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Posted 3/28/2023 1:58 AM (GMT 0)
davie - This is a good news/bad news situation. Good News: the wait is over, you have a small amount of cancer that took a lot of cores to find. Bad News: you have a small amount of cancer that is the real deal and not benign.

This is the set of biopsy slides you will want to get a second opinion evaluation on. You have a lot riding on one core and its cellular pathology so time to be sure about it. The doctors may want more scans given the difficulty of finding one core. MRI and/or PSMA scan may be good idea unless you have had previously.

All treatment options will be appropriate so visit various specialists to get their opinions and recommendations. The urologist can explain surgery and radiation oncologists can explain their various options of which there are quite a few nowadays.

Hang in there, it’s a long ride.
Posted 3/28/2023 2:08 AM (GMT 0)
You have a small tumor that is likely contained in the gland and small. You are 80-90% curable. You can opt for radiation or surgery per your urologist. A 3rd option is focal therapy.

I would ask for a PET scan before making a decision.
Posted 3/28/2023 2:50 AM (GMT 0)
Thank you Mumbo & Duck2

Before I left the Uro office he did mentioned about some kind of scan to determine how aggressive of that one core, but he said he still want me to see the oncologist before the scanning, I did mention to him about cyberknife, but he said he would reconmend LDR with some kind of catheter plan inside he said cyberknife pouring too much radiation is not good but he said it up for me to consult with encologist if i decides to go with radiation.

Gleason 4+3 bad? please help me understand Thank you so much
Posted 3/28/2023 9:09 AM (GMT 0)
Hi Davie. You wrote:

"M. Left transtion Zone: ADENOCARCINOMA GLEASON SCORE: 4+3 = 7, INVOLVING 40% GRADE GROUP: 3 GLEASON SCORE4: 95%"

Are you sure your report doesn't say ".... GLEASON PATTERN 4: 95%" or "GLEASON GRADE 4: 95%"

which IMO would make more sense than "GLEASON SCORE 4: 95%"

I would get a 2nd opinion on the pathology from Dr. Epstein at Johns Hopkins. With such a small amount of Pattern 3, I'm not sure why your biopsy wasn't graded Gleason 8 (4+4). Dr. Epstein might find even a smaller percentage of Pattern 3, or even a small amount of Pattern 5 somewhere.

If you decide on radiation, I would first have a Decipher test done on the last biopsy tissue: the result could affect the total radiation dose, and, possibly, the size of the radiation field. If you opt for surgery, I would wait and have the Decipher test done on the the worst lesions found in the entire prostate. (The Decipher test evaluates the risk of your cancer having metastasized or potentially metastasizing. The test done after surgery is more reliable than the one done on a biopsy, which is why I suggest waiting if you opt for surgery.)

Djin
Posted 3/28/2023 11:35 AM (GMT 0)
davie - you will need to read up on on the various radiation methods and see radiation oncologists who provide the different methods for their opinions and recommendations. Beam radiation is the most common and available everywhere. SBRT/Cyberknife is an accelerated beam radiation which can be completed in a week or two. Brachytherapy is radioactive material placed in the prostate, permanently (LDR) or temporarily (HDR).

Surgery is 99% the skill of the surgeon and team so finding an experienced surgeon that is performing prostate surgery weekly with a record of hundreds or thousands of successful procedures is most important. Depending where you live, you may need to travel to the get best prostate surgeons and be prepared for the recovery and transportation issues necessary.

Gleason 7(4+3) with a high percentage of pattern 4 cells is a well developed cancer and not to be ignored. Pattern 1/2 are nothing special, pattern 3 are essentially benign cancer cells, pattern 4 are real cancer cells, pattern 5 are the fully developed commando cells ready to travel. Your 4+3 means a cluster of real cancer cells was found with some benign cancer cells. However, 20 samples did not show any real cancer which is the good news.
Posted 3/28/2023 2:54 PM (GMT 0)

DjinTonic said...
Hi Davie. You wrote:

"M. Left transtion Zone: ADENOCARCINOMA GLEASON SCORE: 4+3 = 7, INVOLVING 40% GRADE GROUP: 3 GLEASON SCORE4: 95%"

Are you sure your report doesn't say ".... GLEASON PATTERN 4: 95%" or "GLEASON GRADE 4: 95%"

which IMO would make more sense than "GLEASON SCORE 4: 95%"

I would get a 2nd opinion on the pathology from Dr. Epstein at Johns Hopkins. With such a small amount of Pattern 3, I'm not sure why your biopsy wasn't graded Gleason 8 (4+4). Dr. Epstein might find even a smaller percentage of Pattern 3, or even a small amount of Pattern 5 somewhere.

