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Posted 12/15/2021 3:35 AM (GMT 0)
There were 40 needles.
Prostate size is 41cc.
Prostate was divided into 8 zones.
Only in zone D did 2 needles strike cancer.


D. Prostate, Right, Anterior Distal, Core Biopsy:
-Prostatic Adenocarcinoma
-Grade Group 3 (Gleason's Score 4+3=7)
-Percentage of Prostatic Tissue Involved by Tumor, 6-10%
-Present in 2 of 5 cores.
-Percentage of pattern 4: 71-80%





[url]https://imagizer.imageshack.com/img924/8477/NeHtdm.jpg
Posted 12/15/2021 3:46 AM (GMT 0)
I'm not sure where or what to do next.

He is now suddenly offering me access to the surgeon and set me up with an appointment.

But given his track record, I'm not sure me and him brainstorming in his office for 15 minutes on how to beat this cancer is the best idea.

Shouldn't other professionals be involved?
Like is there an overall cancer consultant that gets in on this stuff?

I'm suspicious that it has spread possibly. The doc took 11 months to diagnose.
It would have been a clean removal if he did it early.

Shouldn't there be a bigger plan?
Like doing radiation plus removal? Or some sort.
Posted 12/15/2021 3:48 AM (GMT 0)
On the first post, I tried to imbed an image but it didnt seem to work.
But if you copy/paste the link at the bottom, you can see my PSA plot. It's probably up to near 4 at this time.
Posted 12/15/2021 10:36 AM (GMT 0)
Groundhogy,

OK, you've got your diagnosis. Now, try to settle down a little.

You've got a Gleason 3+4 score, which puts you in "low intermediate risk". Which means, in short, that treatment is in your future, AS is pretty much off the table. That's not particularly bad news.

You also have a great shot at cure. Yep, cure.

First, you do not have to treat tomorrow. So, don't panic. Please go up to the 'sticky' thread at the top of the forum page and read "to the newly diagnosed". Then, start on a plan. Here are the first things:

1. Slow down. Don't let anyone tell you that you need immediate surgery.
2. Make appointments. Is there is major cancer center near you? If you don't know, google "NCCN Centers of Excellence", and make a phone call to the one nearest you. Tell them you want a Prostate cancer workup. They will take care of the rest.
3. Make sure you have consultation appointments with not only a surgeon--make sure he or she has done hundreds, if not thousands, of procedures--but with radiation experts as well. There are a number of different radiation therapies, so try to talk to experts in as many of them as possible.
4. Come in here and ask questions. Ask us about specifics--what therapies have we had, what are our outcomes and challenges, what do we know about a hospital or doctor?
5. Get yourself a big folder with the flap and tie--and put copies of EVERYTHING in it, including a notebook and pen to take notes at your doctor visits and write down your questions.
6. After you do all that, make your treatment decision, and get it done.
Posted 12/15/2021 11:53 AM (GMT 0)

groundhogy said...
Shouldn't there be a bigger plan? Like doing radiation plus removal? Or some sort.

Wow, 40 needles, a few more of those and they would have removed it piece by piece ! Normally it’s 12 so your doctor was very thorough on that front.

Its good they found it. For too many men it stays unfound until things become much more difficult to manage.

Generally speaking the next steps are
1) Scans to see if the cancer is still confined to the prostate. There is a new scan available called Psma pet you may want to ask about. It is way more sensitive than previous generation scans and can help you and your doctors decide on the best way to cure you.
2) Discussions with drs that know how to eradicate the problem. Basically surgery or radiation.

While only 2 cores out of 40 (ouch) did show up, like halbert said, since they were 4+3 its not something you can safely ignore, but you have time to make a decision.
Posted 12/15/2021 1:34 PM (GMT 0)
I would suggest that you check our the Prostate Cancer Research Institute's (PCRI) videos on prostate cancer. They do a good job in explaining prostate cancer, treatment options and side effects. The videos are also on YouTube.

Pay close attention to the date on some of the videos as some of the older ones are out dated.
Posted 12/15/2021 2:09 PM (GMT 0)
groundhogy,
here's your clickable link to your PSA graph: (needed the bracket, backslash,url, bracket at the end):

https://imagizer.imageshack.com/img924/8477/nehtdm.jpg

I am pretty sure mine rose somewhat exponentially like yours, back in 2011-2012, but here I am 7 years later, and PSA was at 71.5 back then, down to undetectable (0.015) currently on Zytiga.
Wings

Post Edited (Wings of Eagles) : 12/15/2021 7:19:55 AM (GMT-7)

Posted 12/15/2021 2:14 PM (GMT 0)
Hi groundhogy. I would have all your biopsy slides sent to Dr. J. Epstein at Johns Hopkins for a review of the pathology reading. He is a leader in prostate pathology and has a regular review service. Your doc can request the review and have your slides sent directly to Dr. Epstein. I would specify that you'd like all slides sent (Dr. Epstein said in an interview that sometimes labs send only the slides where abnormal pathology was seen, but he sometimes finds cancer in the other slides as well.) This will provide a double-check that there aren't more serious lesions elsewhere and that the lesions found was indeed 4+3.

You have time to research your treatment options. I don't remember what imaging you've had done (please create a signature file here so you won't have to keep repeating info and everyone will automatically see your relevant history and info at the bottom of your posts). A bone scan is usually done for men with Gleason scores 4+3 and higher.

Do your research into your treatment options, ask questions here.

Best of luck!

