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Posted 6/5/2017 5:44 PM (GMT 0)
John Hopkins second opinion report:
Pc now in two cores ,Gleason 3+3=6 involving 30%,that's in the mid section core and now in the apex core too,same Gleason 3+3=6 with only discontinuosly involving 30% of one core .
Any other cores benign !

How does that change my initial diagnosis ?! Thanks!
Posted 6/5/2017 5:49 PM (GMT 0)
Doesn't change much. You still qualify for AS.
Posted 6/5/2017 6:11 PM (GMT 0)
Now I wonder what else was overlooked ,cause basically the pc was found not in the nodule found at dre but above ...
Makes me thing what if is more to it ..in the nodule?!
Posted 6/5/2017 6:19 PM (GMT 0)
wow, you do like to look for the bad in everything.
Posted 6/5/2017 8:20 PM (GMT 0)
No I m not ,but first they told me my pc is in the apex ,than after 2 weeks ,they said it's in the mid section ,that's dr bahn diagnosis ,than now John Hopkins says both ...so yes I'm gonna have my suspicions ..
Posted 6/6/2017 9:23 PM (GMT 0)
So, those are percentages then. I would think that would help to relieve some anxiety with those numbers.

Of course, none of us know for sure when our time is up.
Posted 6/6/2017 10:16 PM (GMT 0)
Actually ,no!!
The first dx was one core ,17%,now is 2 cores and 30%.
Still low ,but the question that rises here is,what if I'm being underdiagnosed?!
Obviously they messed up from the get go,they couldn't locate the pc,first they said is in the apex now is in the mid section ,while John Hopkins says both ,so....of course I'm gonna be worried !!!
Posted 6/10/2017 7:28 AM (GMT 0)
So ,I just got a new dx from dr bahn based on John Hopkins second opinion and I'm quoting dr bahn here:
Pathologically is t2b rather than t2a ,that was the original dx.
Even though it should be categorized as an intermediate risk ,but clinically ,its close to a low risk !!

Again: psa 1.9 ,free 13.7%,density 0.07
2 positive cores out of 8(Doppler guided biopsy )
30% involvement in the mid section core and the apex one discontinuously 30%(whatever that means),Gleason 3+3=6,grade 1 both
Dre positive ,nodule was palpable at the base ,yet cancer was found mid and apex section ?!
How is this changing my status ,approach etc ?!

Post Edited (Novi68) : 6/10/2017 2:57:04 AM (GMT-6)

Posted 6/10/2017 12:41 PM (GMT 0)
bottom line, sir, is that you have minimal pc..G6 is the lowest diagnosis. JH has the best prostate pathology team around, and they found something visible that the less skilled guy didn't find. Either way, you qualify for AS...which means that in a year you have another biopsy to see if anything is different. If not, you're good to go. If so, then you do something about it then...and have good year in between.

I know it's hard to do, but you can relax. Really. It's not going to kill you.
Posted 6/14/2017 6:47 PM (GMT 0)
So ,now that dr bahn upgraded me to t2b ,based on John Hopkins pathology ,although ,clinically he thinks I'm still low risk , I'm thinking to schedule an appointment with a surgeon and radiologist.
Any suggestions based on my location(southern california )?!
I've already seen a urologist/oncologist at ucsd who decided ac for now,but that was before John Hopkins report.
Thanks!!
Posted 6/14/2017 7:11 PM (GMT 0)
Dr Bahn is incorrect -- you are not upstaged based on a biopsy. You are still stage T1c
Posted 6/14/2017 7:13 PM (GMT 0)
You are already in an AS program, and the t2b staging does not change your eligibility to be there.

Some reading for you:

