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Posted 3/1/2016 10:00 PM (GMT 0)
Biopsy done Feb 12, 2016. Mike had been prescribed a Valium and slept thru the whole thing.

Dr says he took 16 cores ( 3 from lesion1 identified by 3t MRI and 1 from Lesion2 also identified by 3tMRI and 12 random)

Results:
Lesion 1:Adenocarcinoma. Length 0.8, 1.4, 0.8 cm (left medial peripheral zone) Gleason 3 + 4 = 7 involving 25% of the specimen (3 of 3 cores contain cancer) Gleason pattern 4 comprises 10% of the cancer. cancer length is .75 cm.

Lesion 2:Adenocarcinoma. Length 0.7, 0.5 cm (right medial peripheral zone) Gleason 3 + 4 = 7 involving 30% of the specimen (1 of 1 cores contain cancer) Gleason pattern 4 comprises 5% of the cancer. cancer length is .36 cm.

Of the 12 random cores: 5 were positive adenocarcinoma 3+3=6 All involving 5% or less of specimen. All .08 or less in length. variously located: right mid, right lat base, let apex, left lat apex, right lat apex.

1 atypical small acinar proliferation suspicious for but not diagnostic of malignancy in left lat mid. 0.8 in length-benign

5 cores benign

staging: T1c

Bostwick pathology

Consultation with urologist March 4th.
No matter how prepared you think you are, there's nothing like hearing the words, "cancer". We were really shook up for several days, but have calmed down now and are gathering information for decision on treatment. Leaning towards Di Vinci prostatectomy. Want the best opportunity for eradication and recovery.

Please offer feedback on treatment and prognosis given this report.

Questions:
- When we plug info into nomograms, do we count the 3 cores in lesion #1 as 3 cores or as 1?

-For purposes of staging, since cancer is found on both sides of the prostate, why is the stage t1c, instead of t2c? (Some sites say that a single tumor must extend into both sides of the prostate)

-With these numbers should we expect the cancer to be confined to the prostate?

-What are the most important questions we should ask the doctor at consultation?

-Since Bostwick was the pathologist that reported the biopsy and Bostwick is a recommended lab, is it still important to get a 2nd opinion?

Thanks for all your replies.

Mike's lady


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Posted 3/1/2016 10:51 PM (GMT 0)
Hi Mike's lady,

I'm sorry for to hear the news. It usually takes a while until the immediate shock wears off. Fortunately, Mike's diagnosis allows you that time. There is a lot to know before you can make a decision you will always feel comfortable with, and now is not a good time to make that decision. You will have to talk to a variety of specialists, not just a urologist to help you understand it all.

To address your questions:

- When we plug info into nomograms, do we count the 3 cores in lesion #1 as 3 cores or as 1?

You count them as 3, but you are drawing attention to the problem with using nomograms. The available nomograms were not designed with data from 3T-MRI-targeted biopsies, so they aren't really very valid for projecting prognosis.

-For purposes of staging, since cancer is found on both sides of the prostate, why is the stage t1c, instead of t2c? (Some sites say that a single tumor must extend into both sides of the prostate)

Because the cancer was detected on both sides of the prostate with an MRI, it should be re-staged as T2c (biopsy is not used for staging, but imaging and DRE are).

-With these numbers should we expect the cancer to be confined to the prostate?

T2c means just that. Apparently, there was nothing seen that would indicate extracapsular extension or seminal vesicle invasion.

-What are the most important questions we should ask the doctor at consultation?

See the list of doctor questions in the sticky for the newly diagnosed.

-Since Bostwick was the pathologist that reported the biopsy and Bostwick is a recommended lab, is it still important to get a 2nd opinion?

No, Bostwick is one of the 2 gold standards, so no further opinions are required.


Assuming his PSA was <10, his NCCN risk category is intermediate risk. He doesn't quite qualify for the new "favorable intermediate risk" category which requires both GS 3+4 and cancer in less than half of cores. The only thing that leaves out for him would be active surveillance. Surgery, SBRT and brachytherapy are likely to be curative. Of the two kinds of brachytherapy (high dose rate and low dose rate), some specialists would do them as monotherapies, some combined with external beam radiation - very much a judgment call. With all the options having about equal probability of cancer control, your decision will depend on other factors.
Posted 3/1/2016 11:56 PM (GMT 0)
Thank you for your prompt reply, Tall Allen. I have read so many of your postings and always find them informative, very easy to understand and helpful.

Regarding the question about the staging: Mike's doctor has staged him at t1c but I question that staging since Gleason 3+4=7 cancer is present in both sides of the prostate. Some reputable websites, however, say that the MAIN TUMOR must extend into both sides of the prostate for it to be t2c. Which is correct?
Posted 3/2/2016 12:18 AM (GMT 0)
mikeslady, the key point is that it IS likely organ contained, and that is the bottom line. With his G7, AS is probably not in the cards, as well as the bilateral involvement. Beyond that, his treatment options are fully open.

