Results of Johns Hopkins 2nd Opinion on Biopsy

What it means to me, good news - gleason stayed the same. bad news - more cancer found in the cores.

With your 5 positive cores being as high as 90%, I firmly believe that treatment is needed.

Surgery should work well for you, as long as you fully realize that incontinence and/or ED issues can never be determined in advance. That is where the risk comes with surgery. If you have spent any time here studying men's signatures, those results are all over the page.

Have you considered "seeds" or some other form of radiation for your primary treatment? You could/should get the same results for cancer eradication, but with less risk on the side effects.

Either way, we are here for you in your journey.

Good luck,

David

kdeinv said...

Recently received my biopsy pathology report from Johns Hopkins.

My initial pathology report had 5 of 12 cores malignant with involvement from 45% to 8%.  The Gleason was 3 + 3 = 6)

My second opinion from JH still shows Gleason (3 + 3 = 6) but the percent involvement in each core rose to as high as 90% in one core, 70% in several others down to 30% in others. 

My question is how can the % involvement be so different?  At least the Gleason is still a 3 + 3 = 6 in both cases.  Should I be overly concerned about the increased involvement?

I plan to have robotic surgery in the next month or 2 anyway.

 

I agree and wonder the same thing.

First read 3+3=6 Health Quest Labs.
Bostwick second opinion 3+4=7 One core 20% 4's
Sloan read the tie breaker I guess 3+4=7 same core as above but at 10% 4's
Interesting how different labs read the same slides and all get different results.

Glad to see that your Gleason score remained a 6 -- that is HUGE! Even though they found more cancer within the same cores, it should not matter. As long as the cancer is organ confined you are looking at a cure.

One other thing to keep in mind -- Gleason 6 virtually never spreads to other parts of the body.

While I favor surgery, and would certainly agree with your choice with da Vinci, you might also want to consult a radiation oncologist and learn the good & bad involved with external beam radiation and seeding. Could be that radiation is your best way to go.

I say that it "could" be, but I still would agree with your plan to go with robotic surgery.

Good luck!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

With as much G6 as there is, do not be surprised that the post surgery pathology isn't up graded to G7, which does happen frequently. However the grading doesn't matter too much as long as the surgery gets all the cancer and that it is organ confined. Good luck going forward.

Terry

kdeinv - I agree with an ealier post that suggested that possibly only a fraction of your biopsy tissue was sent to John Hopkins. It does seem odd that the % cancer in the biopsy was so very different between pathologists. At the end of the day, assuming you choose surgery, the final pathology will tell the story. Then you will know the % of cancer in the entire prostate volume. If you see my signature below, my biopsy results were only one core out of 12 positive and only 5% involvement in that positive core. My final pathilogy after surgery also indicated the tumor was 5% of total prostate volume. Best of luck in your journey.
RickyD