Help in uderstanding my Prostate Pathology report

I was recently told by my Urologist that cancer was discovered after having a prostate biopsy, not sure how to understand the report. My brain went numb after he told me what the findings so I was not taking in all the dr was explaining, and he wants to schedule me for surgery right away. Can anyone help me with some insight.

F. Prostate, Left Base, Biopsy:
- Prostateic Adenocarcinoma, Gleason Grade 3+3 = Gleason score 6
involving 70% of the core Biopsy.

G. prostate, Left Mid, biopsy:
-Prostatic Adenocarcinoma, Gleason Grade 3+3= Gleason score 6
Involving 5% of the core biopsy.

H. Prostate, Left Apex, Biopsy:
-Prostatic Adenocarcinoma, Gleason grade 3+3= Gleason score 6
Involving 15% of the core biopsy.

I. Prostate, Left Anterior, Biopsy:
-Prostatic Adenocarcinoma,Gleason Grade3+3= Gleason Score 6
Involving 30% of the core biopsy.

If anyone can help me with insight about my report, and how serious this is, seeing my doctor is suggesting I move fast on this. Thanks

Sleepallday, I am responding to this because I am in Australia and it is early evening here, whereas it is the middle of the night in the US and I expect that most of the gurus who will be able to offer you the best advice are all sound asleep, while you may well be wide awake scared and worried and looking for a reply to your query.

First up let me say, slow down, there is absolutely no need for a mad panic? You have the vey mildest form of PCa at Gleason 6 in all cores. There will be plenty of gurus coming along to offer their opinions, but I know they will all say take your time and consider all your options.

There will certainly be some (possibly many) who will say you don't in fact need to do anything at this stage. GL 6 is a level at which you could adopt Active Surveillance. That means take no invasive action, but monitor closely, ready to act if things get any worse.

I personally think your Dr is being overy aggressive in suggesting immediate surgery. You have plenty of time to think about it. As well as surgery, there are other options which you should consider before making any decision.

Please take the time to read the "sticky" at the top of this forum "Newly diagnosed with PC". You will learn a lot.

Best wishes

Chas

That shows you got low grade, slow growing cancer. Major inconvenience. Nothing more. Listen to halbert.

Sleepallday said...
...my doctor is suggesting I move fast on this.

That's a big red flag!

As odd as it may sound, Gleason score 3+3 is the lowest possible score that a pathologist can give. (One would more intuitively think it would be "0" or "1.") There's been argument amongst pathologists specializing in prostate cancer that most 3+3 cases should not even be called "cancer" because they are so common, so ubiquitious, and so harmless...but that's another discussion.

Not sure of other case characteristics, but if you had a negative DRE and a low PSA (under 10 ng/mL), then your 3+3 puts you solidly in the "low risk" category...which is, by far, the most common initial diagnosis for all men.

I cannot agree more, however, with the others who have suggested that your most important next step is to request that your biopsy slides be sent out for a 2nd opinion to one of the very few pathologists who specialized in prostate cancer, for the reasons described in the "sticky thread" titled "Newly diagnosed with PC - read this thread first." (the links in that sticky thread might be out-of-date) The biopsy 2nd opinion is extremely common and your urologist's office will undoubtedly be familiar with this type of request...but your next step is to contact pathology.jhu.edu/department/services/secondopinion.cfm, then they will guide you further.

Good luck. I'll encourage you not to get caught-up in any effort to make you rush your decision...time is on your side.

Post Edited (JackH) : 10/27/2016 9:37:27 AM (GMT-6)

Sorry to see you are on this forum, but you're in good hands. Being recently diagnosed as well, read the sticky and send off your biopsy slides for a second opinion.

Good luck, but as others have said and all other factors are good, e.g. age, PSA levels, family history - active surveillance may be good option.

Overall, your report is quite good. G3+3 does not spread.

But it is in 4 cores and one is 70%. That is a bit concerning. The only concern would be if there are some G4 cells, and so far none have been found.

You might want to research the criteria for Active Surveillance (AS). I think you fall within the parameters, but I am not sure. Maybe someone else can be more specific.

I see no reason to rush into surgery!

Mel

Thanks everyone for the information, it give me a little better understanding. Here's the extra information I was told i should of posted.