I'm a surgery guy, and had great results. One year after, continence is good, no ED issues. You need to find a well experienced treatment team, whether you go for radiation or surgery, the key is experience. If your surgeon is in the 'thousands' of surgeries, you're in good hands. Same for radiation.

He'll do well. The key now, for the next few months, is to eat healthy, get in shape, and have plenty of sex. Slow down, you have some time to gather information and talk to all your nearby experts. Where are you located? Someone here is sure to know where to go near you.
Posted 3/2/2016 12:54 AM (GMT 0)

mikeslady said...
Regarding the question about the staging: Mike's doctor has staged him at t1c but I question that staging since Gleason 3+4=7 cancer is present in both sides of the prostate. Some reputable websites, however, say that the MAIN TUMOR must extend into both sides of the prostate for it to be t2c. Which is correct?

Neither. The AJCC staging definition (7th edition) has no requirement that the "main tumor" must extend to both sides of the prostate. It just says that there must be tumor involvement on both sides. Unless they remove the whole prostate for examination, it is almost impossible to know with any certainty whether the mass is continuous or discontinuous. Clinical stage is based only on the DRE unless it is "reliably visible by imaging." In Mike's case, it sounds like it was, although his doctor may have had doubts about that.

In any case, it doesn't matter. He is in the same intermediate risk class, whether the doctor stages him as stage T1c or stage T2c, because of his Gleason score (I'm assuming his PSA was <10). It would only matter if he were otherwise "low risk." The important thing about his stage is that it seems to be organ-confined.
Posted 3/2/2016 1:04 AM (GMT 0)
Thank you for you promt reply, Halbert. And thanks, again, Tall Allen.

And can anyone shed some light on whether it is likely that Mike will be able to keep his nerve bundles if he decides for surgery.
Posted 3/2/2016 1:28 AM (GMT 0)
Nerve bundle preservation is up to the surgeon. If it looks like the cancer is well-confined within the capsule and is not growing into the nerve bundle area, he will preserve them. If it is equivocal, he might take frozen sections in that area for pathological review before deciding how wide to cut. Ask the surgeon if he does this (not all do). Nerve bundle sparing can be a matter of degree, rather than spared or not spared.
Posted 3/2/2016 1:33 AM (GMT 0)
Sorry to hear about Mike's diagnosis...sure sucks when you get that news. But I'm glad you're advocating for him. My wife was great throughout the whole process (and she continues to be) and it was immensely helpful to me.

Mike has an excellent chance of a cure with pretty much every treatment option. It sounds like you're leaning toward surgery, which is fine and since the cancer appears to be confined to the prostate there's every reason to think he's an excellent candidate for that.

But I'd also urge you to check out brachytherapy and SBRT, which would have the same chance of a lasting cure and have a different SE profile. To do that, you'll need to find ROs that practice those treatments--you're unlikely to get good info from your urologist on those treatments simply because he/she doesn't perform those. It's a bit of work, but you don't get any do-overs with this and you'll know that you did your full due diligence as you move forward.

Most important, I wish you the best as you move through this journey. It's a bit like going down a rabbit hole, but after a while you'll pop back up and all will be well. Let us know how we can help. Good luck to you both!
Posted 3/2/2016 4:16 AM (GMT 0)
Hi Mikes Lady. Sorry to hear about the diagnosis. You are asking great questions and getting great advice. Glad you found the site and are making yourselves your own experts and advocates. Take time to make the best decisions you can live with. Good luck on your journey. Take care. -JR
Posted 3/2/2016 4:53 AM (GMT 0)
Hello Mikes Lady,you are in the drivers seat. My stats are similar.It will take time,step back take a deep breath.Dont feel alone .We all have been where you are at.We are here for you.After research and asking questions here and visiting with the specialist in surgery and radiation the answer gets easier.Iv talked to top Surgeons, top notch Low Dose Brachy RO,a top notch High Dose Brachy RO,top notch Cyberknife-SBRT ROs.Actually about 2 in each field.Its gets mentally and physically exhausting. This what you have to do.There are many dedicated people here on HW that will help you along the way.Keep asking questions,keep reading all the stats that will guide you to your final decision.I chose Cyberknife-SBRT .After joining HW back in Oct.-2015,which was a miracle in itself,I start my first radiation treatment this friday.Thats 5 treatments every other day.Good Luck and you found the right place to be.
Posted 3/2/2016 6:05 AM (GMT 0)
I was confused about my staging as well. (It can be confusing).

If your doctor staged Mike as t1c, what that means to me is that he didn't feel any abnormalities during his DRE examination. (That's no small thing!)

He'll likely get another couple of DRE's. Ask them if they feel anything abnormal.

Sorry you're here. You'll both get through this. Not too much the worse for wear (I know that may not mean much where you're at now...but, you will)

Hang in there. Your asking great questions.
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