biopsy - fragmented cores and progression risk

[SimMartin]

I had 3 biopsies from January 2020 to July 2022. The first two almost identical being Gleason 3+4 with <10% 4. However 6 months post HIFU it was Gleason 9 with 4+5 with 10% 5 and 70% 5 (see below).

I am curious as the cores are fragmented and so it’s hard to know what this means and if it makes any nomogram impossible or invalid. It seem ls the fragmented cores were NOT from the HIFU treated side which was the only positive cores on previous biopsies and the MRIs only show up possible malignancy on the HIFU side and not the side which has developed Gleason 9 high risk. (PSA always <10 and first 2 years <5)

See below : any comment in this report would be useful albeit hindsight as now on 18-24 months of HT following radiotherapy and negative PSMA/Pet. Any use in genomics ? Just try to plan my future management and recurrence risk time line

CLINICAL DETAILS

Elevated PSA. Post HIFU.

NATURE OF SPECIMEN

A. Right edge of treatment.

B. Left anterior.

C. Right base.

D. Left treated area.

GROSS DESCRIPTION

A. Seven fragmented cores of tissue largest measuring 14mm.

B. Seven cores of tissue largest measuring 10mm.

C. Four fragmented cores of tissue largest measuring 12mm.

D. Four cores of tissue largest measuring 11mm.

MICROSCOPIC EXAMINATION

A. Adenocarcinoma Gleason 4+5 overall (G4 70%, G3 20%, G5 10%), 4mm,

4mm, 4mm and 8mm, fragmented cores so percentage involvement not

assessable.

B. Seven prostatic cores with a group of small atypical acini suspicious for

malignancy.

C. Adenocarcinoma Gleason 3+4 overall (20% G4, no cribriform pattern), 2

foci measuring <1mm and 10mm (discontinuous), fragmented cores so

percentage involvement not assessable.

D. Four prostatic cores with high grade PIN and focal fibrosis.

DIAGNOSIS

Twenty two prostatic biopsies from 4 sites (post HIFU): Adenocarcinoma

Gleason 4+5 overall (Grade Group 5) at 2 sites (see text), maximum tumour

length 8mm. Neither perineurial nor lymphovascular invasion is seen.

[tango65]

Prostate may have multiple areas of cancer in the different lobes. Those cancers may have different Gleason scores. The highest Gleason score is used for the classification of cancer risk,

[Boywonder56 in reply to tango65]

I believe the fact that it says " no cribiform pattern " is in your favor...as in ductal ...what mine says....but then again to arive at g5...that in itself means the samples were " tight".......also so per. Inv., no path to lympnodes involved...if the hifu only removed suspicious areas....id get a rpt now b4 it gets a move on....im not even close to being a dr. Just trying to ease your angst..bw

[tango65 in reply to Boywonder56]

I don't understand your reply.

[maley2711]

gleason 5 was found..that is what matters and puts you now at high risk. 3+5 , 4+5,etc ..all high risk......PSMA PET is SOC scan now. No more HIFU, etc.

[JL1955]

did you inquire to me about radiation? I’ve been offered it several times and declined. My ADT drop from 125 to <.006 is based in ADT of Relogolix and Darolutemide PLUS plant based diet, supplements, and HITT built around weight room, FAST swimming and bouncing/bounding in the deep end of pool, as if on an imaginary trampoline ( it moves lymph)

[j-o-h-n]

What you need is a fourth biopsy....

Good Luck, Good Health and Good Humor.

j-o-h-n

[SimMartin in reply to j-o-h-n]

lol John ! Stabbing city ! I think everyone missed exactly what I wrote and was after - I gabble a lot and I loose myself sometimes in the way !

I actuslly had IMRT 3Gy x 20 to the prostate and put on ADT which I’m 14 months post my RT. I was just asking if having fragmented cores made any prediction models unusable as they ask percentages of positive cores !

I’m just being slightly obsessive- a trait I can go down! PCa is such a trapdoor for rematch and treatment options !

[j-o-h-n]

Slightly obsessive? Aren't we all? This fooking disease grabbed us by the balls, so our hearts and minds just followed.....

Good Luck, Good Health and Good Humor.

j-o-h-n

[PacMan1950]

I'm sorry SimMartin but Pacman 1950 died a couple of weeks ago. The radiation treatments were successful but pulmonary embolism s couldn't be treated. Good luck with your treatment. n

[SimMartin in reply to PacMan1950]

I so sorry for your loss and that his journey was so tough in the last year or so. And thank you for your good wishes. ❤️

[j-o-h-n]

BOT ALERT *** BOT ALERT *** BOT ALERT

youtube.com/watch?v=4qDuaDI...(Not working as expected?)

Good Luck, Good Health and Good Humor.

j-o-h-n