40 year old just diagnosed

Here's what I got:
4/12 cores came back positive
All Gleason score 3+3=6

Core 1: Gleason 3+3=6
Left posterior
11 of 15 mm length and 7 of 13 mm length affected
Perineural invasion is present

Core 2: Gleason 3+3=6
Left posterior
11 of 13 mm length and 8 of 11 mm length affected
Perineural invasion is present

Core 3: Gleason 3+3=6
Left lateral Mid
0.5mm of 11mm length

Core 4: Gleason 3+3=6
Gleason score 3+3=6
0.5mm of 11 mm length affected


I understand this is low risk, and we have plenty of time to make a choice concerning treatment.

What does perineural invasion mean? I asked about spread, and the doctor said he had a 0.1% chance of it having spread, and the MRI showed it hadn't.

Also, if there is anyone on here around age 40, please say hello. My husband would like to talk to people his age who are dealing with this.

it's the invasion of PC cells into the space around a nerve. It can be a sign of increased risk. It's unlikely that it's spread anywhere at this time and likely no scan could confirm/deny that.

G6 seldom metastasize. While this is concerning, you're still left with the same basic choices:

Treat or do AS
If treating then: Surgery, SBRT, brachy, etc.

It's a tough call and often there is no scientific way to choose between the options.

Andrew

CrazyLady, well, you've got your answer.....

I'd agree with the suggestions that you send the slides for a second opinion to Epstein. With that, you'll have your final answer. He has the best reputation in the business.

I'd also suggest you see about getting into an AS program. It is the only treatment decision that has no immediate side effects. Now, AS isn't for everyone...some people can't handle the mental side of doing it. I'll expand on what it is: It means that you keep an eye on things with regular PSA tests, a confirming biopsy within a few months, and regular checkups. The whole idea is to watch for something to change...and THEN do something. And, it may be that nothing will change for a long time.

The cool thing is, that the long term prognosis, with a properly run and followed AS program, is that there is NO long term difference in outcome.

Now, if you guys do decide to treat aggressively, then all the options are on the table. The key point is to find the best team you can get access to wherever it is that you're located. Do the research into side effect profiles. And then, talk to the experts..and don't ask a surgeon what he thinks of radiation therapies (or vice versa).

Hang in there...keep asking.....we're here to listen.

CrazyLady said...
Here's what I got:
4/12 cores came back positive
All Gleason score 3+3=6

Core 1: Gleason 3+3=6
Left posterior
11 of 15 mm length and 7 of 13 mm length affected
Perineural invasion is present

Core 2: Gleason 3+3=6
Left posterior
11 of 13 mm length and 8 of 11 mm length affected
Perineural invasion is present

Core 3: Gleason 3+3=6
Left lateral Mid
0.5mm of 11mm length

Core 4: Gleason 3+3=6
Gleason score 3+3=6
0.5mm of 11 mm length affected


I understand this is low risk, and we have plenty of time to make a choice concerning treatment.

What does perineural invasion mean? I asked about spread, and the doctor said he had a 0.1% chance of it having spread, and the MRI showed it hadn't.

Also, if there is anyone on here around age 40, please say hello. My husband would like to talk to people his age who are dealing with this.

I don't understand what's going on.

this was posted an earlier thread about your husband's MRI.....

MRI @ Duke 2/13/18
.39ml lesion on left periphial
Prostate 37 ML
Capsular contact w/ mild bulge (less than 1 cm)
PI-RADS category 4

Yet....in the path of this post....how many cores are there? 12? And he had a fusion biopsy?

*is this normal .... HW guys*???

Also.....if it was a 12 core biopsy....then there is more than 4 cores (samples) positive for cancer. Isn't there 6 cores positive for cancer?? But...that would make sense if the urologist pointed the gun at the same lesion.....and fired off 4 stickers.

I don't know how to interpret this path report.

Thanks for posting and I know this is a shock to the system. The key now is information and learning. Emotions may run wild and you need facts to help sort through the decision process. No one should tell you what to do or not do. Learn about the disease, about the options, and see multiple docs to find one that makes you comfortable. As you said you have time. I waited nearly 7 months to get treatment. Denis

CrazyLady said...


Also, if there is anyone on here around age 40, please say hello. My husband would like to talk to people his age who are dealing with this.

Hello. Was diagnosed at 45 years old. Not quite 40 but pretty close. I'd be happy to chat/answer any questions.

I've been tracking a high PSA (due to family history) from age 30, underwent several biopsies over the years between 30-40 years of age. Finally chose to go to JH for a consult, and was diagnosed with a single core of G6 at age 42 in Nov 2013 via a MRI guided TRUS biopsy at JH. Had subsequent fusion mapped biopsy at NIH-NCI in May 2015 - up to 6/18 cores all GS6, 5-75% in the cores. Saw many specialists...chose HDR-BT at FCCC and underwent procedure in Feb 2016 at age 45. Happy to help in any way that I can for you and/or your darling husband. The link to my entire story and journey is in my sig.

Hello, I was diagnosed last year at 39 (now 40). Sorry you guys have to be here with us. Mine was similar although slightly less favorable than his. I gotta admit things were very stressful at first. I couldn't think anything but doom and gloom until I spent some time learning more about this stuff and visiting with some well known treatment specialists. Once you come to your final decision (or non-decision) and are comfortable with the choice, it becomes much more tolerable. Obviously you can see in my signature that I chose to go with SBRT for treatment and I honestly have gone back to my normal life with virtually no change. I only think about "having cancer" when something reminds me of it and when it's time to test my psa again. In fact, I've taken this opportunity to improve many aspects of my health mentally and physically. My diet is better, I exercise six days a week, and I visit with family a lot more than I did before. All this has really done is put my life in perspective and I focus more on things that I believe should be most important to me. I'm making every attempt to turn a negative into a positive. Some things may or may not be out of our control but we can certainly give ourselves the best chance. I have two kiddos and I don't intend on going anywhere anytime soon. Not without my best fight. We're all here to chat when your wheels are spinning.

Frosty