If you decide on radiation, I would first have a Decipher test done on the last biopsy tissue: the result could affect the total radiation dose, and, possibly, the size of the radiation field. If you opt for surgery, I would wait and have the Decipher test done on the the worst lesions found in the entire prostate. (The Decipher test evaluates the risk of your cancer having metastasized or potentially metastasizing. The test done after surgery is more reliable than the one done on a biopsy, which is why I suggest waiting if you opt for surgery.)

Djin

Yes that is exactly what it stated on the report
LEFT TRANSITION ZONE: ADENOCARCINOMA GLEASON SCORE: 4=3=7. INVOLVING 40% GRADE GROUP: 3 GLEASON SCORE 4: 95%
Posted 3/28/2023 3:15 PM (GMT 0)
Thank you all for all your valuable input & advices.

It was a shock for me while i am in doctor's office. So I emailed my Uro Doctor to have him explain to me what he said while in the office.

He said that positive core was deep in the middle of the prostate and it was lucky to find it early and he wanted to send the sameple to have Decipher Test done and have me come back to see him in 3 weeks and wanted me to see Oncologist before come back and see him. He also said from his opinion either Surgery or Radiation would be good and mentioned about LDR with temporary Catherter for the treatment and he feel CyberKnife was too much radiation in my case but all depend after seeing Encologist to see which are the best options for me.

I am 60 yrs old and considering healthy, I ride bike 3 times a week ( 30-40 miles each) walking 10K steps a day, but I was former smoker which doctor think have some to do with this.

Now the question is Surgery or Radiation? Surgery I am going to deal with 50/50% chance of incontinence & ED. Radiation would retain those quality of life which is a big deal for me.

Any thoughts and opinion please chime in

Again thank you all for all valuable advices

Post Edited (davie1803) : 3/28/2023 7:37:03 AM (GMT-8)

Posted 3/28/2023 3:40 PM (GMT 0)
How big is your prostate in cc? Do you have any urinary issues, BPH, etc.?

If it it right in the middle of the prostate, so in the transition and central zones (and not in the peripheral) than a BPH procedure like TURP or HoLEP will actually remove that tissue while resolving BPH symptoms. Just a thought. Cancer is usually in the peripheral zone. You would still expect to need some kind of cancer treatment, assuming there was some left. But maybe not.

Definitely talk to different radiologists. LDR or HDR brachytherapy should be on the list of things to consider, along with the beam treatments.
Posted 3/28/2023 4:17 PM (GMT 0)

centralPAdude said...
How big is your prostate in cc? Do you have any urinary issues, BPH, etc.?

If it it right in the middle of the prostate, so in the transition and central zones (and not in the peripheral) than a BPH procedure like TURP or HoLEP will actually remove that tissue while resolving BPH symptoms. Just a thought. Cancer is usually in the peripheral zone. You would still expect to need some kind of cancer treatment, assuming there was some left. But maybe not.

Definitely talk to different radiologists. LDR or HDR brachytherapy should be on the list of things to consider, along with the beam treatments.

Thank you for replied.
I am not recall exactly but when past CT scan i thought i saw it somewhere 63cc and beside go pee little more frequently I don't think i have any BPH symptoms.
Posted 3/28/2023 6:09 PM (GMT 0)
Davie, It’s my experience that modern radiation is safe and very effective at treating prostate cancer. SBRT has an advantage of being very convenient as well. One disadvantage is that it may not be as widely available as other forms of radiation. I regularly attend spinning classes at our YMCA and was able to spin during the five treatments. I did feel some pressure on my perineal (seat) area following the third fraction during spinning. I also had some mild burning when urinating and during ejaculation. Both resolved without medication in about two weeks. When comparing treatment options I also used the estimate of 50% of guys will have urinary or sexual issues following surgery. No matter what treatment option you choose search out the best practitioner and team you can find. Most urologists treat men, women and children for a variety of issues and not only prostate cancer. Most urologists have little understanding of modern radiation. I was treated by a radiation oncologist who specialized in prostate cancer. My urinary and sexual function are the same as before treatment.
Posted 3/28/2023 6:40 PM (GMT 0)
IMO, surgery if done well only has an impact on the quality of life short term. If nerves need to be removed then sexual SEs become an issue. Incontinence is 50/50 gamble. With radiation there can be some short term SEs that usually disappear within a few weeks. However, if the bladder is hit or strictures develop latter on then you have to deal with that. To me, the most effect and affect on quality of life occurs if given hormone treatment. ADT can really impact your energy level and has several other SEs. If you decide to do nothing because of what may happen to your quality of life, the outcome is much worse. Get as much information as you can from your doctors, make your own choice of treatment and don’t look back. My best wishes for a very positive long term outcome.
Jack
Posted 3/28/2023 7:06 PM (GMT 0)
Thank you Terry & Jack

Given very small core that positive what type of radiation would be appropriate for small area with minimal of destroy good tissue surrounding the treated area?
I've googled and read HDR, LDR, Cyberknife and other, in my head right now it's overwhelming info's. Cyberknife can accidently destroy good tissue so do external beam can also destroy it too, the only thing to me seem like LDR would be ideal in my case but problems is that the seed will be permanently in my prostate for ever, despite of the seeds will be there, does it any draw back?

