Pathology Results - What's Good What's Bad...

Artemis biopsy procedure on July 20. Results are below.

Two 4+3 and one 4+4 and one there was not enough cells to grade

The first number at 4 has me concerned. I see the doc (UroOncologist that specializes in surgery) on Aug 7. I am sending the information to have my slides sent to Epstein in the morning. Hoping that those results will be back in time for my appointment.

If anyone has any recommendations for doctors in the Indianapolis area I am all ears. I do like the guy I see but will also seek other opinions.

Honestly, it all makes my head spin.

Daron

NUMBER OF ABNORMAL SPECIMENS; 6
DIAGNOSIS 1: ADENOCARCINOMA BLOCK (S); B,G,I
DIAGNOSIS 2: RARE ATYPICAL GLANDS SUSPICIOUS FOR ADENOCARCINOMA BLOCK(S); H
DIAGNOSIS 3: BENIGN PROSTATIC TISSUES WITH ACUTE AND CHRONIC INFLAMMATION BLOCK(S); E,F Final
Diagnosis:
A. Prostate Needle Core Biopsy, Right Apex Lateral -Benign prostatic tissue
B. Prostate Needle Core Biopsy, Right Apex Medial Adenocarcinoma Gleason Score 4+ 3= 7 Percent of core(s) involved: 30%
C. Prostate Needle Core Biopsy, Right Middle Lateral -Benign prostatic tissue
D. Prostate Needle Core Biopsy, Right Middle Medial -Benign prostatic tissue
E. Prostate Needle Core Biopsy, Right Base Lateral -Benign prostatic tissues with acute and chronic inflammation
F. Prostate Needle Core Biopsy, Right Base Medial -Benign prostatic tissues with acute and chronic inflammation
G. Prostate Needle Core Biopsy, Targeted-RAntCG-5 Adenocarcinoma Gleason Score 4+ 3= 7 Percent of core(s) involved: 30% ( 3 of 4 cores)
H. Prostate Needle Core Biopsy, Left Apex Lateral -Rare atypical glands
I. Prostate Needle Core Biopsy, Left Apex Medial Adenocarcinoma Gleason Score 4+ 4= 8 Percent of core(s) involved: 30%
J. Prostate Needle Core Biopsy, Left Middle Lateral -Benign prostatic tissue
K. Prostate Needle Core Biopsy, Left Middle Medial -Benign prostatic tissue
L. Prostate Needle Core Biopsy, Left Base Lateral -Benign prostatic tissue
M. Prostate Needle Core Biopsy, Left Base Medial -Benign prostatic tissue
N. Prostate Needle Core Biopsy, Targeted-LPZ-3 -Benign prostatic tissue
Pathology QC A. Dr. xxxxxxxx has reviewed and agrees with the diagnosis

Definitely will not be scheduling anything at this visit. He has been my regular Urologist for the last year since this little journey started. The group he is part of has a fairly extensive list of providers that all have their specialties. The IU Health system has a good size group at their cancer center that specialize in prostate cancer. I saw one of their docs last year but he did not like me asking questions, so I went elsewhere.

We all know about spinning heads! Surgery or radiation is sort of a coin flip.

"We all know about spinning heads! Surgery or radiation is sort of a coin flip."

in some cases, yes. but in cases where you'll likely need radiation after surgery I really question the wisdom of surgery.

Thanks everyone.

So much good info here. Reading so many different experiences is helpful.

Daron

I live on the Northeast side near I69 and 96th street. Currently seeing a doc with Urology of Indiana.

Sounds like a helpful conversation. You should know that the bone scan is unlikely to show anything, but it will be good to get that behind you. I'm glad he's encouraged to speak with other doctors--unfortunately there's not good one-stop shopping, but you should likely see at least one surgeon (urologist) and radiation oncologist that specializes in SBRT (external radiation) and another that specializes in brachytherapy (radiation directly in the prostate).

Keep us posted as to what Johns Hopkins says about biopsy slides...

