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Posted 6/28/2018 1:40 AM (GMT 0)
I was diagnosed with prostate cancer on 12/05/2016 and the first biopsy result is as follows: Took 6 samples and found 4 were benign and
A) Prostate gland, left base, needle biopsies:
- Atypical small acinar proliferation, no diagnostic evidence
of invasive malignancy
B) Prostate gland, left mid, needle biopsies:
- Adenocarcinoma, Gleason grade 3,3 (score 6), involving 1 of
multiple cores, approximately 5%
- Perineural invasion not identified
- Dual immunohistochemical stain PIN4: Positive racemase,
negative basal cell staining

I had my second biopsy on 05/07/2018 and (6 samples again), 4 were benign and
B. Prostate, left middle biopsies-
-Prostatic adenocarcinoma, Gleason's grade 3+3 score 6 (grade group 1)
comprising 5% of biopsy volume.
D. Prostate, right base biopsies-
-Prostatic adenocarcinoma, Gleason's grade 3+3 score 6 (grade group 1)
comprising 30% of biopsy volume.

The Dr said that the 30% was concerning and that we should do an mri in 6 months and decide if surgery is the way to go. I have been thinking about this a lot and why wait is where I am heading. To me, this 30% is not going to be less in 6 months so why take a chance and wait. If you can provide me guidance, I would appreciate it. I tried to follow the MSK predicition tool but I dont have the tumor stage or the gleason score. I know I am a 6. Thank You.
    Posted 6/28/2018 1:45 AM (GMT 0)
    PSA Levels:
    10/22/2016 3.1
    11/12/2016 3.1
    3/13/2017 2.6
    6/16/2017 2.3
    9/11/2017 2.4
    12/20/2017 2.7
    4/19/2018 2.8
    Posted 6/28/2018 2:12 AM (GMT 0)
    You should be reading the sticky posts at the top, paying particular attention to active surveillance.
    Posted 6/28/2018 2:19 AM (GMT 0)
    Thank you for responding quickly. According to the active surveillance guide: "Active Surveillance (AS) is a very different strategy of proactive, prospective therapy for carefully selected LOW-RISK men .....". To me since I am at 30% in one area of the prostate, I am beyond low risk. Shouldn't I go ahead and request the surgery? How do others who have the same condition make their decision?
    Posted 6/28/2018 3:36 AM (GMT 0)
    Teddy I will remove my posts if I offended you at all...you will be fine...If I offended the mods...the will remove it...win win...Teddy umm that name reminds me of the movie AI...a very haunting movie...and quite possibly a future reality...
    Posted 6/28/2018 8:51 AM (GMT 0)
    I had 4 cores that were G6. Two steps led me to treatment. First, a second opinion from a leading pathologist, which found a bit of 3+4 G7. Also had a Decipher genomics test which tips the scales so I then pursued treatment. The good news is you have lots of time. I took six months to decide. Study all the treatment options, their difficulty of the procedure, the post-op recovery and the probable side effects than make an informed decision. Denis
    Posted 6/28/2018 9:26 AM (GMT 0)
    Teddy, the 30% is just based on where they hit the core. So picture a very small cancerous area of the prostate. If the needle on biopsy hits that riny core smack in the middle, like a bullseye, then it could be 70, 80, 90, even 100% Cancer . But if it just hits the side of that core it could be 50% and if it barely grazes it , it could be 10%.

    I had one core out of 3 that was 70% cancerous. When I had the surgery, the final pathology showed that the cancer was 5% of the total prostate.
    So that’s not a huge worry.
    If you are comfortable with ACTIVE Surviellance, you seem to be a perfect candidate for it.

    But first, did you get a second opinion on your biopsy? If not, you should

    pathology.jhu.edu/department/services/secondopinion.cfm
    Posted 6/28/2018 11:00 AM (GMT 0)
    Teddy,

    A few things..first, slow down. Second, SLOW DOWN. Third, IF you are bound and determined to treat, don't do what the first guy you talked to told you to do. Take some time to do some real research into options, potential side effects, and likely outcomes. THEN, make a decision.

    I was diagnosed with 3 G6 cores. My diagnosis Urologist told me I had 6 months to make a decision. Reality is that I made it shorter than that...but I did my digging, I did my research, and I made a careful, thought out, rational decision--not the "gotta get it out tomorrow!" emotional decision.

    Always remember this: You were diagnosed by a urologist. Urologists are surgeons, that's what they do. He is going to recommend surgery. Radiation oncologists do radiation. They are the ones to talk to about that.