I'm 58, my PSA 3yrs ago was 4, which led to my first biopsy, which was negative, but after being retested 4mo ago, (also 3years later) my PSA came back as a 6, which led to a second biopsy (saturation biopsy) I do have a family history of prostate cancer. My brother who is two years younger was diagnosed in 2009, he was 48, with a Gleason score of 6, he elected for prostatectomy surgery, which he wished he had more info before he made his decision, which he felt was made from fear. His last PSA was 0.3 4mo ago. My father also was diagnosed in 2003 at the age of 71, and also went with the surgery, and is still alive. Sorry about posting this earlier, I was just very nervous about all of this. I hope this will help Thanks!

Hi Sleepallday, welcome to HW, sorry you have to be here and for your PCa diagnosis. You have received some great advice so I will not reiterate that. Just know that you have a place to also bounce your ideas about treatments paths and anything else that concerns you. We are not doctors but a collective group of men and women who have been down the PCa journey. Good luck on your research and treatments. Keep us posted. Take care. -JR

Jack:

Well, thank goodness I was in the "PSA era." Otherwise, my serious case of PC would not have been dx.

Give up PSA and we will see (correction: we are starting to see) more serious PC cases that are not usually found on initial dx.

Mel

Sleepallday said...
Do I make this request to the Urologist that did the biopsy

Yes.

...and yes. $250 at John's Hopkins I believe it was. (but mine paid)

I follow the advice i received on the site and got a second opinion from Johns Hopkins, and received the report, but not understanding how to interpret one section on the new report compared to old. Can anyone help?
Here the section of the first report: F. Prostate, Left Base, Biopsy:
- Prostateic Adenocarcinoma, Gleason Grade 3+3 = Gleason score 6
involving 70% of the core Biopsy.

This is the section of the new second opinion F. Prostate Adenocarcinoma, Gleason score 3+4=7 (Grade Group 2) involving Two (2) cores (70% Discontinuously involving 60% of one (1) core) (Less Than or Equal To 5% Gleason Pattern 4). Perineural invasion identified in This case

Hope someone can explain this section. Thanks

Welcome back, sleep.

Peter nails it. You've bumped up slightly with the G7 and PNI from low risk to low intermediate risk. That isn't a huge deal, but it's a move in an unwelcome direction.

You've got solid information now. You can take that report and run with it. It's as close to truth as you'll find.

Now, the next series of questions that we can work with to help you even more:

Where are you located? Knowing that, we can steer you to the best places and doctors near you.
We would encourage you to set up consultations with specialists in all the various treatments that are available, and note that with your pathology, your odds of cure are high, no matter what treatment route you choose.

The different choices are:
Active Surveillance--and it IS a treatment, not a way to ignore it.
Surgery--either open or robotic. The key here is having a surgeon with thousands of successful operations. Hundreds is barely enough to be good at it.
Radiation--this comes in multiple flavors, if you will. Again find someone who has done thousands of treatments with success, no matter which version you choose.

Sleepy - I missed your initial posts here because I was in the mind-fog of being newly diagnosed and learning about treatment options myself. Your new reading puts you, along with me and many others, into what is called "favorable intermediate risk" PCa. That means that although we are statistically in the intermediate group, our particular statistics should behave more like low-risk cancer than intermediate risk.

That is good and bad. The good is that this form of PCa is not as aggressive as some others, so we have time to learn, discern and choose the treatment that is best for ourselves. The bad news is that there is a dizzying array of treatment options to choose from. There is surgery, in 2 or 3 different forms of procedure. There is brachytherapy, which is radiation therapy from radioactive materials either implanted into the prostate or passed through it. There is external beam radiation, which is, as its name implies, radiation beamed into the prostate from outside the body. External beam radiation comes in some 4 or more varieties. Then there are the other, less common, sorts of treatment, such as High Intensity Focused Ultrasound, Cryoablation, and others. I'm not trying to confuse you, but I am trying to alert you to the fact that no matter what one doctor tells you about this or that being your only option, unless there is something way past the pathology reports you've related here, almost all of these options would be viable for you.

You owe it to yourself to at least learn the basics about many of the treatments. Only then can you feel that you have made an informed decision as to which is best for you. Your doctors (note the plural) can tell you which of the treatments they feel are medically appropriate for your disease state, but only you can decide which treatment (including side effects) you can best live with.

Hang around. Read some more. Ask lots of questions. The folks here will be happy to do our best to help you learn and decide.