Anxiety - waiting

Thanks Mumbo. The doctor said he doesn’t like to call people with results. My next appointment with him is on 25 October he said he would provide the results at that time.

Biopsy Back. 10 cores. 7 benign. Two with a Gleason score of 6 and one with a Gleason score of 7. I have no more details. My Urologist was to tell me this next Monday at our appointment. He sent a copy of my pathology report to my primary care physician who called me (I asked him to). To summarize, my MRI showed a normal prostate, but I have one core sample that is a 7. My Dad had prostate cancer at about the same age as me. Anyone have thoughts? Thanks.

Thanks Jim. I appreciate the advice and recommendations. My prostate was 60 ml on the MRI and 55 on the ultrasound.

Hi Geordi. Make sure you get a written copy of your complete biopsy report if you can't access it directly online. It's an important document you should have for your records.

All the best,

Djin

Sorry you got this news. Based on that diagnosis, it's very treatable, but no one ever wants to hear that they have cancer. I fully agree with sending your slides to Epstein for a second opinion--reading biopsy slides is as much an art as a science, so to the extent that you can have your slides reviewed by one of the top labs in the country, you might as well take advantage of that.

Good luck and we're here to help as you move through this.

Geordi, here is a link on how to get the slides to Dr. Epstein:

https://pathology.jhu.edu/patient-care/second-opinions/send

Good news about the 3 + 4. Let's hope it holds up with Epstein.

Jim

Epstein said in one interview that he likes to get all the slides, not just the ones where cancer was seen (to double check).

Djin

Insurance generally does cover it, but if I not, I seem to recall it's in the $200-250 range. Sometimes I don't think the second opinion matters that much, but it could be helpful for your diagnosis. You want to make sure the G7 is really (3+4). And not to put out false hope, but I've seen guys here where the G7 was downgraded to G6 and at that point Active Surveillance is potentially a treatment option for you. (For the record, I was upgrade from a G8 to a G9...so it can go the other way as well.)

Geordi, based on the info here you are almost certainly not seriously ill and potentially (depending on ALL circumstances, some of which I do not know) a candidate for AS at least for a while (I sat on a similar Dx for 5y). Your prostate is pretty chunky: good news as it contains the cancer better but bad news because I never got comfortable radiating mine. Sounds like you are similar. It is NOT a free lunch. Many, many difficult choices ahead but hopefully knowing where you're at is a help. If you consider cutting it out, make sure you get an outstanding surgeon: one way to let off that anxious energy is researching that. I spent 5y doing it!

Every treatment can come with unwanted side effects; but, most are highly likely to cure your cancer. I encourage those recently diagnosed to make an informed decision and do your home work to avoid any regret later. Chose wisely and find the very best treatment team you can find.

Can a prostate still be removed surgically after SBRT? I believe that after radioactive seeding, the prostate cannot longer be removed. I might be incorrect on that.

Geordi…SBRT is one of the newer types of radiation therapy and in my opinion it has some significant advantages over other forms of radiation. First is arguably the highest rate of cure for low and intermediate risk guys. It’s also more convenient than the more common forms of beam radiation such as IMRT/IGRT and typically takes five radiation treatment sessions vs as many as forty five. It seems the prostate cancer cells are more sensitive to higher doses of radiation given in a shorter period of time. As with any treatment there are down sides as well. Because the dosage is higher it has to be delivered very precisely. The very best beam radiation practices use guided technology. Tiny metallic markers are inserted into the prostate prior to treatment. These little markers are used during the actual radiation procedure and today’s RT results are significantly better than in the past.

Although a lot of guys have had good results with surgery for me the side effects risks were simply too high. I didn’t want to compromise my good urinary and sexual function and removing a prostate is not minor surgery. Since all the data suggested my cancer was fully contained I saw no value in a post surgery pathology. I quickly ruled out surgery for my situation and I started evaluating the radiation options and on this forum I learned about SBRT.

SBRT can go by other names including Cyberknife and I believe Sloan Kettering calls it PRECISE. For me I had a total of eight visits to Cleveland Clinic. The first was our initial evaluation to discuss options including reviewing my biopsy slides. The second was to have my markers inserted, the third visit was for preparation, CT scans, body cast, mini tattoos and simulation. Visits four through eight was for the actual radiation. All other visits have been virtual by phone. I did have some minor and temporary burning with urinating that lasted a week or so. Nothing more. I recommend every guy do his homework and evaluate all the options. An informed decision is always best.

Terry--when you state that all the data showed that your prostate cancer was contained--what were the facts/factors that you considered? When you state that you saw no value in post surgery pathology--what are you stating/thinking there? I am still learning about this. Thanks.