Awaiting biopsy results. What are next steps?

[KC18]

Hi. I posted on the Advanced Cancer network a few months ago. My husband has had a rising PSA for about 4-5 years. He is 49 now. He has had one biopsy about 2.5-3 years ago. That one didn't show any cancer. Then, he had an MRI last January b/c the PSA was still rising (it was 4.9 after being 2 something?). That showed two inconclusive spots. His urologist said he could wait and take his PSA again in 6 months. He did that. In July, it was 5.8. He had another biopsy this week. We should hear something by the end of the week. What do we do after the diagnosis (if it is cancer--which, of course, we are still praying it is not!). Should we ask for a set of all his records? We want to look at a variety of treatment options, including HIFU, FLA and possibly proton therapy, if he is a candidate for any or all of these. Should we try to find an oncologist in town? Should we get a second opinion on the biopsy results? I would appreciate any guidance on what our next steps should be. Thanks in advance.

[Hidden]

I would first have your urologist send the slides to Johns Hopkins for a second opinion. Data and knowledge is power as my urologist pointed out. Your urologist should not mind doing this. This will cost $250.00 but well worth it. Second, see what the results of this biopsy show.

Is it Gleason 3+3=6 or Gleason 4+3=7 or 3+4 or Gleason 8 or above? Go to the American Cancer Society website to understand what Gleason scores mean if you are not familiar. Read up on Gleason scores today! A Gleason (GS) 6 is very slow moving, A GS 7 a little faster and GS 8 or above very fast. The bx report will also say how many cores are positive. Each of the positive cores will have a GS score and % of involvement. If all the positive cores are GS 6 and if they are fewer than about 3-4 positive out of 12, and if none are over 50% involvement, you can consider active surveillance. A GS 4+3=7 or above most likely either surgery or several of the radiations offered or a combination of both. This process is very data driven I've learned and doesn't resemble how other cancers are treated. In my case, one bx showed 3 positives all GS 6 all under 20% and the followup bx a year later showed 4 positives all under 20%. I was diagnosed April 2017 and am on an Active Surveillance program at the moment. The data really matters. Recap, when you get your biopsy report telephone call, ASK # of positive cores, GS score of each positive core, % involvement for each positive core. Is it cancer or not cancer is not enough information. It's a diagnosis but is treatable. You will have to take a deep breath. I'm not a doctor just a patient.

[Tall_Allen]

The most likely outcome is no cancer. The second most likely outcome is insignificant, indolent cancer that never needs to be treated. No matter what the outcome, you will have plenty of time to contemplate next steps. You will find that you have a lot less anxiety if you deal with things as they are instead of what you imagine they might be. Stop back after the biopsy findings are in.

[Hidden]

A bit of a dilemma here. It's good to be well informed, but it's just anxiety provoking to be OVER informed. Presuming that the physician you have using so far is competent then they will explain the biopsy result to you and then advise treatment options. The information they give may include such things as Gleason score and number of cores etc. If you trust them why seek a second opinion?

Tall Allen has got it right for me, it's best to take it as it comes, one step at a time. I know the hardest part is waiting for the results, but it shouldn't be too long a wait.

[cpcohen]

>>>

. . . No matter what the outcome, you will have plenty of time to contemplate next steps. You will find that you have a lot less anxiety if you deal with things as they are instead of what you imagine they might be. Stop back after the biopsy findings are in.

>>>

+1. One step at a time -- don't try to see past the next bend in the road.

If you have a PSA history (which I think you do), figure out the "PSA doubling time" using semi-log graph paper, or this calculator:

nomograms.mskcc.org/Prostat...

As a general rule, long PSA doubling times (and Gleason scores of 6) are associated with tumors that can be watched (rather than treated), and that (if treated) have a good chance of being "cured". ("Cured" is a tricky word, with cancer.)

Short PSA doubling times (and Gleason scores of 8 or more) are associated with tumors that need to be treated.

. Charles

[Roger2Dodger]

What ever your biopsy reveals, take your time, and do research on PCa.

ejc61gave you some good numbers and advice to begin with. I agree with what he said.

I had Genetic testing on my biopsy results, and the results will help you make an informed decision. The results will let you know if you aggressive, non aggressive PCa .

You can do this at Prolaris , Myriad laboratories. Just google Prolaris and read how it is done and the results they can give you.

G'Luck

[KC18]

Thank you to all of you who replied. We got the results yesterday and they were negative! No cancer! Such a relief. I appreciate all of you and will be thinking about all of you on these boards. You will be in my prayers. Thanks for all of your support and expertise.