cure.

This is a long way from the end of the world.

Yes, the diagnosis is a punch in the gut. Tomorrow, it will look manageable. The staging will be done by the Urologist, and it's based on whether there are any nodules he can feel on the DRE along with the biopsy results.

You've got great treatment options there in Cleveland, between Cleveland Clinic and University Hospitals, you've got world class facilities all the way.

The key to remember today is that this is totally treatable, and any of the treatments are likely to work for him. Keep coming around, we'll keep you off the edge of the ledge.
Posted 7/13/2015 10:00 PM (GMT 0)
Thx to all for your continuing support.

I might be wrong, but I'm thinking there are 4 positive cores, two in each of the areas reported to have PCa? I'm really new to this, so what am I reading wrong?
Posted 7/13/2015 10:12 PM (GMT 0)
Suzhtz,
Take a deep breath...
Your beloved husband has many options available to him that will likely cure this cancer. Reach out when you want and I will provide you the Dr's names I met with at the Cleveland Clinic and at University Hospital before I made my decision.
I am in Cleveland fairly regularly so if you and your husband want to meet for coffee I'm sure that can be arranged.
Take care.
Posted 7/13/2015 10:46 PM (GMT 0)

Suzhtz said...
Also no staging on the report. Shouldn't that have been included?

No. Staging is not based on the biopsy. It's based on the DRE plus any imaging that was done. So if the Uro felt nothing, it's stage T1c. If he then did an MRI with a single small suspicious area on one side, it's stage T2a. Neither of those stages carries any risk greater than low risk. Those stages don't preclude AS or any kind of treatment.

- Allen
Posted 7/14/2015 12:03 AM (GMT 0)
Suzhtz - you've gotten good advice here, i'll try to not clutter things up by adding too much more.

One thing to clear up, is regarding cancer at the apex. Sure, if you get this, its better not to be at the Apex. The reason is that from what i've read, 52% of positive margins or escape from the prostate occur at the Apex. BUT- AND THIS IS A BIG BUT - that doesn't mean that you have a high chance of positive margins or escape. Just that if your husband does find himself in that situation, there is a good chance it comes from the Apex.

BTW - I had what was ultimately a G7 (3+4) AND one of my positive cores was at the Apex, AND it was 80% cancer. So i too was worried about the Apex. Bottom line, i just past the 6 month mark with no detectable PSA.

Telling your husband will be hard there is no getting around it. There is no easy way to tell someone, especially someone you love, that they have cancer. But it will be ok, you'l both handle it, and as the days go by and you get busy doing research and making decisions, you will both start to feel a sense of control coming back. And you will feel much better.
So breathe. It may not seem like it now. But its gonna be OK
Posted 7/14/2015 1:55 AM (GMT 0)
Again, thank you all for your support and insights that were given with kindness, grace & candor. Steve was truly touched by your caring comments. He's not much of a computer guy, but thinks this forum is amazing.

We are both surprisingly calm tonight. We are leaving on Thursday for a long weekend trip to Canandaigua, NY (Rochester) to visit our first and only grandson who is 5-1/2 months. During our road trip, we will have plenty of time to talk about options & prepare for the 7/22 visit with our DaVinci trained uro.

Samster - Would love any and all recommendations for both CC and UH. A meet up for coffee in the future would be very helpful.

TallAllen - Uro felt asymmetry and MRI found 7 mm nodule classified as PIRADS 4 - high probability of clinically significant cancer. Will this bump us out of the favorable intermediate risk category?

Prato - On another thread you mentioned you do lots of research and had made some dietary changes. Can you tell us what you are avoiding and what you've added to your diet? Hubby is 6'1" and 155 lbs (underweight!) but was diagnosed with some early heart disease last summer. Since you also have some heart issues, thought any suggestions you had would be good for us.

Tudpock - I had Walsh's book in my hand yesterday at the local bookstore, but put it back on the shelf. Thought it best to wait for the DX. I'll be going back for it tomorrow.

I started a signature summary, but am not sure when it will be visible.

Suz
Posted 7/14/2015 3:04 AM (GMT 0)
Hi Suzhtz,

Welcome to HealingWell. As you've already found out, it's a great place for information and support.

You've already received plenty of information, so I'm here for moral support. Your husband is going to be fine. Five years ago I had surgery at the Cleveland Clinic for a 3+4 cancer in three cores, some of which was in the apex. My PSA at the time was 4.11 -- higher than your husband's. My PSA last month was undetectable; there's no sign of cancer.

This whole thing isn't something that anyone wants to deal with, but he'll be ok and so will you. Enjoy your visit to NY. When you come back you can read up on this and consider your treatment options. You're at a world class center of medical excellence with a very treatable condition, so try not to worry. Everything will be fine.

Best,

Jonathan
Posted 7/14/2015 3:29 AM (GMT 0)
Suz, re the diet question. ....
I've eliminated red meat, fried foods. I try to be as plant based as possible but I know a fully plant based diet is just not sustainable for me. So I do eat, but limit quantities of, chicken (white meat no skin) Turkey breast, and shrimp (it has lots of cholesterol but I'm told is ok in limited quantities. I eat a lot more fish.
I eat whole grains, nothing that says "enriched flour" so no white pasta, bread, rice, chips, pretzels, etc. I do eat whole grain and whole wheat bread, pasta, brown rice (but not much.
I try to severely limit fat intake, wherever possible I eat fat free foods, and try to watch sugar content. No transfats, no added sugar. But fruit is ok.
Dairy is only fat free, but I try to limit even that, because there have been credible sources that believe dairy is not good for prostate cancer (lots of debate on that though)
Lot of broccoli, cauliflower, mushrooms, onions, arugula, tons of tomatoes. Olive oil instead of salad dressing.

