Preliminary Questions

I am new

Going to doctor tomorrow. Had MRI and Biopsy.

Biopsy came back with 4 cancerous areas, the largest at 3.75 mm
Gleason score of 8. Is prognoses for this good?

However, can you tell me if Transcapsular / Periprostatic Extension: Capsular
abutment without gross distortion or measurable ECE means the cancer has spread?

Also what test can definitely diagnose ECE?

Should the doctor have still called me when biopsy results came yesterday and I have appointment tomorrow?

Thanks for your time.

Hi Fred, and Welcome to the Forum!

An MRI can only suggest whether one's cancer has grown out of the prostate. "Capsular
abutment without gross distortion or measurable ECE" means that the lesion(s) appear to have grown up against the thin prostate capsule, but does not appear to be pushing it very much out of shape and nothing measurable appears to have grown through the capsule ("extra capsular extension" or ECE). I don't think that rules out a finding either growth into the capsule itself, or, more common, a microscopic breach of the capsule ("focal" or "multifocal ECE") were the whole prostate to be removed and examined. You can discuss your MRI with your uro, who can tell you if I've gotten it right.

A Gleason score of 8 put you in Gleason Grade Group 4, or "High-grade cancer." It requires treatment and you can discuss your treatment options with your uro and also, I would suggest, a radiation oncologist (R.O.). The prognosis depends on both the aggressiveness of your cancer and whether or not the cancer has spread out of the prostate, whether into neighboring anatomical structures (the seminal vesicles, the fat surrounding the prostate, the bladder neck, etc.) and/or has metastasized (e.g. into local pelvic lymph nodes or distant metastases).

You can discuss the value of a Decipher test of your biopsied tissue. The test looks at your cancer's RNA and gives you a score for the risk (low, intermediate, high) of your cancer metastasizing.

If your cancer is truly prostate-confined, then whatever primary treatment you decide on (surgery or radiation) has a good chance of letting you put your prostate cancer in the rearview mirror. Surgery is a radical prostatectomy, where the prostate and neighboring lymph nodes are removed and examined. There are different radiotherapy modalities, which you can discuss with a R.O.

It is generally a good idea to have one's biopsy slides reviewed to double check your diagnostic pathology, including the Gleason score. Dr. Jonathan Epstein is a leading urinary pathologist who runs a 2nd Opinion service at Johns Hopkins. You can request that your biopsy slides be sent directly to him for review. The cost is usually covered by insurance.

Djin

Hello Fred - Gleason 8 is only good news if you had any doubts about having prostate cancer. You have it and there is no doubt about it. As F8 asked, PSA history would be helpful in assessing your situation. That is one of the first questions that any of the cancer risk calculators would ask for. Your prognosis assessment depends on what you consider "good". Will you be able to have a procedure and forget about prostate cancer? Probably not. Will you die in a year or two? Probably Not. PCa tends to play the long game for higher risk cases to the point where it becomes chronic disease management for a long time.

The only way to know for sure about Extraprostatic Extension (EPE) is to have the prostate surgically removed and examined under a microscope by a pathologist. This is a pretty extreme method to acquire some data that is not really going to affect treatment considerations much. The fact that your cancer is noted at the capsule boundary is not definitive by itself but an educated guess that it has not passed the boundary. Close enough as the high risk G-8 assessment trumps some of these other considerations.

The doctor may have received the results about the same time you did assuming your doctor did not spend the day in surgery. Given that your appointment is tomorrow, it might be reasonable to not get a call. My doctor called after Labor Day weekend but I still had over a week until I saw him again. He did not really answer many questions and just said to relax and bring wife to next meeting to go over everything. He said he planned the meeting at the end of the day so he could spend as much time as needed with us.

The process is slow. Please report back after your meeting when you get the full story. The treatment selection process is the next hurdle after your meeting since there is surgery and numerous radiation methods that can all work. If you are seeing a urologist, expect the discussion about surgical options. Ask for referrals to radiation oncologists to get the other side of the story. Depending on who are seeing, you may wish to get opinions from well known cancer centers like Mayo, Universities, etc. Later....

Everything you guys stated above turned out to be correct. Thank you for all the time you put into the answers to my question.
Gleason 8 is aggressive.
7.5 PSA
Age 62 Today

Appointments are all set
Bone Scan on Monday
Radiology/Oncology March 28
Consult with Surgeon April 5

I did ask the doctor this question. What are your experiences?
Do I have to get radiation after surgery if I decide to do it?

Happy Birthday Fred!

You usually only do radiation after surgery if the surgery failed. Please make sure to see radiation oncologist/s before settling in surgery! What does the Uro/surgeon say about looking into radiation?

Some men have been able to get a newer PSMA PET scan (much more sensitive than conventional bone scan) after biopsy results to check for spread of cancer that can not be detected any other way. This can be a key piece of information for higher risk situations when determining treatment scheme(s). For example, if a lymph node lights up, it needs to be treated in some manner as part of the initial treatment. You should consider putting that on the list to ask the oncology people about at your meeting. Oh yeah, prepare a list for the meetings.