Feedback Request On One Year Followup Biopsy Results After Initial Diagnosis

[Fox2018]

Hello All,

Just got the results of my one year followup TRUS biopsy after initial diagnosis. I have copied and condensed the notes down to the paragraph below. Please give me your thoughts and feedback regarding what you thinks should be my next step. I meet with my doctor next Wednesday.

Biopsy Results

TRUS biopsy - 12 specimens - #1 right lateral base, Prostatic ductal adenocarcinoma, Gleeson's score 8 (4 + 4), Grade Group 4, involving 1 of 2 cores and 10% of the tissue, perineural invasion not identified - #9 left lateral mid, Prostatic adenocarcinoma, Gleeson score 6 (3+3), Grade Group 1, involving 1 of 1 core and 10% of the tissue, perineural invasion not identified - #11 left lateral apex, Prostatic adenocarcinoma, Gleeson score 7 (3+4), Grade group 2, involving 1 of 1 core and 10% of the tissue, 5% of pattern 4 identified in Gleeson score 3+4=7 cancer, perineural invasion not identified - all other 9 samples benign prostatic tissue, no tumor seen

Mike

[tom67inMA]

The words "ductal adenocarcinoma" jumped right out at me. That was in my biopsy as well. I went from a PSA of 2 during a routine check to 216 just over a year later at diagnosis with widespread metastases. My understanding (and experience with) this rare form of prostate cancer is that it has this nasty habit of leaving the prostate before the PSA goes up significantly.

[Tall_Allen]

I'm a fan of the clinical trials for the newer PET scans for high risk guys like you, but you may have travel, as they are not available outside of clinical trials. If you're in Philly, you may be able to get in on the free NIH trial of DCFPyL. Call Yolanda ASAP as there is a waiting list:

clinicaltrials.gov/ct2/show...

Assuming the PET scan is negative for distant mets, you are fortunate to be at Fox Chase. Eric Horwitz is one of the leading experts in high dose rate brachytherapy. That, combined with external beam radiation of the entire pelvic lymph node area coupled with some long term ADT may be able to cure your ductal PC. Brachy boost therapy has the best track record for curing high risk PC:

pcnrv.blogspot.com/2018/03/...

(note: Eric Horwitz is one of the co-authors of the study referred to in that article)