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Help on Hubby’s PC biopsy

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Posted 4/1/2023 4:36 PM (GMT 0)

Final Diagnosis
A - PROSTATE, LEFT LATERAL BASE, NEEDLE CORE BIOPSY: ADENOCARCINOMA, GLEASON
SCORE 3 + 4 = 7, (PROGNOSTIC GRADE GROUP 2, INVOLVING 30% (4 MM) OF 2 OF 3
CORES. GLEASON PATTERN 4 COMPRISES 15% OF TUMOR. CRIBRIFORM GLAND: NOT IDENTIFIED.
B - PROSTATE, LEFT BASE, NEEDLE CORE BIOPSY: BENIGN PROSTATIC TISSUE.
C - PROSTATE, LEFT LATERAL MID, NEEDLE CORE BIOPSY: ADENOCARCINOMA, GLEASON
SCORE 3 + 3 = 6, (PROGNOSTIC GRADE GROUP 1), INVOLVING 60% (8 MM) OF 1 OF 1
CORE.
D - PROSTATE, LEFT MID, NEEDLE CORE BIOPSY: BENIGN PROSTATIC TISSUE.
E - PROSTATE, LEFT LATERAL APEX, NEEDLE CORE BIOPSY: ADENOCARCINOMA, GLEASON
SCORE 4 + 3 = 7, (PROGNOSTIC GRADE GROUP 3), INVOLVING 5% (2 MM) OF 1 OF 1
CORE. GLEASON PATTERN 4 COMPRISES 60% OF TUMOR. CRIBRIFORM GLAND: PRESENT.
F - PROSTATE, LEFT APEX, NEEDLE CORE BIOPSY: BENIGN PROSTATIC TISSUE.
G - PROSTATE, RIGHT BASE, NEEDLE CORE BIOPSY: ADENOCARCINOMA, GLEASON SCORE
3 + 4 = 7, (PROGNOSTIC GRADE GROUP 2), INVOLVING 75% (13 MM) OF 1 OF 1 CORE.
GLEASON PATTERN 4 COMPRISES 40% OF TUMOR. CRIBRIFORM GLAND: NOT IDENTIFIED.
H - PROSTATE, RIGHT LATERAL BASE, NEEDLE CORE BIOPSY: ADENOCARCINOMA,
GLEASON SCORE 3 + 4 = 7, (PROGNOSTIC GRADE GROUP 2), INVOLVING 70% (9 MM) OF
1 OF 1 CORE. GLEASON PATTERN 4 COMPRISES 40% OF TUMOR. CRIBRIFORM GLAND:
NOT IDENTIFIED.
I - PROSTATE, RIGHT MID, NEEDLE CORE BIOPSY: ADENOCARCINOMA, GLEASON SCORE 3 † 4 = 7, (PROGNOSTIC GRADE GROUP 2), INVOLVING 15% (6 MM) OF 1 OF 2 CORES.
GLEASON PATTERN 4 COMPRISES 20% OF TUMOR. CRIBRIFORM GLAND: NOT IDENTIFIED.
J - PROSTATE, RIGHT LATERAL MID, NEEDLE CORE BIOPSY: BENIGN PROSTATIC TISSUE.
Report for: 1


After reading several posts, I think because one of the biopsies was in group three with criboform gland present he cannot do a wait and watch. Do they still do the seed implants???

Thanks for your support! Overwhelmed at this point!
Posted 4/1/2023 5:15 PM (GMT 0)
Welcome to healing well Marmac. It is usually a little slow on the weekends, so hang in there and the science people will be along soon.
Michael
Posted 4/1/2023 5:26 PM (GMT 0)
It's a good idea to get a 2nd opinion on a biopsy from an expert like Dr. J. Epstein at Johns Hopkins. You want an accurate biopsy reading because the biopsy is a crucial factor for ruling in or out various treatment options

Even a single G7 (4+3) core by itself would rule out active surveillance, as would more than one 3+4 core, as would even bilateral 3+3 disease, as would even unilateral 3+3 cores with such high cancer percentages, as would even just the presence of cribriform glands. So yes, the biopsy puts the kibosh on AS.

Your husband should discuss with his uro his treatment options, the likelihood that his cancer is prostate-confined, and the suitability of surgery as a treatment. A bone scan (or perhaps a PSMA-PET scan) may be advised to check for metastases. The best info about his radiotherapy options would come from a consult with a radiologist.

