G7 - Biopsy consultation

Hi everyone-

For those of you following my posts, I'm writing on behalf of my Dad who was just diagnosed officially last week after receiving the biopsy results.

Today was the first consultation post biopsy results via phone last week.The Dr. was very optimistic on the phone last week when delivering the news, and followed up by saying "the kind that was found, isn't the type that will kill you". He has a great demeanor and put us at ease.

This morning we received more detailed information. The 1cm area that was biopsied found 3+3 AND 4+3 (G7) cells. It was explained that because the 4 preceded the 3, it indicated it needed to be treated and was intermediate risk on the aggressive scale. He is recommending the Cyber Knife - Robotic Radiation (5 treatments consecutive days) and Dad will follow up with an actual consultation with the Radiology Oncologist for specific recommendations. The Dr. explained that since Dad is in great health and would be in the category of "having a life span of at least 15 years", that treating it would give him the best quality of health.

I certainly appreciate the doctor's optimistic outlook. He said that in this day and age, Dad's PC is "curable and treatable".

I apologize for not having the specific path report but below I will note what I do know for certain. Will follow up with more specifics once I have it.

Thanks everyone for your ongoing advice and support! I am sure Dad will actually become a member soon, so he can get his information first-hand. He has appreciated ALL of the information I have shared with him from everyone here!!!

Dad's age - 71
2 negative biopsies 2007 and 2011, Positive biopsy 8/16
G7 4+3, 3+3
1cm area detected by MRI followed by fusion biopsy
DRE negative

Do get the second opinion.

The SBRT is a great choice and your dad will do just fine with it. The side effects aren't bad (almost none from reports I've heard here).

Another 15 years? Depending on your dad's health, it could be longer. It's possible that your dad is in that 'curable' zone and won't have to worry about PC ever again.

Andrew

Mermaid88 said...
All noted and I will certainly encourage the second opinion by Epstein or Bostwick. Just wondering - how often is it found that another opinion finds a difference in results?

I don't know the real stats, but happens often enough to be a wise precaution. Reading the slides is a bit subjective and Epstein, Bostwick are considered the best.

Andrew

Halbert and Andrew - Thank you. That makes a lot of sense considering the percentage. It's always better to be thorough and cautious.

Do you recommend having both review the slides or just one or the other?

Also...I was a bit confused by the grading system to get the Gleason score. Is it significant that the "4 precedes the 3" or did I misunderstand the Dr.?

M

Gleason 4+3 means there are a majority of more advanced cancerous cells in that sample. Usually surgery isn't considered for somebody your dad's age but radiation is appropriate. My urologist (associate professor at MD Anderson) told me "radiation is radiation. ." so I wouldn't obcess over what kind of radiation he selects.

As far as a second opinion, not a bad idea but it is highly unlikely another reading would make a treatment difference since he is a 4+3. Even if the slides were graded as a 3+4, he still needs intervention.

He should have a good outcome so don't stress out.

halbert said...
Mermaid, a common statement is that about 30% of the time a second opinion gives a different gleason score. And it's about 50-50 between upgrade and downgrade.

Do try to get a copy of the biopsy report and share the details here. We can help you interpret.

There are several guys here who have done SBRT and they report good results with minimal unpleasantness during or after.

Halbert, I remember reading an article by Dr. Epstein which said that second opinions give different Gleason scores in 1-2% of the readings. If you recall, I would appreciate your letting me know the basis of the 30%. Thanks.

Tall Allen said...
Mitchden-

Halbert is right.

Epstein said...
In a recent six-month period, Epstein and colleagues looked at 3,000 consults, almost 700 of which were sent at the request of either the patient or the urologist. Overall, we changed the diagnosis about 35 percent of the time-which to me was quite striking because these were not cases where the pathologist even had a problem.

www.hopkinsmedicine.org/hmn/f02/feature2.html

- Allen

What I find interesting about that is also this: Post surgical pathology shows a different Gleason score than biopsy about 30% of the time. It did for me.

We've talked about the unreliability of the standard TRUS biopsy many times. It samples a miniscule percentage of the prostate tissue, and it's pretty much hit or miss. Plus the fact that reading the slides is very subjective. It's a tool, a not very good one, and as long as we accept those limitations, it's ok.

Still, in a case like this, it's a good idea to get a second read to help make the best treatment decision possible.

halbert said...

Tall Allen said...
Mitchden-

Halbert is right.

Epstein said...
In a recent six-month period, Epstein and colleagues looked at 3,000 consults, almost 700 of which were sent at the request of either the patient or the urologist. Overall, we changed the diagnosis about 35 percent of the time-which to me was quite striking because these were not cases where the pathologist even had a problem.

www.hopkinsmedicine.org/hmn/f02/feature2.html

- Allen

What I find interesting about that is also this: Post surgical pathology shows a different Gleason score than biopsy about 30% of the time. It did for me.

It did for me too. And not in the way I wanted.