    As far as AS goes, you are still low risk. In fact, very low risk. Your risk level will change if your Gleason score moves up to 7 or higher. Which means you're developing what they call pattern 4 cells--which are the more aggressive ones. G6 cells can grow and multiply--which may require treatment someday--but they rarely (if ever--there is debate on this) turn into pattern 4.

    In short, do this:

    1. Ask your doc to send your slides to Johns Hopkins for second opinion.
    2. Study up on prostate cancer, risk levels, and Active Surveillance: it means exactly that--you keep an eye on things and only treat if needed. about half the men on AS NEVER treat. It has no long term negative effect--and lots of positive ones (no risk of incontinence and permanent ED).
    3. Try to relax and slow down. Actually, your doc's suggestion isn't bad: Wait a few months and do an MRI to see what's in there. They can even use the MRI to provide a map for where to do the next biopsy.
    Posted 6/28/2018 11:00 AM (GMT 0)
    Teddy,

    A few things..first, slow down. Second, SLOW DOWN. Third, IF you are bound and determined to treat, don't do what the first guy you talked to told you to do. Take some time to do some real research into options, potential side effects, and likely outcomes. THEN, make a decision.

    I was diagnosed with 3 G6 cores. My diagnosis Urologist told me I had 6 months to make a decision. Reality is that I made it shorter than that...but I did my digging, I did my research, and I made a careful, thought out, rational decision--not the "gotta get it out tomorrow!" emotional decision.

    Always remember this: You were diagnosed by a urologist. Urologists are surgeons, that's what they do. He is going to recommend surgery. Radiation oncologists do radiation. They are the ones to talk to about that.

    As far as AS goes, you are still low risk. In fact, very low risk. Your risk level will change if your Gleason score moves up to 7 or higher. Which means you're developing what they call pattern 4 cells--which are the more aggressive ones. G6 cells can grow and multiply--which may require treatment someday--but they rarely (if ever--there is debate on this) turn into pattern 4.

    In short, do this:

    1. Ask your doc to send your slides to Johns Hopkins for second opinion.
    2. Study up on prostate cancer, risk levels, and Active Surveillance: it means exactly that--you keep an eye on things and only treat if needed. about half the men on AS NEVER treat. It has no long term negative effect--and lots of positive ones (no risk of incontinence and permanent ED).
    3. Try to relax and slow down. Actually, your doc's suggestion isn't bad: Wait a few months and do an MRI to see what's in there. They can even use the MRI to provide a map for where to do the next biopsy.
    Posted 6/28/2018 12:30 PM (GMT 0)
    Teddy, sometimes as they say doing nothing is the best thing to do. This is one of those times.

    If you go to surgery- you may end up not being able to do the things you currently do.
    Posted 6/28/2018 12:35 PM (GMT 0)
    There is a major chance element in a biopsy. They take samples of your prostate that might not be exactly representative of what is actually there. Because of that, even though the biopsy results from your two procedures were somewhat different, it might be that there was no change or progression from biopsy one to biopsy two. The fact that you have had a lot of samples taken from your biopsy and apparently none of them have revealed the presence of any G4 cells should be encouraging. The cause for concern with a biopsy always is that perhaps there are more dangerous cells lurking in there that have not been found.
    Posted 6/28/2018 2:29 PM (GMT 0)
    Thankyou Prato...I was a little wacky yesterday....yeh...I know so what's new....
    Teddy...don't run off....we really can help you a lot.....just mention what we are saying about the volume to your doctor...If you are comfortable with his answers and him...well...that's all I'll say about that...good luck...in any case....(the I just want it out....can be a big mistake... your call...)
    Posted 6/28/2018 10:38 PM (GMT 0)
    Thank you for the response. I know waiting is the right thing at this moment. Sometimes it is a lot to process all of this but I know I will get thru it. I will keep reading and educating myself. Thank you.
    Posted 6/29/2018 12:12 AM (GMT 0)
    Teddy - Also remember that you are still low risk with one core at 30% G6. Do not let any doctor rush you into treatment with that pathology. G6 doesn't do anything fast. You have time to continue to monitor it and to learn a lot so that IF you ever progress to the point where treatment is appropriate, you will be much more prepared to decide which treatment is right for you.

    I would have gone with AS, too, except for the fact that I did have a G3+4 core. I didn't want to risk the G4 cells getting anywhere, so I chose treatment (SBRT). We all have different decision points, but I don't think you should be at yours yet.
    Posted 6/29/2018 12:28 AM (GMT 0)
    Think of a blueberry muffin...if you stuck in a needle and pulled out 12 samples, you wouldn't get the same amount of blueberry each time. The differences between your first two biopsies are certainly within the Blueberry Muffin Margin of Error (BMMoE). Now, if the second biopsy came back with eight G6 cores or one or two Gleason 7s, I think it could be time to take action.

