HealingWell
Search Close Search
☰

Reliability of a G6 even after an Epstein 2nd opinion

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 7/12/2022 5:16 AM (GMT 0)
I was replying to a recent post from maddixone who had a biopsy that yielded a G6 along with a PSA in the 9's. Most everybody recommended that he get a 2nd opinion from Dr. Epstein as many (including myself) have.

I started to say that even if Epstein comes back with good news that he is, in fact at 3+3, the biopsy is a small sample of the prostate and there still could be more aggressive cancer cells lurking about and why take the chance. After thinking about it I deleted that part of my comment as I'm not sure how true that is and taken to it's logical conclusion it would mean that everybody with G6 should get treatment when their PSA rises to a certain point and/or they have a high volume.

What do you guys think? If Epstein says G6, what's the probability that it's true throughout the prostate?

Now, if Epstein upgrades you to G7 (as he did with me), then that of course is a different matter.
Posted 7/12/2022 5:36 AM (GMT 0)
Dr Epstein’s review is of the biopsy slides performed by others. He has no new information about the prostate so his review does not make the biopsy a more accurate representation of what is going on.

Djin’s story is as good as it gets about his high grade cancer hiding in his prostate. The key to AS is the active part with MRI’s and additional biopsies to get something you can count on for the long run. If all holds, one can not have treatment if they can handle it. Lots of anxiety thinking something is amiss inside of you.
Posted 7/12/2022 5:58 AM (GMT 0)
The more serious AS programs are designed to alert G6 men with a lerge number of G6 lesions and/or a PSA >10 that it's time to treat for the reason you mention: it is no longer save to assume that there are no lesions higher than G6. Recently there has been more willingness to include certain G7 men on AS, but tumor burden and PSA still remain important criteria on when it's time to leave AS and seek treatment.

I was never on AS (surveilled while having had a PC diagnosis), but I was carefully monitored with biopsies to ensure my PSA increases over the years were, in fact, all attributable to my BPH rather than BPH + cancer. At the time of my last, positive biopsy, my PSA (correcting for finasteride) was only 8.6. I doubt my cancer had been around very long because of my frequent biopsies, my PSA, and my final (post RP) tumor burden of only 5%.

Djin
Posted 7/12/2022 1:44 PM (GMT 0)
As mumbo said, the key to AS is the active part.

I'm another one who was G6 with 3 positive cores out of 12, all on one side of the prostate. I went ahead and had the surgery, and my post-surgery pathology revealed two changes: G3+4 overall AND tumors in all 4 quadrants of the gland.

Now, I do believe (but cannot prove of course) that if I had gone AS and had the MPMRI along with a guided or saturation biopsy, my stay on AS would have been very short.
Posted 7/12/2022 2:29 PM (GMT 0)
The initial diagnostic biopsy is used to sort men into two lanes, AS or treatment. Once AS is chosen, then they must have an MRI followed by a confirmatory biopsy within six months. If they are Gleason(3+4), a genomics test is also required. At that point, there is more confidence that the patient is correctly placed in AS. In my case, a review board that included Drs. Walsh, Partin, and Carter reviewed my second biopsy results to approve my continuance in JH’s program.

Total PSA is only used at JH to calculate PSA Density, which is a trigger for more testing.
Posted 7/12/2022 7:15 PM (GMT 0)
Although the Partin tables and nomagrams suggested I was a candidate for active surveillance. At the time of my diagnosis I had just completed joint replacements in both knees and one shoulder with the second shoulder the next joint to go. A proper active surveillance program would involve at least three additional biopsies in the coming five years. The infection risks associated biopsy were larger concern for me than the risks associated with SBRT treatment. A simple blood infection in my case could result in the loss of my replacements. In hindsight the RT was a great choice for my situation.

If I factor costs into my situation I believe I saved the ‘system’ a lot of money and myself a lot of time and anxiety.
Posted 7/12/2022 10:26 PM (GMT 0)
Hi have been on AS for 4 yr. If you have pattern 3(g6) the issue is whether or not there is any pattern 4 that has not been sampled. All Epstien can do is provide a second opinon on what has been sample. My personal opinion for what it is worth Age,PSA and tumor loading all play a roll in the probability of pattern 4 being present but undetected or develope in the future. I feel that those who are younger(50s) with higer PSA(5 to 10) and higher tumor loading(20 to 30%) are likely to need treatment in the future. So if you want to defer treatment or hopefully none at all then get and annual biopsy for at least 3 years along with mri and frequent psa testing. the more biopsy that show no change the lower the probability of no pattern4 present. After this you can reevaluate schedule based on clinicle findings and comfort level. This iis acomplicated disease and there is no one size fits all. everyone is differrent
Posted 7/12/2022 11:47 PM (GMT 0)
I dont know how you AS guys do it. I think it takes alot of intestinal fortitude/courage to know something is growing inside you that has a reasonable chance of causing what might be a painful death, but stare it down anyway!
Posted 7/13/2022 1:48 AM (GMT 0)
I held out for a little over a year and then caved. It was for sure, stressful. Glad I did as after my decision to treat, Epstein came back with 3+4.
Posted 7/14/2022 12:49 AM (GMT 0)
I have been on AS since 2014. All my biopsies have been 3+3. Have not had my biopsy reviewed. I am currently 74 and have been on finasteride for 8 years. My PSA has been wavering between .7 and 1.1 for the last two years with quarterly blood tests.
✚ New Topic ✚ Reply