biopsy interpretation re fragmented cores

[SimMartin]

Not sure if anyone here can help me understand the biospy report that triggered a fast move to RT & 2 years HT. I still can’t quite understand how accurate/informative a biospy of Gleason 9 (4+5) and negative PSMA. It follows two previous 12 months and 24 months prior showing T2a stable  Gleason 3+4 causing me to opt for HIFU. Could the 3 MRIs and 2 previous biopsies just miss/underestimated the grade and involvement? - for instance cab the amount of fragmented cores add uncertainty? 

[Tall_Allen]

HIFU often allows PCa to progress and grow, even in the treated area.

prostatecancer.news/2021/03...

[SimMartin in reply to Tall_Allen]

yes I knew it was not necessarily a long term solution but given the mri and biopsies I hope to knock it back a few years. I was also overly warned of the dangers of RT on my disability which was I think now because the specialist didn’t understand polio and saw it as much more like MS which it isn’t. My fault as I have had this all my life and almost no medic has met polio in their career.

But what’s done us done ! My query is judging just how extensive my G9 is given the report as yes some recurrence on edge of Hifu treatment area but also oddly the other side which 2 previous biopsies rated suspicious but no positive cores.

my new oncologist says it’s just bad luck they missed them even with the mri and targeted biopsies. Also says I sit between rusk levels for SOC treatment despite the G9. Just curious of the issue of fragmented cores and the report saying therefore percentage estimate not possible.

But I’ve gone anyway for the RT 20 x 3Gy and attempting 2 years goselerin.

[MobilityTech]

The Gleason score change I would chalk up to the cancer having grown more in the prostate. As far as the Negative PSMA it would mean no tumors found elsewhere. What is your PSA? If your PSA has held low, I do wonder why the Gleason score has gone up.

I went with a radical prostectomy when I had my Gleason score of 7, 3 + 4. My PSA went to zero for two years, and just as the urologist told me I could go to yearly blood tests, my PSA began to rise. So at that point I knew it was mestastic. I've since had discussions with others who had the same as I did, and went with the Prostectomy, but their radiologist suggested a radiation of the prostate bed as soon as possible afterwards. They did not have it return. Kinda makes me wonder it I had, had the radiation would I be in their place, but I was told that wasn't something that was done. I had radiation of the prostate bed after seeing my PSA return and go up, but it dod nothing to help. I wish I had gone for a second opinion on that one. I'm on Orgovyx as a pill hormone therapy now for two years and my PSA is .02 and holding. I hate the hot flashes which are intense, but the therapy is working so far.

[SimMartin in reply to MobilityTech]

I think it’s really tough for us to make the best treatment choice at the start aa SO much info and different medics opinions. So because of my polio and wheelchair use I think it freaked out the first oncologist I saw who over played the side effects of radiotherapy- I probably should have just had RT straight after my PSA rose to 8 instead of HIFU but I thought it was worth a shot as my PSA had been stabler at around 4-5 for about 2 years. The rate of 5 to 8 in 5 months should have been a warning but again waa told RT and hormones would destroy my muscles and the RT side effects might be bad for me given my polio and breathing. Of course 3 months post HIFU my PSA only went down to 5 and at 6 months rising again to 6.2. So hence yet another biopsy that showed G9 and immediately referred for RT and put on bicalutimide

In the event the RT wads uneventful- the hormones how we are not great and yet 6 months in my psa is 0.01 and testosterone 0.6 - fatigue isn’t great and hot flushes but dint mind then. So my PSA was highest briefly at 8.