Biopsy Results

Looks like I'm headed for surgery,

SPECIMEN(S):
A: Prostate biopsy, right base
B: Prostate biopsy, right mid
C: Prostate biopsy, right apex
D: Prostate biopsy, left base
E: Prostate biopsy, left mid
F: Prostate biopsy, left apex
G: Prostate needle biopsy, target 1
H: Prostate needle biopsy, target 2

FINAL DIAGNOSIS:
A. Prostate biopsy, right base:
- Prostatic adenocarcinoma, acinar type
- Gleason score 7 (4+3)
- Grade Group 3
- Extent: Involves 2/2 cores (10 mm, 75%; 5 mm, 70%)
- Perineural invasion is present

B. Prostate biopsy, right mid:
- Focal atypical small acinus

C. Prostate biopsy, right apex:
- Benign prostate tissue

D. Prostate biopsy, left base:
- Prostatic adenocarcinoma, acinar type
- Glea
son score 8 (4+4)
- Grade Group 4
- Extent: Involves 2/2 cores (9 mm, 65%; 5 mm, 50%)

E. Prostate biopsy, left mid:
- Prostatic adenocarcinoma, acinar type
- Gleason score 8 (4+4)
- Grade Group 4
- Extent: Involves 1/2 cores (4 mm, 30%)

F. Prostate biopsy, left apex:
- Prostatic adenocarcinoma, acinar type
- Gleason score 6 (3+3)
- Grade Group 1
- Extent: Involves 2/2 cores (<1 mm, <5%; <1 mm, <5%)

G. Prostate needle biopsy, target 1:
- Prostatic adenocarcinoma, acinar type
- Gleason score 8 (4+4)
- Grade Group 4
- Extent: Involves 2/2 cores (9 mm, 75%; 6 mm, 60%)

H. Prostate needle biopsy, target 2:
- Prostatic adenocarcinoma, acinar type
- Gleason score 8 (4+4)
- Grade Group 4
- Extent: Involves 2/2 cores (1 mm, 5%; 1 mm, 5%)

Not the best news, I trust you are dealing with it in the positive manner you have had in the past.

Going through a similar diagnosis and treatment, I might suggest you consider radiation options as well as surgery as you make your choices. There is a good chance you will need radiation after surgery with the major involvement of high risk PCa noted so there is some merit in skipping surgery and just go for a radiation based treatment scheme. Surgery with radiation is also a good choice for high risk so it just depends on what your preferences are.

GeetarMan said...
...The last time I had a biopsy I sent the results to John Hopkins, but I don't know if a slight change in Gleason score would influence my course of treatment,

Y not consider radiation as a form of treatment?

halbert said...
With the G8, make sure you have the entire series of scans to look for potential spread outside of the prostate. If you do have visible spread, then surgery more or less moves off the table anyway.

The scans showed no evidence of spread to lymph nodes or bone. The results specifically called that out.

F8 said...
they seldom do. G8 cancer. i would definitely attempt to open my mind to radiation.

I'm totally open to RT. I have a consult with my Uro (who is a surgeon) on Thursday and we'll discuss all options. There are ROs at the U of M and he will set me up with a consult. It will be interesting to hear what he recommends.

Post Edited (GeetarMan) : 3/13/2021 9:26:10 AM (GMT-7)

Sammas said...
please know if your uro discourages you for ANY reason from having radiation he's not lookng out for your best interests.

Ooops. I edited the quotes and I messed up. So some quotes are attributed to people that did not say them! Sorry halbert!

Sammas - I totally get that, and I had that conversation with my uro on my first consult with him. He assured me that he would have no problem referring me to an RO, and said that I absolutely should no matter what his recommendation might be.

F8 said...
you started out saying you were headed to surgery. that concerns me for a couple of reasons but the main one in your case is you will most likely need radiation at some point which makes surgery a poor choice. the way i see it is you need to hit the cancer with a triple therapy for a chance at a cure.

the odds your cancer is contained to prostate are very low, but it might be contained to prostate bed.

the piecemeal approach isn't a good choice especially if you are concerned about permanent, life-changing SEs and like a said earlier a cure.

sorry to be so blunt but i think you can beat this if you act quickly and aggressively. good luck!

I said 'looks like I'm headed for surgery' out of ignorance, not because I prefer that, or that it was recommended. I would actually prefer to NOT have surgery if that gives me an equal shot at a cure.