Dman,

I was in your backyard. I have a second cousin and several friends that live in Fishers so I stayed at the HI Express at 96th and I69. Had a high school reunion in New Castle Saturday night. Notably I had a great breaded tenderloin at Sohms for lunch with my cousin. Can’t get them in Georgia.

Your dx indicates that you have several different treatment options. However it is vital you meet with each specialist for their specific assessment. Do not get radiation information/assessment from an urologist. Do not get surgery information/assessment from an oncologist. Etc. You should meet with different radiation oncologists that perform SBRT/CyberKnife and that perform brachytherapy, preferably High Dose Rate (HDRBT).

So your search has begun and you do have time. You can easily take 3-6 months to do research and meet with specialists without concern before you begin treatment. I was higher risk and performed mine more quickly as I met with three surgeon/urologists, two radiation oncologists (permanent seeds and HDRBT) and a medical oncologist that specialized in PCa in a six week time frame. The meetings and a lot of internet research including Healingb Well all helped me reach a treatment decision.

Friday August 3 I had a bone scan and Urogram with and without contrast.

Bone scan was clean...as expected.

Results from CT are below. Nothing odd other than the comment about a lymph node. I see the doctor in the morning.

Daron

INTERPRETATION: There is a 2 mm stone at the inferior pole right renal calyceal system. There is no additional urolithiasis. There is no obstructive uropathy. There is a 7 mm exophytic cyst at the superior pole left kidney and a 17 x 13 mm cyst within the anterior aspect of the right kidney. There is a smaller 4 mm parenchymal cyst within the infrahilar aspect of the right kidney. There is no suspicious renal mass identified. There is no significant ureteral filling defect identified. Contrast filling of the urinary bladder is unremarkable. There is mild prostatic enlargement.

There is a 6 mm left external iliac lymph node. There is no abdominal or pelvic adenopathy identified.

There is diffuse hypoattenuation throughout the liver, compatible with hepatic steatosis. Included portion of the spleen is normal. The adrenals, pancreas and gallbladder are unremarkable.

The gastrointestinal tract is nondistended and without focal inflammatory change. There is no free intraperitoneal fluid or gas. There are small bilateral fat-containing inguinal hernias, right greater than left.

There is mild endplate arthropathy at the lumbosacral junction. No acute bony abnormality is identified.

CONCLUSION:

1. Mild prostatic enlargement. There is a small 6 mm left external iliac lymph node. No pelvic adenopathy is identified.

2. A 2 mm right renal stone, without obstructive uropathy.

3. Benign renal cystic change.

4. Hepatic steatosis.

5. Small bilateral fat-containing inguinal hernias.

Daron,

My interpretation: you have a minor kidney stone, a minor inguinal hernia, and a visible lymph node. Your prostate biopsy came in at G7/G8.

So, treatment is in your future. There are advantage and disadvantages to the various treatments you can have-and only you can weigh them for your situation and needs. Do make sure you actually talk to people who perform the procedures about their recommendations. I used this analogy recently in another thread: asking a surgeon about radiation therapy is kind of like asking a plumber how to fix your roof. The plumber may (and probably does) know a good roofer--but he's not going to tell you how to fix the roof.

Dman, the downgrade is awesome news. The 4+3 raises your risk slightly. That being said, you're making some good moves. Asking the company doctor for referrals is a great idea--he has no particular axe to grind.

The great thing is, you have time to make a reasoned decision. PC is not like other cancers, in that it gives you time to decide and consult. Brachy with external boost is a great therapy, many have had good luck with it. It will take care of the lymph nodes too.

An apical tumor IS harder to treat--for surgeons as well as radiation oncs. It might be better to go radiation (wider treatment area) with the apex tumor. I'm sure more opinions will roll in. One problem with having medical folks in the family is that they think they know more than they do: Cut it out now is the classic reaction--but it's not always the best choice.

I'm a surgery guy, and I'm happy with my choice. I did take time to research and make a solid decision based on what was important to me at the time. You owe it to yourself to do the same. And, I hope you can sit down quietly with your wife (especially) and friends and explain that their reaction isn't helpful: you need to slow down and make a reasoned decision, not an emotional one.