Its Official - Diagnosed Today

No matter how I tried to prepare myself for the news on my 3rd biopsy, it is still a blur and upsetting.

2 of 12 cores positive. 1st core gleason 7 being primary 3 and secondary 4 with 25% tissue involvement. 2nd core same rating with 3% tissue involvement. Both located left base lateral. % Gleason patterns 4,5 is 5%.

Other information: Volume cc 15.4; PSAD 0.50

If anyone has knowledge on the gleason ratings please chime in....... I have not quite got them figured out..

Uro is confident the cancer is confined to the prostate and curable.

He asked me to come back next week after I have some time to digest the news. From what I remember he said open RP can be done by him or he can refer me to robotic surgeon. Other alternative is seeds.

Talked a little about side effects, RP will be a journey on ED for a year. May not have same erection and may need to use viagara to help. He is confident that he can save both set of nerves. Seeds will have little impact in early years however can have an impact as I age.

..

I am going to drink a bottle of Rye, hug my wife and then take the day tomorrow to research as much as I can.

Greg

Hi Halbert,

Yes, I have the pathology report. The overall gleason score is 7 (3,4), the highest gleason score is 7 (3,4) and the % gleason patterns are 4,5 and 5%. Does this make sense?

The 3 + 4 was in both core samples.

The uro offered to refer me to the radiation specialist which I am going to do. I am not sure of the advantages (if any) of open RP vs. Robotic?

Anyone who has been down this research road, I will take any advice on what questions to ask.

My goal.....kill the cancer....with as little side effect as possible...I also want to be able to have a quality sex life.

I may be asking for something I can't have....not sure....

Greg,

Your options are wide open and you have plenty of time to make the right decision for you. I agree with Halbert's advice, get second opinions on the slides, and if possible set up interviews with multiple surgeons and radiation oncologists if they're available in your area. You only have 2 positive cores. One is almost insignificant at 3% involvement. The 25% core sample tissue involvement is probably going to require some sort of treatment. The question I have is what % gleason pattern 4 is in the 25%? You mentioned 5%. That's a good low number. But is there also a Gleason pattern 5 in the mix?

John

Hi Greg and sorry about the diagnosis. Sure does suck to hear that. But it's very curable and hopefully we can be helpful in getting you there.

First off as Halbert and others mentioned, please get a second opinion on your biopsy slides by either Epstein or Bostwick--there's info in the newly diagnosed sticky to get that done. As stated, your Gleason 7 (3+4) is "favorable intermediate" risk and you want to make sure you're moving forward knowing that you are truly a 3+4. They could downgrade you or upgrade you, although you'll likely just be confirmed. But it's important to do this and it's cheap and easy. It might be the only low-hanging fruit out there as you start this journey.

Treatment options are:

* Surgery (robotic or open), most are robotic these days. If you go this way you want to find an expert that does lots of these.
* Low-dose-radiation brachytherapy or seeds
* High-dose-radiation (HDR) brachy, which uses a higher dose but is not permanently in your prostate like the radioactive seeds
* SBRT, an external beam radiation that typically requires five treatments

There's other options of course, but those would be the main four and any would have an excellent change of curing you. However, they all have different SE profiles and you want to understand how they could affect you.

You also won't find one specialist that can talk knowledgeably about all of them, you need to find the individual experts. Just know that PC is a very slow grower and you do have time to figure this out. I urge you to use this time to learn and talk to people--we can help, particularly if you tell us what part of the country you're in. (Perhaps Canada since you drink "rye"?)

Good luck to you! You'll get through this!

Greg, sorry for the bad news. As others have suggested you should get another reading on those pathology slides from Epstein or Bostwick so you can be sure about what you have. I would also recommend that you read the sticky thread at the top of our forum that is designed for newly diagnosed patients.

If there is good news in your diagnosis it is that you should have several options for a cure. This surgery vs. radiation question is one that most of us faced. Assuming your cancer is contained then you should be cured with equal effectiveness by surgery (either open or robotic), LDR Brachy (seeds), HDR Brachy or SBRT. Your due diligence should include visits with doctors in each of those specialties so you get a full picture.

I try to simplify the surgery vs radiation choice a bit. Both options cure you so take that for granted. The value proposition for surgery is that you get immediate knowledge of your final pathology - for some people that is important (it was not for me). For the radiation options listed above you do not get that immediate pathology knowledge but you do get a better chance of avoiding onerous side effects like incontinence or ED. Your choice.

Good luck.

Jim

Good luck and welcome to the club that no one wants to be a member.

Hi Greg welcome to HW and sorry you have to be here. You got some great advice from many here already. Read as much as you can, look into options that these others have given you. I wish you luck on your journey. Take care. -JR

Sorry to hear about your diagnosis, but welcome to the group.

Ask your urologist to get a second read of your slides from Jonathon Epstein at John's Hopkins. He reread mine and I went from GS of 9 to 7. Big difference in options and urgency. I chose the DaVinci robotic from an expert, but since I had pni, I lost the nerves on both sides... oh well. Easy come, easy go as they say.

Good luck.

Tony

Actually they don't disagree "a lot " with all grades of PC. They are in nearly 90% agreement with G6 ..granted only about 60-70% for G8.

newtopc, When I was getting 2nd, 3rd, and 4th opinions with different Urologists or cancer hospitals they all wanted to see the original slides and grade them with their labs. So we did not necessarily look to send them out as others suggest, we just followed the request of the new Drs. we were going to see. Some had us do the legwork; others did it for us. We just contacted our original Urologist and found out the lab that graded the slides. We contacted the lab, they sent us a release form that we had to fill out and on the form you list where you want the slides sent (Just call the place you are having the slides sent to for the info).

I found having the 3 opinions helped me because the original was 3+4,the second well known cancer place was 3+3(I was surprised but Leary of that result because I had a lot of cancer in there so if 3+3 is so non-aggressive how could I have so much.) and the 3rd was 3+4. I felt comfortable going with the 7 which eventually became 4+3 with the targeted biopsy. It's important because it can really affect your treatment decisions and the time that you may have to come to that decision. While others may disagree here I would probably get a 3rd opinion if the first two conflict with each other(esp. if it lowered the gleason score), even if the 2nd one is from one of the well respected labs. It may or may not affect your treatment decision, only you will ultimately know that. Best to have more info then too little if you can....Good luck....Jim

One other thing Greg, my uro in Markham gave me a loaner book with a card for a free online download. Did you get that from your uro?
Are you in Peterborough?