Djin
Posted 12/15/2021 8:53 PM (GMT 0)
Hi Groundhog,
lots of great advice here. Having gone through this myself I can say its overwhelming at times. Deciding on the right course of action can be daunting.

You are early in your journey and I cant stress enough to weigh all your options. I personally agonized over every little thing which did not help my situation one bit. Nothing runs smooth and setbacks are common. Take someone with you to all appointments as we have a tendency to only hear half of what drs or techs have to say.

As there are many treatment options available for cancer use this forum as you can best believe someone before you has gone down this same road. Whether its Brachytherapy, RP or a combination of beam radiation along with some type of surgery there are people here who have gone through it already. Read everything you can and ask lots of questions. There is plenty of help here.

In the end I chose what I thought would have the least long term side effects. As I am now dealing with my own problems two years out from surgery I can safely say I am second guessing myself to death. That being said the fine people here are helping me get my ducks in a row and hopefully live my days in less pain.

Best of luck to you.
Posted 12/15/2021 9:37 PM (GMT 0)
Groundhogy,

I'm sorry to hear that you're going through this. A Gleason score of 4+3=7 isn't a medical emergency, but it isn't anything to ignore either.

I agree with those who said you should talk to both a surgeon and a radiation oncologist. It goes without saying that you want somebody who's really good, and I'd suggest you also see a medical oncologist who doesn't do surgery or radiation. That person can be a source of unbiased information (even the best docs have their professional biases).

If I had it to do over again I would have considered all my treatment options more extensively. You have time, and information is power. Good luck with your journey.

Post Edited (Jazzman1) : 12/15/2021 2:40:21 PM (GMT-7)

Posted 12/15/2021 11:38 PM (GMT 0)
Groundhogy,
Your biopsy statistics are "real" but by no means a "do it now" or a "death sentence." They indicate, to me, that like others have said, treatment is in your future. They do not indicate a rush to some treatment just because one of your docs recommended it.

What I would do, were I in your place, is to get that second opinion on your slides, unless you are sure you want to move on to treatment regardless. That's where I was. I was diagnosed as G 3+4=7, and I chose not to try to delay but to move right on to treatment. Having a second opinion would not have changed my course of action, so I skipped it.

Next, I would go about trying to identify ALL of your treatment options. By that, I mean that in addition to surgery, you probably have several radiation options and maybe other focal treatment options. Once you have identified which treatment options are applicable to your case, look at their success rates and their side/after effects. Choose those treatments that look likely to be successful for you, and which have the most acceptable side effects. Based upon that information, then locate practitioners who offer those specific modes of treatment and meet with them to discuss. What I am trying to explain is that if you are considering radiation therapy (as I was), you must be very sure that you meet with a provider who does that specific mode of treatment to ensure that you get the full and accurate picture of what it is and how it works, success rates, side effect profile, etc. For example, if you are considering low-dose brachytherapy (permanent radioactive seed implantation), do not try to discuss it with a specialist in external beam radiation. They just will ad-lib, and will not know all the details about brachytherapy. It is kind of like the caution "Don't take your Ferrari to a Kia dealer. They will try to tell you they can fix it, but they can't."

Take a deep breath. Research shows that at your stage, taking a couple of months to decide your treatment path will not measurably affect your outcome. I was diagnosed in July, and treated in November. Didn't make a difference in my case.
Posted 12/16/2021 2:26 AM (GMT 0)
Yup, you have prostate cancer and it is treatable. You can either blindly trust your doctors or learn enough to be dangerous and make a plan to see the necessary doctors and/or better known cancer institutions to get the information you need to make a decision. There are a few solutions to your cancer so it will not resolve itself other than you selecting the one that makes the most sense to you, no one can do that for you. Prostate cancer does not grow quickly so you should not feel the need to rush things faster than your mind can deal with at this point.

There is nothing comparable to getting a cancer diagnosis. I started studying the disease once I found out my PSA went up like yours but still was not prepared for the biopsy results phone call. It was an eternity to my urologist meeting two weeks later. Then got with the program and got a second URO opinion and a RO opinion along with a CT and bone scans. The rest is in my signature and did not go quite as planned. Took me a while to realize that I was not going to die in a few years.
Posted 12/16/2021 3:18 AM (GMT 0)
Thank you all for your kind help and assistance.

I have begun the study as of today. Always learning as Benny Hill would say.

It will take me some time to come up to speed.
I very much did not wish to have to study myself into a prostate doctor, but here I am.

I will take notes tomorrow on all of your posts and harvest all of your suggestions.
Posted 12/16/2021 3:42 AM (GMT 0)
When I started asking all sorts of questions to my Dad who had PCa, he wanted to know if I was planning to become a doctor. He just listened to his doctors and had brachytherapy (seeds) since he did not want to risk surgery and side effects. I have seen what urinary issues he has over the years (94 now) and did not want the seeding based on that single observation. Not really sure why people make the decisions they do but something will seem right to you at some point and the choice will become clear.

PCF puts out an annual publication that is pretty good for learning about lots of things without being a novel. You might find it handy.
https://www.pcf.org/guide/prostate-cancer-patient-guide/
Posted 12/17/2021 10:44 PM (GMT 0)
Treat a G7. Surgery, radiation? Who knows. For me, the 1.25 pint bladder is a payoff, but opinions vary, to put it mildly. But if surgery it has to be the right surgeon. Every week I get my heart broken here as I read a post to which my reaction is "what are you doing having this person do this surgery?" We can define "right" at your leisure: you have time, albeit not forever. Good luck.
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