As you get additional information, you'll no doubt have more questions, which you can post to the Forum. I wish you both all the best.

Djin
Posted 4/1/2023 5:57 PM (GMT 0)
Yes, seed implants (brachytherapy) can be an excellent choice of treatment for him. A full assessment has to be made and he should get expert assessments by both surgeons and radiation oncologists before deciding on a treatment path.

As you can see from my signature, I was a high risk with several 3+4 and 4+3 cores. Based on several consultations (two surgeons and two radiation oncologists), I chose High Dose Rate Brachytherapy and was able to successfully avoid surgery and successfully treat the cancer. I was treated more than 12 years ago and my PSA continues to be undetectable and I have no negative treatment induced side effects. HDR brachytherapy is similar toe permanent seeds brachytherapy, but does not leave the radioactive seeds in the body. Both are well proven excellent treatment options.
Posted 4/1/2023 7:44 PM (GMT 0)
Hello Marmac and welcome. Sorry you have to be here and we will help as much as we can. As Djin said, the first thing to be done is to get your biopsy slides sent to Dr. Epstein at Johns Hopkins so you have a "for sure" accurate reading on those slides. Second thing is to get educated on our disease. The sticky thread at the top of our forum can help. Also I recommend 3 books, "Guide to Surviving Prostate Cancer" by Dr. Walsh and two books by Dr. Scholz - "Invasion of the Prostate Snatchers" and "The Key to Prostate Cancer". Dr. Scholz also has a number of excellent videos that you can view for free by searching on YouTube.

Specifically, in answer to your questions:
1. With this diagnosis, assuming it hold up under scrutiny from Dr. Epstein, Active Surveillance is not likely to be a good choice.
2. Yes, they still do the seed implants. Both LDR (low dose rate) where the seeds are permanently implanted and HDR (high dose rate) where the implantation is temporary. If it gets down to a choice, we have members who have had both who can help with specifics.

Beyond this, surgery should be explored as well as other radiation options such as IMRT and SBRT. We can talk with you about those if you wish.

Good luck. We are here to help.

Jim
Posted 4/2/2023 12:00 AM (GMT 0)
Hello Marmac - How old is your husband? The term “wait & watch or watchful waiting” usually only applies to fairly old men nowadays where a long life is not expected. “Active surveillance” is much more aggressive with periodic scans and biopsies to insure the situation remains stable.

In any case, treatment of some sort is probably in his future but no need to get too excited. The process takes a while to get sorted out and the results are generally good. PCa rarely makes quick moves so there is plenty of time to obtain information and consider the options of which there are a number. How is he doing? Is he overwhelmed like you, ignoring it, or just calmly waiting for the biopsy?
Posted 4/2/2023 2:43 AM (GMT 0)
Thank you everyone! I already feel like I have a new family 🥰
How do I get info to the Doctor at John Hopkins???ty ahead of time!
Posted 4/2/2023 2:48 AM (GMT 0)
Hubster will be 70. It’s been 15 years since since his psa was a little high, of course he is a man that has “white coat syndrome”. He was looking tired and weak, his thyroid test came back at 40.and his PSA 8.0. Actually went down two points month later.
Posted 4/2/2023 4:32 AM (GMT 0)

Marmac said...
Thank you everyone! I already feel like I have a new family 🥰
How do I get info to the Doctor at John Hopkins???ty ahead of time!

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


Mine was 8 or 9 years ago. It involved nothing more than asking my doctor to send the slides. I don’t recall having to fill out any forms but things may have changed. Calling JH is a pleasant experience. I’ve called that hospital twice in the past 2 weeks. A real person answers. Dr. Epstein is extremely available for phone consults as well.

You’ve got plenty of time to get Hubster’s ducks in a row. Could be 8 to 12 weeks before treatment is initiated.

Welcome to the forum.
Posted 4/2/2023 11:33 AM (GMT 0)
This is a link to the next JH webpage IT listed with the instructions:
https://pathology.jhu.edu/patient-care/second-opinions/send

Sometimes the key is making sure the person who actually has the pathology slides get these instructions. Some do biopsy pathology in-house, others send to pathologist. Start with urologist and follow up. I sent message to my urologist and ended up getting a call from the hospital asking where they needed to send the slides so sent them the same link.