    And yes, you are still low risk--you're a G6 and a low volume one at that. Unless a core is G7 or higher, your risk level doesn't change. AS is ideal for these situations, plus it's safe. There's a 20-year study from John Hopkins showing that low risk guys that choose AS have the same outcomes as the guys that choose treatment.

    You don't mention how old you are, but once you treat things will change. You may or may not end up with ED or urinary issues, but even if you don't, I think most guys would say things work differently. (You certainly won't ejaculate if that's important to you, although in my case I'm used to it by now.) My advice would be to do AS as long as you can. I also agree with getting a second opinion on your biopsy slides, specifically from Johns Hopkins.

    Good luck to you and hope you stick around our community.
    Posted 6/29/2018 2:51 AM (GMT 0)
    Teddy,

    I was exactly where you were two years ago. I wouldn’t rush to any conclusion that you are being duped as other members are implying. I personally believe it’s reckless for any member here to imply you are being coerced into any decisions or that a doctor is trying to take financial advantage of you with tests. I’m not sure where the thoughts of those members are coming from but it’s definitely nothing you need to deal with at this point. Seek the advice of members that don’t seem so extreme with such statements. Most of all use this forum as a reference to seek the advice of other “professionals” for second opinions.

    Keep calm as some have said. There’s plenty of answers out there. I chose active surveillance for the period of time I was researching my options and my post surgery biopsy showed that my Gleason 3+3 became a Gleason 3+4. My surgery went very well for many reasons and it wasn’t “Luck” as some of the other members have stated. You can find many others out there who have had very good success with surgery. And there were many reasons why their surgery had a very positive outcome. You may also eventually choose another treatment option and that is Okay too because it is what you have found yourself to be comfortable with. If you do choose active survellience you must have a needle biopsy again at reasonable intervals defined by your medical professional.

    Best regards and remain positive.

    Chris
    Posted 6/29/2018 3:29 AM (GMT 0)
    Teddy,
    You have an ideal diagnosis for going into an active surveillance program. I had a similar diagnosis of a G6 back in 2014. I have had 4 great years on an AS program keeping my Prostate intact. Even though, in my case, other more aggressive cancer was recently diagnosed, I was fortunate that we were monitoring this closely. I had only 1 index lesion now of a much more aggressive Gleason 4+3, which is in a different area of the prostate from my original G6 diagnosis. A G6 like yours is nothing to lose sleep over right now.

    An AS program, properly monitored, is all you need to stay out in front of this. You have early stage cancer, which is not known to be aggressive. Worst case scenario, something else pops up elsewhere in your Prostate like mine did years down the road. Guess what, I still have my prostate. Because of my AS program being on top of things, I chose to have my singular index lesion of 4+3 Gleason 7 cancer taken care of by Focal Laser Ablation and am now in a continuing AS regimen, and potentially cured awaiting my first PSA, post treatment in a few months.

    Men today have many more options than either surgery or radiation, to treat this common disease. Keep your prostate while everything works properly. Realize life is precious. Enjoy it. If your PC progresses (most with your diagnosis don’t) you have plenty of time to deal with it. You will be fine. Don’t rush into anything.

    Good luck,

    PC Legacy
    Posted 6/29/2018 6:41 PM (GMT 0)
    I appreciate everyone's comments above. I have a quick question about the second opinion. It looks like John Hopkins is the recommended place for the second opinion. I had my second biopsy in May 2018. Should I request my dr to send that one to John Hopkins or wait for the next biopsy?
    Posted 6/29/2018 7:20 PM (GMT 0)
    Teddy,
    Sending the May 2018 biopsy results for second opinion would be a good idea as that will likely provide you some piece of mind. Again, I think your a strong candidate for an AS program.

    Good luck!
    Posted 6/29/2018 7:31 PM (GMT 0)
    Yes send the May 2018.
    Posted 6/29/2018 7:39 PM (GMT 0)
    Not only are you "low risk" PC, you are "very low risk PC." The NCCN definitions are:

    Low risk: PSA<10, stage ≤T2a, GS=6

    Very Low risk: Low risk AND 1 or 2 positive cores AND no greater than 50% positive in any core AND PSA density ≤0.15 (prostate density= PSA/size of prostate)

    AS is an option for any man diagnosed as low risk; AS is the preferred option recommended for any man diagnosed as very low risk. Many men live their full lifetimes on AS.

    BTW - why did you only have 6 core biopsies? - 12 is standard. You are stage T1c unless your doctor felt anything during your DRE. The prostate size was estimated by 3 numbers by your ultrasound.
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