I could go on and on...oh, wait, I just did, sorry... But that's the idea.
I've lost 8-10 pounds over the last 4 weeks nit by dieting, I eat a lot, but by eating the right foods. That's on top of the 30 pounds I'd already lost over the last 3 years.
Also exercise is really important. I walk, with a little jogging mixed in, 3-3 1/2 miles a day, on average 6 days a week.
Feel free to email me if you have questions.
Posted 7/14/2015 4:58 AM (GMT 0)

Suzhtz said...
TallAllen - Uro felt asymmetry and MRI found 7 mm nodule classified as PIRADS 4 - high probability of clinically significant cancer. Will this bump us out of the favorable intermediate risk category?

7 mm is pretty small and because it was on one side, that puts you in T2a, as I said. Nothing to worry about on that account.
Posted 7/14/2015 5:12 AM (GMT 0)
I meant to mention about the apex thing - while it's true that apex involvement is somewhat correlated with recurrence, that is not a cause/effect relationship. Apex is where most tumors occur, so of course, it will be correlated with everything. So the correlation means nothing. The only danger- and it applies to surgery only - is on small prostates, it can sometimes be hard to dig it all out (it's the part of the prostate where the capsule isn't well-integrated. Even there, it's usually not a problem. It just means that if you go the surgery route, get a really experienced surgeon (I heartily recommend Pratoman's surgeon.) It shouldn't affect radiation treatments at all.

- Allen
Posted 7/14/2015 10:40 AM (GMT 0)
Suz, things will work out fine. As others said, you're in a region that is blessed with two world-class medical communities. Enjoy your trip. I'll be passing Rochester mid-day on Saturday on the Thruway, I'll wave.
Posted 7/14/2015 1:02 PM (GMT 0)
Suz,

getting the bad news is always earth shattering. When I got my results everything got quiet and I could hear the earths rotation. Its normal to be shocked, and the first few days after hearing the results may be a bit of a blur. Let it sink in, ignore all the old wives tales that you'll hear, because as soon as the news reach the ether and everybody knows you'll get some strange "help" from all sort of quarters. Acknowledge all and wait at least a week or so.

There is a problem ahead for you, as there are so many options, and everyone you speak to has a preference. There are a lot of men out there who have had some intervention for PCa, find them and start investigation options. Treatment side effects are a big issue that is hardly mentioned those early days because the focus is "cancer, cancer, cancer ...." Don't forget Quality of Life issues ... factor all of these into your decision making processes.

Start reading ... acquaint yourself with terminology and options. all the best!
.
Posted 7/14/2015 1:13 PM (GMT 0)
It was very strange waking up this morning. I had the usual inclination to hit the "snooze" a few times and then I remembered -- Steve has cancer. I wonder when I will be able to start the day without that being my first sobering thought....

Steve is telling our two sons and his parents about his DX today. We are also setting things in motion to get slides sent to Epstein @ JH.

Jazzman - Thx for the reassurances. Who was your surgeon at CC?

Pratoman - Thx for all the nutrition info. We are pretty much doing the same type of "clean" eating but we could do better, especially in the grain area.

TallAllen - I truly understand why you need to put that disclaimer in your sig about not being an MD. You are amazingly informed for someone without a medical degree.

Suz
Posted 7/14/2015 1:22 PM (GMT 0)
Hi suzhtz,
I don't have much to add here as it seems like everyone who knows anything about this disease has already chimed in. I think that any diagnosis of cancer is devastating and your reaction to the news is quite normal. I think that it is a great thing that your husband has you in his life. Us men are funny creatures. We like to believe that we don't want anyone fussing over us but get our egos crushed when we think no one cares. Oh, I guess I just gave myself away.

As far as diagnosis goes, it seems like this was caught pretty early and is very treatable that can help the both of you enjoy a long and happy life together. Best wishes to the both of you in this new journey.
Posted 7/14/2015 1:47 PM (GMT 0)
When will you wake up and your first thought is not "Steve has cancer"? I suppose the length of time varies for all of us. While I know that thought now is huge and looming right in front of you, the reality is that thought does recede over time. Treatment will cure Steve and time will cure everything else.

PS If I wasn't active here on HW, I think I would rarely think about the whole cancer thing. In fact, I was filling out a health form a few months ago and my wife pointed out to me that I forgot to check the box that said I have cancer.
Posted 7/15/2015 5:59 PM (GMT 0)
Just wanted to check in with an update.

Steve's slides should be on the way to Johns Hopkins soon. (Cleve Clinic has a 3-5 day turn around, but we are trying to expedite.) Someone mentioned that Dr Epstein will actually give a recommendation regarding a treatment plan and we are going to pursue that.

Someone has recommended proton radiation to us. I could not find much CURRENT info on this forum using the search option. The most recent comments I could find implied that it was effective but had serious ED sided effects. Is that the final opinion on this?

Halbert - Please do wave when you pass thru Rochester. Have safe travels to Maine.

Pratoman - Wanted to congratulate you on the 40 lbs you've lost. That is great! I get a monthly newsletter from the Clinic's Center for Lifestyle Medicine. Today's newsletter covers impact of diet, exercise and stress on lifestyle diseases. Both cardiac issues and prostate cancer are classified as lifestyle diseases by them. Keep up the work you are doing in all those areas.
Posted 7/15/2015 6:04 PM (GMT 0)
I don't think proton has ED side effects to that great an extent. It is extremely expensive some places.
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