I wasn't that scared before, but now I am. Ugh. Oh well, one day at a time.

Hi Geetarman,

I'm sure that whatever you decide, will be well thought out and supported by your doctors and family. Its great that you are plugged in here as there are many of us who had to make the same decision.

5 years ago, when I was diagnosed, I had a Urologist who was very pro radiation. He stopped recommending surgery in 2011 except in rare cases. I did consult with a Urologist at Vanderbilt Medical Center and also an RO.

I actually had a heated discussion with my Urologist after I circled back to discuss the Vanderbilt recommendation for Surgery. I wanted it out of my body, I had lost my younger Brother to prostate Cancer in 2012.

I ended up opting for Radiation because of the risk of fewer side effects, and because of the experience of my RO. I also trusted my Urologist's recommendation. While RALP Surgery is commonplace, It is still a pretty serious operation in my opinion.

Good luck on your treatment decision.

Al

GM, sorry for your results but you obviously have your head on straight. You have been around here long enough to know the surgery vs. radiation debate. But I must say that I'm really glad you are looking at the radiation option especially given your advanced cancer diagnosis and the likelihood that radiation is in your future anyway.

Good luck.

Jim

GeetarMan said...

F8 said...
you started out saying you were headed to surgery. that concerns me for a couple of reasons but the main one in your case is you will most likely need radiation at some point which makes surgery a poor choice. the way i see it is you need to hit the cancer with a triple therapy for a chance at a cure.

the odds your cancer is contained to prostate are very low, but it might be contained to prostate bed.

the piecemeal approach isn't a good choice especially if you are concerned about permanent, life-changing SEs and like a said earlier a cure.

sorry to be so blunt but i think you can beat this if you act quickly and aggressively. good luck!

I said 'looks like I'm headed for surgery' out of ignorance, not because I prefer that, or that it was recommended. I would actually prefer to NOT have surgery if that gives me an equal shot at a cure.

I wasn't that scared before, but now I am. Ugh. Oh well, one day at a time.

#######

sorry man. i know how you feel. i had all 12 cores positive, and there was at least one at 70%. i was G7 but who really knows for sure. after i was given the biopsy results we went to the see the urologist fully expecting i was headed to surgery. had to get it out.

but my uro recommended against surgery and instead recommended triple play. he said that he had never had a recurrence with any patient who had triple play. we were sold and i will be eternally thankful to that guy!

You can tell from my signature I was in a similar situation to F8 and pursued the same treatment course. Three surgeons all told me no surgery as I would also need radiation and the combination is too damaging to do intentionally.

My decision was between permanent seeds and High Dose Rate brachytherapy. After speaking to two different ROs I chose HDRBT.

Please do not discuss radiation with your urologist. He is not board certified in radiation therapy. And who is he to allow you to seek an additional assessment. You call the shots and do not need his permission to do vital research with board certified specialists.

I am sure your urologist has walked you through the MSKCC and JH monograms. If not, you should do so. Mine did and showed I had a 99% probability of spread to the nodes and that eliminated surgery as a primary therapy.

Hey Gman, sorry to read of your new situation but it sounds to me that you're going into it with a clear head, and you've gotten some great advice here. As someone on AS I will not weigh in on treatment options; one day perhaps I'll have to consider them, but for now I simply respect the guys here who have gone through the mill. (I do have experience with radiation and surgery, though for a different kind of cancer)

The advice to consult with various specialists is great. The RO who treated me years ago also does brachy for PCa. She's brilliant, but if I were faced with treatment now I would also look for ROs specializing in other modalities.

No question that the squeaky wheel concept is important when listening to patient accounts. One such in my life is a friend who went right to RALP 4 years ago without considering options and now regrets it. I'm buoyed to read that you're considering all the parameters!

Finally, I'm with my fellow Californian Michael_T on the Epstein read. Like chicken soup, it can't hoit! I also know of at least one guy whose Gleason score changed after JH (upgraded in his case).

Best of luck, man. Keep us posted, and courage!
David

Had my consult with my URO about biopsy results. No surprises, about what I expected.

Next steps... Consult with RO (EBRT), CT Scan, and Bone Scan. Will get results of all that on 4/15 and then I will make a decision on treatment plan.