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Posted 12/21/2015 1:10 AM (GMT 0)
Gleason 6 Aug 2014, chose watchful surveillance , Had MRI of prostate in Nov 2014---no cancer seen.

MRI of prostate in Nov 2015, 2 urologist's state they can see the tumor ( in same area the gleason picked it up on biopsies, Left side). They both told me this has grown rapidly in 1 year, and recommend surgery or radiation. If I do anything it will be surgery.
One urologist told me he would bet, based on the MRI, I am now a Gleason 7 or 8.
They don't think it has escaped the capsule.

Question: Would you get another Biopsy just to confirm the gleason has gone up, beyond a 6?

I would be quite pissed if I have this taken out and the pathology report says it's still a gleason 6.
Posted 12/21/2015 1:22 AM (GMT 0)
By all means another biopsy. And then get a second opinion on the biopsy slides. I wouldn't make any decisions until I did those 2 things.
Posted 12/21/2015 1:34 AM (GMT 0)
I'd recommend another biopsy too. It might not be as bad as they're saying, but it it is, you'll be better prepared for treatment decisions. And it'll only delay surgery for about 8 weeks if that's where your heading.
Posted 12/21/2015 1:36 AM (GMT 0)

brian3222 said...


Question: Would you get another Biopsy just to confirm the gleason has gone up, beyond a 6?

I would be quite pissed if I have this taken out and the pathology report says it's still a gleason 6.

Hi Brian and welcome.

Yes, I would get a targeted biopsy and, as Geetar says, make sure it is read by Epstein or Bostwick to be sure of the results.

Then, if it is determined that treatment is needed, I would recommend that you look at ALL of the applicable options before making a decision.

Jim
Posted 12/21/2015 2:00 AM (GMT 0)
Thanks for you replies guys, I appreciate it.
Jim, what do you mean, "read by Epstein or Bostwick"?

Thanks Again.
Posted 12/21/2015 2:28 AM (GMT 0)
I'd also get a biopsy based on that news. And I'll bet you an adult beverage that it doesn't show Gleason 8.

Epstein and Bostwick are the two labs that specialize in reading prostate cancer biopsy slides. Epstein is a doctor at Johns Hopkins. The sticky at the top of the page says how to send the slides there for a second opinion. It's cheap and easy and very important to get more info in making a treatment decision.

Good luck to you. Sometimes even when MRIs show something, it's still a Gleason 6. Happened to my brother this past month.
Posted 12/21/2015 2:47 AM (GMT 0)

Tudpock18 said...
.... targeted biopsy...

Biopsy is one thing, targeted is something else. I am aware that Brian may be referring to targeted, fusion or similar, but since Brian has not brought it up I will.

Tudpock is the only one that has mentioned targeted, and I thought it important to emphasize. You need more information to make the best possible decision. "in the general area" shown on the MRI may or may not give you full information.

Basically, you are talking MRI guided (which a limited number of places offer) or Fusion which is now being offered in more places.

Post Edited (Ken) : 12/20/2015 7:56:34 PM (GMT-7)

Posted 12/21/2015 1:49 PM (GMT 0)
Brian, what Ken and MichaelT said...

Reading prostate biopsy slides is as much art as science and it's wise to make sure that one of the experts does the reading so you know what you are dealing with. In fact, Dr. Epstein says that a small minority of patients are told they have cancer when if fact they do not. And, a larger minority of slides are simply misread - giving an improper Gleason score that may affect treatment choice.

You have one chance to get this right the first time so do your due diligence at every step of the process.

Jim
Posted 12/21/2015 5:57 PM (GMT 0)
YES
Posted 12/24/2015 4:08 AM (GMT 0)

Michael_T said...
I'd also get a biopsy based on that news. And I'll bet you an adult beverage that it doesn't show Gleason 8.

Epstein and Bostwick are the two labs that specialize in reading prostate cancer biopsy slides. Epstein is a doctor at Johns Hopkins. The sticky at the top of the page says how to send the slides there for a second opinion. It's cheap and easy and very important to get more info in making a treatment decision.

Good luck to you. Sometimes even when MRIs show something, it's still a Gleason 6. Happened to my brother this past month.

Thanks for you input guys, I appreciate it. I am having another Biopsy done.
Where is the "sticky" you speak of, can't seem to find it. Or do you have a link?
Thanks again
Posted 12/24/2015 3:38 PM (GMT 0)
Its at the top of the thread topic page with a lock on it authored by Casey59.. the lock means you can't post on it but is open to read.
Posted 12/24/2015 7:29 PM (GMT 0)
You say 2 urologist state they can see the tumor. It wouldn't mean much to me what a urologist had to say about MRI images, especially telling you what he thinks the Gleason is. Only the radiologist's opinion matters.

If possible, I would want a fusion biopsy to confirm areas of concern. If the place where you had the MRI doesn't have a urologist who collaborates with the radiologist to do the fusion biopsy, try to find a place that does. Having a blind random biopsy is not worth much for you now. You already know you have PCa. You want to know if there is another place nearby or if the previously identified Gleason 6 has somehow progressed higher which, as I understand these things, does not happen. If it has, then maybe the pathologist who graded it was wrong. I don't know if you had it double checked, I would assume you did if you're on AS.
Posted 12/24/2015 9:49 PM (GMT 0)
Guided biopsy.

If if comes back G6 (by Epstien) and you're comfortable on AS, have another MRI in 6 mos.

My guess is a radiologist has already read your mri and your urologist(s) are only inferring from his report what they interpret it to mean.

If so....it's not that you need 2 urologists' opinion on the same report....you need to instead send the pictures on a disc to another radiologist and have a second radiologist's opinion on what he's seeing. Different radiologists can read and interpret the same pictures differently.


If possible. ...talk directly to the radiologist. Cuts out the middle man by getting it straight from the horses mouth. They can also tell you how they come up with what they're seeing.

Post Edited (island time) : 12/24/2015 3:07:16 PM (GMT-7)

Posted 12/25/2015 12:32 AM (GMT 0)

island time said...
....My guess is a radiologist has already read your mri and your urologist(s) are only inferring from his report what they interpret it to mean.....

You need to get a copy of the MRI report. It should have a pi-rads score. Get the results of the MRI, straight from the radiologist you are entitled to them, uro has to agree to release them. Right now, you are making decisions based on someone else's interpretation. Read them for yourself.

radiopaedia.org/articles/prostate-imaging-reporting-and-data-system-pi-rads

Get a targeted biopsy. Fusion is probably easier to find.

When you have targeted biopsy send slides for second opinion to Epstein or Bostwick.

You really want to have all possible info in order to make the correct treatment decision. You only get one shot to live with whatever decision you make.

sticky

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