HealingWell
Search Close Search
☰

Our results are in...

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 9/8/2011 11:24 PM (GMT 0)
We just received the results of my husband's biopsy which was two weeks ago today. He is seeing Dr. Peter Carroll at UCSF. For some background, my husband is 45 years old and in otherwise good health. The biopsy was ordered after rising PSA's and seeing an area of concern upon prostate ultrasound. His latest PSA just before biopsy was 4.92 and his free PSA (calc) was 6.91%.

They took 16 samples and of those two are cancerous. They are both Gleason 3+3 = 6. One is in the R lobe, mid and occupied 33% of the sample with <5% higher than Gleason 3. Perineural invasion is present here. The other was in the L lobe, anterior and occupied 8% of the sample. On this one 0% was higher than Gleason 3. No perineural invasion present in this one. His estimated prostate size is 30 cc.

So my obvious question is...now what? Obviously more appt's with the Dr. to follow-up and discuss options. What should we expect in this case? Any guess as to the staging? How specifically does PNI correlate with prognosis? What do you think the Dr. will suggest treatment-wise with these results? I think my husband wants the Dr to say AS (active surveillance) only. I don't agree with that as he is still so young and with the added PNI that option concerns me.

Thoughts?

Thanks for your time and replies everyone :)
Posted 9/8/2011 11:49 PM (GMT 0)
TN2GS,

With a Gleason 6, the options are open. When I was at this point, my doc recommended that I get a number of opinions, and you have time to do that. But, like you, I'd be surprised if AS will be considered viable. Still, talk to several experts and find out what they all say.

DJ
Posted 9/9/2011 2:07 AM (GMT 0)
Your husband's biopsy result makes many options available to him. Make sure you consult with an Oncologist and a Radialogist. You have a lot of time to evaluate and decide.
Posted 9/9/2011 2:35 AM (GMT 0)
Dr Carroll is one of those exceptional doctors, so you are in good hands and I would trust his judgement. UCSF has one of the best AS monitoring programs in the country, so if Dr Carroll recommends AS it is because he believes that it is safe for your husband. With your husband's stats just about any conventional treatment will have very good results; you should look at treatments that minimize side effects
JT
Posted 9/9/2011 7:23 AM (GMT 0)
I don't think your doctor is going to recommend active surveillance at 45. AS is for older individuals. Your doctor is going to go for a cure like surgery or maybe radiation. Do a lot of reading talk with your doctor wieght your options and make an informed decision.
Posted 9/9/2011 10:00 AM (GMT 0)
TN2GS,

Welcome.

With Gleason 6, This is the phase where you pause and think. However bad it is hearing that you have cancer, at least with prostate cancer you get time to think. But it does still mean you have to make a decsion sometime, in the comiong days and weeks you have to ask the questions get the opinions and then perhaps in a few weeks time you will have a clearer picture, about time scales, side effects, etc.

And, looking at the calendar, I suggest you take the holiday season into consideration. Several guys here have timed their treatment so that it did not get in the way of things like Thanksgiving and Christmas.

Alf
Posted 9/9/2011 11:35 AM (GMT 0)
 

I am not an expert nor a doctor but with the large volume 33% of the G6 with Perineural invasion I would not think AS is a good non treatment choice. If you are being treated at UCSF I assume you live in the California Bay Area.  One treatment option you should look at is proton beam RT at the Loma Linda PBT Center which pioneered this treatment for PCa. I do not know if the Perineural invasion would preclude PBRT but at his young age this could save your husband from the side effects of conventional RT and surgery.

Again I am not an expert but how did the doctor confirm Perineural invasion from a needle biopsy? I thought this was something only a post surgery pathology or advanced scanning could confirm.

Good luck and please keep us informed on your progress.

Terry TWG

Posted 9/9/2011 12:41 PM (GMT 0)

You said...
One is in the R lobe, mid and occupied 33% of the sample with <5% higher than Gleason 3. Perineural invasion is present here.

I'm concerned about the fraction of higher grade cancer. While the practice is to ignore it if it constitutes less then 5%, its existence is suggestive. There is a growing concern about tertiary Gleason grades, and the need to engage in more refined analysis than the current Gleason grading system allows. To me, it would be cause for concern that there might be more happening. The PNI would also support at least a concern that there may be higher grade cancer in there. Before you make a decision, you might at least have your slides sent to Bostwick, Epstein, or some other expert lab for a second opinion on the biopsy results.

I hope all turns out rosy.

Nellie

[Edited after doing some research.]
Posted 9/10/2011 6:02 PM (GMT 0)
Thanks for your replies everyone. I really appreciate the support here. Right now we are in research mode. He hasn't yet made his follow-up appt with his doc but that will be coming up shortly I am sure.

I am wondering if anyone can help me clear up a question I have in regards to staging. In some places I have read that if the cancer is found in both L and R lobes, that it is automatically Stage II. In other places, I've found that Stage II would have to mean that the cancer is palpable on DRE. My husband thinks that since the Dr's couldn't find anything on DRE, that he would not be considered Stage II, even though it is in both lobes.

Thanks again...and healthy thoughts for all of us :)
Posted 9/10/2011 6:18 PM (GMT 0)
My biopsy showed my cancer in both lobes with a negative DRE and my URO considered it to be stage II and post pathology confirmed this.
Posted 9/10/2011 7:40 PM (GMT 0)
In somewhat difference to Water Guy, my biopsy showed PCa in both lobes but my clinical staging was T1c. If I remember correctly the Uro may have said either T1c or T2c making it sound like not much difference between the two and more to having to do with whether in both lobes or not. My DRE's were all negative. Pathological staging ended up to be T2c.
Posted 9/11/2011 1:01 AM (GMT 0)
My docs think that this stuff is usually further advanced than what biopsies indicate. The comment about the importance of tertiary Gleason is very astute. We can wish it to be less but the reality is that far more Gleason scores are upgraded than downgraded with surgical pathologies versus the biopsy readings. At age 45 don't take this lightly. See Carrol and also consider Demanes at UCLA the premier radiology oncologist in that area.
Posted 9/12/2011 8:48 PM (GMT 0)
Thanks for the advice everyone. We really appreciate it. We've been doing lots of reading and he will be meeting with his doctor again next week to discuss options and next steps. I tend to err on the side of caution in everything in life, whereas my husband is usually more of a risk-taker. Hope he sees things my way this time around! If this were me, I'd take the surgery in a heartbeat and just be done with it. Of course, he is very concerned about the potential side-effects associated with a RP such as incontinence and ED. Such a crap-shoot pCa is...sigh.

To answer your question Terry aka The Water Guy...I have no idea how they were able to see PNI on the biopsy. I had the exact same question as I was reading the biopsy results report! That is something we'll be asking the Dr. about.
✚ New Topic ✚ Reply