What are you thoughts on this?

I can only speak personally, but that 4+3 finding would have me making a quick treatment decision.

Thanks for your reply. I am planning on sending all 4 biopsies slides to Dr. Jonathan Epstein after meeting with my Uro to be sure on path forward.

I’d recommend you consult with a couple RO’s. The urologists/surgeons will most assuredly only recommend RP surgery. It’s what surgeons do best but it may not be your best option.

Ray, how many total cores and how many were positive? Were the positive bilateral?

Having two G7 cores isn't good for going on, or remaining on, AS. Have you considered a genomic test like Decipher, OncotypeDx or Prolaris?

Djin

[quote="Have you considered a genomic test like Decipher, OncotypeDx or Prolaris?]

Not sure what these are? Need to look them up. Thanks

Welcome Ray; sorry to meet you here. It sounds like your AS run is coming to an end. You’ve already received some good advice and the one thing I’m comfortable adding is to learn as much as you can and make an informed treatment decision. This forum is a great place to ask questions and start that learning process. Initially choosing between all the choices will seem overwhelming; however, as you research the options the choice best for you will likely become obvious. It takes some effort; but, in the end it’s worth it. No matter the treatment choice I always recommend seeking out the very best practitioner and team you can find. If you share your location you may even get more specific recommendations. Terry

Ray51 - No doubt you are thinking about treatment at this point. The final decision should be after the second opinion from J Hopkins is received. It is not unheard of to have a biopsy Gleason score downgraded by Dr. Epstein's group so you will want to know that if it happens, same if gets worse. The Decipher genomic testing is a risk assessment independent of Gleason score that can you push one way or the other when there is treatment doubt.

The fact that you are on Finasteride probably means that you have have/had prostate related issues so don't be too quick to reject the surgery option without discussion. Please have serious talks with your urologist(s) and radiation oncologist(s) about your specific situation and how it should be best approached. Some options get taken off the table with giant prostates while others make more sense. Not advocating one way or the other but make sure it is addressed in your questioning.

So there is a 4 in there and they only sample a tiny percentage of your prostate.

You are on top of things. Its time for action.

A new scan was recently approved, psma pet, which is really good at detecting if any of the PCa escaped the prostate. Ask about it as you are deciding how to eradicate the critters. If it escaped and is in a nearby lymph node that would likely alter the recommended definitive treatment.

You want that first swing at it to be your best swing.

Your prostate is not very large in the scheme of things but that doesn’t mean you don’t have issues with it. I suspect the size won’t scare many of the doctors but the topic still deserves discussion since you have issues with it.

Ray, Thanks for sharing the images of your biopsy progression. It certainly helps show the hit and miss aspect of needle biopsy. The combination of BPH and PCa makes your treatment decisions a little more complicated and challenging. MD Anderson would be where I’d be seeking out advice to evaluate my options. As Steven said earlier, you want that first swing to be your best. The very best can make a big difference. Keep us posted…Terry

Good Morning Everyone.....

I did meet with my uro and just like everyone said the time for AS is now gone. He agreed on the second opinion on the slides. He has already faxed over the form to John Hopkins and I have already requested AmeriPath to send the all 4 biopsies slides to JH. Let see how soon this happens and how much time will JH take to review them.

My uro still thinks that even @57 I am young enough to be a prefect candidate for surgery. He stated my cancer is still small 10% of 2.00mm for 4+3=7 and 60% of 8mm for 3+4=7. The uro thinks that any radiation type will cause secondary cancers in the long run and as such surgery is a better option. He stated he will not be offended if I get surgery elsewhere as I long as I am comfortable. He mentioned the name of Dr Vipul Patel out of Celebration, FL as he knows him and that Dr. Patel is the highest volume surgeon in the world.

In coming weeks, I will schedule an appointments at MD Anderson for consultation on both radiation and surgery once I have idea when will i receive the results from JH . I have already setup an online account for MD Anderson. I am open to any suggestion and thoughts that come to your mind so I can make an informed decision.

Post Edited (Ray57) : 3/30/2022 9:00:57 AM (GMT-6)

Terry's Cellar said...
Ray, Thanks for sharing the images of your biopsy progression. It certainly helps show the hit and miss aspect of needle biopsy. The combination of BPH and PCa makes your treatment decisions a little more complicated and challenging. MD Anderson would be where I’d be seeking out advice to evaluate my options. As Steven said earlier, you want that first swing to be your best. The very best can make a big difference. Keep us posted…Terry

Thanks Terry, I will be seeking opinion for both radiation and surgery at MD Anderson.