https://prostatecancerinfolink.net/2016/07/07/can-a-man-be-too-young-for-active-surveillance/
Posted 6/14/2017 8:08 PM (GMT 0)
Initially I was t1c/t2a,cause one positive core ,but now ,per JH pathology, is two cores and according to dr bahn ,pathologicaly I'm t2b,even so ,clinically ,he thinks I'm at low risk too.
What concerns me is that nodule that started everything and turned out not to be cancer ,dr bahn did like 3 biopsy on it ...
So if the nodule is not cancer, than I should've been t2a either,correct(no palpable cancer)?!
Posted 6/14/2017 8:15 PM (GMT 0)
Novi. You are completely mistaken about how staging is done. You are stage t1c
Posted 6/14/2017 8:18 PM (GMT 0)
All due respect Allen ,I'm quoting dr bahn!
Anyway that I can post his dx letters ??!
Posted 6/14/2017 8:27 PM (GMT 0)
All due respect to dr bahn. He is mistaken. The new AJCc v8 staging manual makes it very clear. Clinical staging is only based on DRE. It has never been based on biopsy results.
Posted 6/14/2017 8:29 PM (GMT 0)
Ok,so what to do ...look for another dr that can diagnose me right ??!
Posted 6/14/2017 8:42 PM (GMT 0)
I mean,I've already seen dr Parsons at ucsd who enrolled me in ac and prostvac clinical trial ,but that was based on the dx before JH pathology report !
Posted 6/14/2017 8:51 PM (GMT 0)
He did tell you correctly that you are low risk and a good candidate for AS.
Posted 6/14/2017 8:55 PM (GMT 0)
Actually he said ,and I'm quoting :"you are know ,pathologically ,t2b,intermedient ,but clinically more like low risk !!!
Posted 6/15/2017 12:27 AM (GMT 0)
I was on my iphone earlier and couldn't explain adequately...

Here is an article that explains about staging:

/pcnrv.blogspot.com/2017/03/prostate-cancer-staging-update.html

Pathological staging is done on the basis of prostatectomy only. Biopsies are not used for staging. Under version 8 clinical staging is done only on the basis of DRE. In version 7, they allowed ultrasound or MRI imaging in clinical staging, but they removed it in order to maintain consistency.

Staging is one of 3 risk factors used in risk stratification (PSA and Gleason score are the other 2). NCCN recommends AS as an option for all "low risk" men. "Low risk" means stage T1c/T2a AND PSA<10 AND GS6. Some AS programs attach additional restrictions, but with mpMRI-targeted biopsies, there is little need for that. In fact, you seem to fall into the more restrictive "very low risk" category - that adds the 3 "Epstein criteria to the low risk definition: T1c, no more than 2 cores positive, no more than 50% cancer in any core, and PSA density<0.15 (yours is 0.07)

That said, you don't have to conform to the NCCN risk stratification system - you may regard your risk level to be whatever you and your doctor agree upon. NCCN is the most widely used risk stratification system, but it's not the only one. If you were allowed into a clinical trial based on being "low risk," they mean the NCCN definition unless they specifically qualify it. Your risk level remains unchanged.
Posted 6/15/2017 12:48 AM (GMT 0)
First of all ,thanks for taking your time and give me a thorough explanation Allan !!

Secondly ,in regards of me being admitted into a trial ,I just wanna add that was done before getting the results from John Hopkins ,although I just have it faxed to the trial doctor that happenes to be my ac dr ,no reply yet .
What threw me off was the letter from dr Bahn who upstaged me from t1c/t2a(low risk ) to a t2b,intermediate ,though he does admit that,clinically ,I'm more low risk!

Post Edited (Novi68) : 6/15/2017 12:13:23 AM (GMT-6)

Posted 6/15/2017 1:25 AM (GMT 0)
Regardless, you would still qualify for AS, please ask about it.
Posted 6/15/2017 2:32 AM (GMT 0)
It does not affect your eligibility criteria for the ProstVac trial

/clinicaltrials.gov/ct2/show/NCT02326805

The inclusion criteria (in part) are:

• Biopsy-proven (consisting of ≥ 10 tissue cores) adenocarcinoma of the prostate with cancer present in at least one biopsy core, either random or targeted, in the most recent biopsy

• All prior biopsies must meet the following: ≤ 50% of the total number of random biopsy cores positive for cancer

• Gleason score ≤ (3+4)

• Clinical stage ≤ T2a by digital rectal exam (DRE)

• Screening serum PSA < 20 ng/mL...

As you see, you meet all criteria.

BTW - if you are near UCSD, why not be part of their AS program? They have that great new RSI-MRI that seems to outperform all other imaging in early tests.
Posted 6/15/2017 2:44 AM (GMT 0)
I am!
I just saw dr Parsons(about 3 weeks ago ,right after my first dx) who's in charge with the prostvac clinical trial and I'm his patient too!
He enrolled me into AC there at ucsd
Meanwhile ,last week ,I got the report from JH where they found another core to be cancer and dr bahn told me ,now I'm t2b.
Just sent the JH report to ucsd ,waiting on a reply ...
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