Follow up is a key item in this journey. Sometimes you have to call or message to break things loose.
Posted 4/2/2023 4:23 PM (GMT 0)
Thank you everyone so much!
Posted 4/2/2023 7:31 PM (GMT 0)
Marmac and husband, welcome to the forum. Unfortunately prostate cancer is far too common and the diagnosis and number of treatment options can seem a bit overwhelming at first. Your husband’s early results suggest treatment is in his future. The good news is that he can expect to beat this. In addition to getting second opinions on his biopsy results; getting informed regarding treatment options is a great idea. Although your urologist knows surgery he/she is probably not up to date regarding radiation treatments and there are several to chose from. Modern guided radiation is safe, very effective and with mostly minor and short term side effects. At age 70 your husband is most likely not the best candidate for surgery. Removal of the prostate is very involved and often results in unwanted long term side effects. At age 69 and in excellent health at the time of my diagnosis I quickly ruled out surgery for myself.

Brachytherapy therapy comes in two forms and is very safe and effective. The low dose kind has radioactive seeds placed and left in the prostate. The high dose type has the radiation placed to do it’s job and quickly removed. Another type of radiation is beam radiation and can also come in several forms. Although the alphabet terminology can be confusing radiation treatments are safe and effective. I chose one called SBRT. It had a very high success rate and with only five treatment sessions was very convenient. You’ll find guys here that have experience with each of the radiation treatment options and be glad to answer any questions you may have.

I would recommend finding a radiation oncologist that specializes in prostate cancer. The best can make a big difference. Best wishes…keep learning and asking questions. The best treatment decision is an informed one. Terry
Posted 4/2/2023 11:52 PM (GMT 0)
Welcome..
As said active surveillance may not be the way to go.
My doctor's office took care of sending the slides or were helpful. Second opinion is always good.
I choose SBRT mainly because it was painful lying down for 55 sessions.
I'm doing well going on two years.

Glen
Posted 4/3/2023 4:16 AM (GMT 0)
Yes, treatment appears to be in your future. What has the doctor said? As others have noted, a number of treatments are available, and each comes with its own set of advantages and disadvantages. Unfortunately, there is no one correct choice, so the only way to choose wisely is the learn a lot about the different options and figure which one makes the most sense for you and your husband.
Posted 4/3/2023 3:02 PM (GMT 0)
Many options are out there.
I went with IMRT but for some reason I developed urinary retention and had to have a catheter and that led to a nasty infection called paraphimosis.
I opted to change to SBRT mainly because it was only five sessions.
My PSA is dropping and things look good.
My low back pain made sitting on the table for 55 sessions untenable.
Good news is that you have lots of choices.
I thought surgery was too risky for side effects but surgery is improving.
Your husband has time so don't rush but as said AS is not a good choice.

Glen
Posted 4/13/2023 5:48 PM (GMT 0)
hey everyone! We are progressing with appointments and the slides etc have been forwarded to Dana Farber (Boston) for a second opinion. Will be calling there soon. So appreciate all your help! We requested John Hopkins and the doctor asked why not Dana Farber he has many prostatic colleagues. Pray hubby can have Brachytherapy! The story the doctor told about surgery completely made us have a melt down. I’m personally praying no matter what he goes Dana Farber. Where we live they do not have Brachytherapy in our area it’s too remote. He is going to have a PET scan and the micro nuclear test done May 5th. This the doctor said will be able to see if the cancer you cannot see has Invaded the outside core. If it hasn’t then Brachytherapy will be great! With his thyroid problem just diagnosed 3 months ago we hope the 150 dose will help him lose a little weight. Thank you everyone! Thank you so so much!!! Will post again soon!
Posted 4/13/2023 7:03 PM (GMT 0)
Thanks for the update, and you all have done a lot of work since your last post. Hopefully he will find the place that he needs to be that offers the treatment that he wants.
Michael
Posted 4/13/2023 7:35 PM (GMT 0)
You will be in good hands at Dana Farber.
I don't know right now which radiation options they provide, but you will find out soon enough.
We will be happy to provide background information (and personal experiences), if necessary.
Posted 4/13/2023 8:55 PM (GMT 0)
I've had my treatment at Dana-Farber since 2016 when my PSA returned after salvage radiation. I can't say enough good things about D-F. I've had personalized responsive care at D-F from my oncologist and team including CT, bone, and PET scans, ADT shots, and prompt replies to any questions I've posted on the D-F portal. When I needed to start on Abiraterone Acitate (Zytiga) I found it had a pretty hefty copay through my Blue Cross plan. I'm eligible for treatment through the VA so my D-F team now forwards my lab results to the VA so the VA can fill my prescription.
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