Reason for a 2nd Opinion of your Prostate Biopsy Report .

[Conlig1940]

As the resuly of my rising PSA of 7.3 , I have been on Dutasteride for 4 yars for BPH , I proceeded to have a Tesla 3.0 Prostate MRI which showed an increased T2 Signal plus a PI - RADS 5 . highly suspicious of cancer . Following a 5 Core Transperineal MRII Fusion Biopsy ( All cores in the target area ) my pathology results came back " NEGATIVE " . A time for joy - HELL NO . This result was in conflict with thhe MRI report . Yes I know the report could be correct in a limited number of cases , but a very low percentage .

Three months later , " I " requested a 2nd Biopsy with more cores . In preparation , I had a 2nd MRI , this time with & without contrast . The 2nd Biopsy was performed , this time 6 cores in the target area and 10 in other areas of the gland .

The Pathology report came back : ALL 6 CORES IN THE TARGET AREA , Gleason 3 + 3 = 6 .The other cores were negative .

Once again , not being satisfied and thinking they may have missed some Gleason 7 or undervalued the G6 . I requested a 2nd Opinion of the G6 pathology report .

Surprise , surprise . The report came back ALL 6 Cores in the target area were upgraded to Gleason 3 + 4 = 7 . The remaining cores were all negative . My 1st negativee report and my 2nd Gleason 3 + 3 = 6 report were performed by reputable pathologists , experienced in readiing "High Volume PROSTATE BIOPSIES " .

The upgrading of my G6 to G7 was performed by the Head of Pathology at a major Toronto , Canada Hospital .

Who to believe ? Take your pick -- Negative , Gleason 6 or Finally Gleason 7 . Put them in a hat and draw one out . 🙂🙂🙂👍

I am making my treatment decision , at this juncture on Gleason 7 . Active surveillance for 6 months with a PSA every 3 months , plus an another " Contrast MRI " 6 months after the last one which was May 2024 . Additionally , in the meantime I am looking at potential treatment options -- Fical Theerapy , Monotherapy HDR Brachytherapy etc . -- I am 84 + years old annd in good health otherwise .

What do the say " You will die WITH cancer NOT FROM IT --- My response , Utter BS .

[Conlig1940]

Sorry - FOCAL THERAPY ,, HIFU , NanoKnife , etc.

[Tall_Allen]

You may want to fill this out:

webcore.mskcc.org/survey/su...

[Conlig1940 in reply to Tall_Allen]

I did . If I do nothing I will live another 10 to 15 years .🙂🙂🙂👍

I am 84 + years young . I " MAY " consider Monotherapy HDR Brachytherapy . I will be getting into the minutia of the procedure with my Radiation Onclogist . OR At my age stay on AS and strictly follow the guidelines . Regular PSA , DRE plus a Contrast MRI at say 9 months to 1 year .

The location of my single 2.2 cm lesion at the Midline Anterior Transition Zone - Mid Gland , was not detected via several DRE's . by my GP or Urologist . My PSA in May 2024 was 8.2 , 7.3 in Dec 2023 and was 8.4 in May 2023

I have been on Dustaride & Flomax for 4 years for BPH . My prostate volume is 80 cc .

In conclusion . At my age do I just continue on Active Surveillance and enjoy my current quality of life . I am otherwise healthy and play golf regular .

Or do I risk a procedure and live out my remaining years feeling like s----t.

[Tall_Allen in reply to Conlig1940]

They call it "Watchful Waiting" if you would only use hormone therapy if you develop painful bone metastases.

[Tommyj2 in reply to Tall_Allen]

Just my opinion….but if someone told me with assurance that I could have another 15 years doing nothing that is exactly what I would be doing.

[Conlig1940 in reply to Tommyj2]

No-one personally told me I would live another 15 years . I simply , for fun , filled in a survey site proposed on this forum by Tall__Allen , namely :

webcore.mskcc.org/survey/su

[Tommyj2 in reply to Conlig1940]

Got it….thanks

[addicted2cycling in reply to Conlig1940]

I would be concerned about the found *4*, concerned that being on Dutasteride according to some actually lowers your PSA number, meaning the PSA 8.4 is more like PSA of 16 and also the biopsy is still incomplete since it was not a Saturation Transperineal 3 Dimension Prostate MAPPING Biopsy performed by Dr. Gary Onik.

When in 2018 I had a *4* show up in a recurrence I had IRE performed BUT earlier this year all that returned was some 3's so I'm just WATCHING and testing.

note -- I replied in another thread you posted titled -- *Gleason 6 Treatment options*

healthunlocked.com/advanced....

[NanoMRI]

Yes whom to believe? My initial biopsy G was 3+3 - mpMRI suggested more serious cancer. 2nd and 3rd opinions 3+4. Final after RP, 4+3. All the best!

[Conlig1940 in reply to NanoMRI]

Yes the Gleason is typically upgraded after the findings of a post RP pathology report . But not always .

[NanoMRI in reply to Conlig1940]

based on my experiences the reason for mpMRI prior to biopsy, second options of pathology and radiology findings, and further investigations if the opinions do not align.

[Mgtd]

Not trying to be a smartass but from what you wrote above your life expectancy is 94 to 99. How much longer do you expect to live with treatment? In my mind “quality of life” needs to be considered. None of these treatments come without some down side.

[Conlig1940 in reply to Mgtd]

I'm a realist . I could take a heart attack and die typing this reply . I do not want to live , if you call it that , to 99 .

[janebob99]

I just completed 5 sessions of RT (SBRT) at our local cancer center, and it was a piece of cake. You will find many more centers that do SBRT than do Brachytherapy. It's an option you may want to consider. Very few side effects, and they contour the beam to focus more radiation on the tumors identified by MRI, while also irradiating the whole prostate. Today's Linac machines are very accurate.

A recent, high-level study by Artera.ai discovered that 2/3 of men don't benefit from doing ADT, while 1/3 of men do benefit from ADT. Their results are published on the Artera.ai website.

You could do SBRT and skip ADT. ADT causes osteoporosis and heart problems, among other problems, which you don't need at your age. I agree that quality of life should be a high priority.

Stay on the Dutasteride, it helps to reduce prostate cancer (many studies support this).

HIFU or laser focal therapy is good if your insurance will cover it.

Bob in New Mexico

[Conlig1940 in reply to janebob99]

Thanks Bob ,

How many leisons did you have and what was your PSA . and Finally what % of your cores had cancer ? 40 % of my 15 cores had cancer All upgraded from G6 to Gleason 3 + 4 = 7

[Tommyj2 in reply to janebob99]

My understanding is that you can’t get any more accurate than HDR Brachytherapy (needles rather than seeds)…..looking into it for myself.

[Hailwood]

Wow, I wish that I had that diagnosis at 65, with 11 of 12 cores positive. I think the advice you are receiving about monitoring is sound. At 65 I decided to have the prostate pulled out and then I have been on ADT without any changes for the past 4 years, but the surgery option may be more difficult at your age, but you may well feel that you can manage it. Good luck on your journey.

[MateoBeach]

I agree and would proceed with presumptioG3+4. The HDR brachy sounds good. Paul

[Conlig1940 in reply to MateoBeach]

At age 84 + it appears reeasonable . What is your opinion of HIFU or NanoKnife ?

[PTvsPC]

Did 3+4 pathology report state the percentage of G7 found? Did it mention anything about cribiform pattern?

Both of these would heavily influence my decision to stay on AS vs getting treatment.

[Conlig1940 in reply to PTvsPC]

No cribiform -- 19 % average Cancer in 2.2 cc leison .