Can anyone point out pros and cons in my case?

Thanks
Posted 3/28/2023 7:08 PM (GMT 0)
When looking into RT, I would ask whether IMRT + BT boost has better oncological outcomes than SBRT (e.g. Cyberknife) for high-risk disease: with 95% Pattern 4, I think your are closer to being a G8 (4+4) than a G7 (4+3). IMO a second opinion on the (second) biopsy pathology would be especially important, in addition to his upcoming Decipher test.

Djin
Posted 4/13/2023 7:58 PM (GMT 0)
Hi all,

I am pretty much Opt for Brachytherapy HDR / IGRT the treatment will be:
- Tumor classification: T2a
- Lupon hormone treatment
- Place fiducial markers: 3-5 gold fiducial
- 2 HDR treatments for 1 week each, each one session in the morning and other one in the afternoon, total: 4
- 6 1/2 weeks of 33 IGRT.
My question is how bad of sife effects of Lupron side effects?
Anyone have had similar treatment please educate me with your journey

Thank you so much!
Posted 4/14/2023 3:50 PM (GMT 0)
David, I can only answer your question about lupron side effects. And it sounds like you might be looking at time limited lupron. If so my guess is the primary side effects would be hot flashes. After ten years I no longer get those, but they can be pesty. Having said that, I was able to continue running and working out for the first five or six years of lupron and other drugs like Zytiga and xtandi. So hopefully you will experience limited interruption in your daily routine. Keep us posted on your progress.
Michael
Posted 4/14/2023 4:04 PM (GMT 0)

60Michael said...
David, I can only answer your question about lupron side effects. And it sounds like you might be looking at time limited lupron. If so my guess is the primary side effects would be hot flashes. After ten years I no longer get those, but they can be pesty. Having said that, I was able to continue running and working out for the first five or six years of lupron and other drugs like Zytiga and xtandi. So hopefully you will experience limited interruption in your daily routine. Keep us posted on your progress.
Michael

Thanks Michael ,
I forgot to mention that per doctor i will only be on Lupron for 6 months. Did you experience with tiredness at all or just hotflashes?

Thanks
Posted 4/14/2023 5:09 PM (GMT 0)
My memory says just the hot flashes. The other stuff can take a while. As a good friend who was on lupron a long time used to tell me, " I start crying when a squirrel falls out of a tree."
Michael
Posted 4/14/2023 10:53 PM (GMT 0)
I have a friend who has been on Lupron for 6 months and he has had minimal side effects, no hot flashes, etc. More SE from radiation treatments than Lupron. Not the typical reaction but he is an odd fellow so who knows.
Posted 4/14/2023 11:14 PM (GMT 0)
I wouldn't think a 6 month stint on Lupron will present much discomfort. At least you will have the light at the end of the 6 month tunnel to focus on. I didn't catch your age, but sometimes guys can struggle with getting the T back up to normal range after the shot wears off. This could be more problematic for older guys.

Good luck with your treatment!
Posted 4/15/2023 12:30 AM (GMT 0)
Davie, i was on Lupron for 6 months. Its different for everyone but for most, including me, its not fun but its manageable. I had hot flashes, but not so bad that they made me soaking wet. i gained some weight, and my lipids went out of whack. but its all resolved now.

best advice i can give is, keep an eye on your lipids , watch your diet, and exercise as much as you can no matter how much you dont want to.
Posted 4/19/2023 5:07 PM (GMT 0)
Thank you all for inputs,
With my active lifestyles. I am hoping I can overcome those possibles side effects.
I just had MRI and Pet yesterday and the conclusion:

1. Probable known tiny tumor in posterior periphery of the prostate base.
2. No metastasis in seminal vesicles and pelvic bones
3. No pelvic lymphadenopathy

So my Uro doc have me on BICALUTAMIDE TAB 50MG for 30 days. After 2 weeks i have to come in for 4 gold metal marker and start 2 Lupron shot, so each shot for 3 months = 6 months.
Again thank you for all your help and input. Any advice will be appreciated
Posted 4/19/2023 5:21 PM (GMT 0)
No advice, just wishing best of luck, D1803!
Posted 4/19/2023 6:08 PM (GMT 0)

centralPAdude said...
No advice, just wishing best of luck, D1803!

Thank you Sir! appreciated
Posted 4/19/2023 6:33 PM (GMT 0)

mattam said...
I wouldn't think a 6 month stint on Lupron will present much discomfort. At least you will have the light at the end of the 6 month tunnel to focus on. I didn't catch your age, but sometimes guys can struggle with getting the T back up to normal range after the shot wears off. This could be more problematic for older guys.

Good luck with your treatment!


I am 59 of age.

Thank you!
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