Hi there. First post. Biopsy was Gleason 7 (3+4) with no invasion etc as far as I can understand. Grade 2 Intermediate Favourable. I haven't discussed any treatment yet as I've only known for a week. Any ideas, or just be patient? I'm a bit paranoid about my health as I'm just nearing the 5 year all clear for bowel cancer and now this arrives to take its place! Not happy.
Biopsy results.: Hi there. First post... - Prostate Cancer N...
Biopsy results.
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Thetoad
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Toad sorry you have to go through this again, but yes be patient. You will want to learn everything you can about your own situation before selecting a treatment option. A second pathology opinion, T3MRI, and genetic testing. If you have had a recent colonoscopy which I bet you have that would be great information too. There are a lot of choices, but you will need to constantly point out that you have had colon cancer and any other health information. Radiation and sometimes surgery can impact the colon. A favorable 3+4=7 is good. Hopefully, your research and consultation will end in a straightforward treatment and cure. Take your time.
Hi Thetoad I had a Gleeson 7 3+4. The 4 year anniversary of my surgery was in July. I’m sorry it sucks to get that news when you are clear 5 years on bowel surgery. Im prof there is hope. hope. I had resources in NYC and Boston and found support I could not imagine that got me through. You have gotten this far on your attitude and you will draw on it again. My mantra was “Im going to face this challenge and have it make me better. I’d look at the options and for surgeons be sure they have done high volume. If you are in Boston or NYC I can tell you who I saw. Diet has played a big role in my recovery and a Practice that offers that service is worth considering. Hang in. I’m proof you can come through following the plan.
Redsox1967, I’m just wondering what kind of diet you’re referring to that made a big role in your recovery. My wife and I started eating a plant based diet 4 weeks ago. My surgery is in 3 1/2 weeks.
Some context is in order. After surgery I moved to a Mediterranean Diet more plant based largely taking our dairy. I lost 34 lbs. my PSA was detectable would rise then pause. When it hit 1 I my surgeon suggested radiation. I’ve avoided radiation under an MD’s care with 20 grams of fat per day and low calories. I 700 calorie fast for 3 days 2x times per month. My PSA has not risen and if I follow low calories (low fat low sugar and other elements) I can see my PSA go down. I see an MD (trained radiation oncologist) every 3 to 6 months. The diet is whole grains, vegetables, low fat and lots of dark berries. IT NEEDS TO BE DONE UNDER THE GUIDANCE OF A PROFESSIONAL. I live in NYC
Sorry to hear of your prior experiences and recent biopsy results. Good advice from prior posts - the more information you can get, the better. My biopsy showed Gleason 3+4 and in addition to doing a lot of research, I had mpMRI (confirmed lesion with high likelihood of malignancy) and Decipher test (put me in the "unfavorable" category based on an aggressive cancer). Although somewhat disheartening, additional tests and meeting with additional doctors helped me considerably with making the RALP treatment decision (surgery next month). Hopefully, if you have some follow-up tests done, your results will come back more favorably and you may be a candidate for active surveillance. I wish you good luck and good health.
I don't think you need any more diagnostics or imaging for now. What percent of the cores were positive and what was the highest percent of pattern 4 in any core? I suggest you have your urologist send your biopsy slides to Dr Epstein's pathology lab at Johns Hopkins for a second opinion ($250).
If you have a very small amount of pattern 4, you may be a candidate for active surveillance. That would involve a multiparametric MRI -targeted confirmation biopsy within a year. If it shows no progression, you may want to get some genomic testing then to assure yourself that AS is a good strategy.
If you are not a good candidate for active surveillance, all kinds of surgery and radiation provide about equal chance of a cure. Take your time - unlike your other cancer, prostate cancer is very slow growing while localized. You should meet with specialists in each of these: surgery (open or robotic doesn't matter - the surgeon's experience does), SBRT (5 external beam radiation treatments), low dose rate brachytherapy (seeds) monotherapy, and high dose rate brachytherapy monotherapy (temporary implants). I don't include IMRT or protons because they are too costly and time consuming (although results are the same). All kinds of radiation may require special imaging - let your radiation oncologist tell you what he needs.
Hi Tall.. saw your reply to this poster. Have picked your brain a few times since joining this site. I just had a fusion targeted biopsy at Emory and got a second from Johns HOpkins which was a little more favorable than Emory's reports.That said both show 2 lesions...one is GS 3+4=7...10% cancerous(JH says 5% of the total specimen and Gleason pattern 4 is only 10%) and the other is GS 3+3=6. So i am still in Group 2 as i have been since early 2016 which im relieved and happy about. Now trying to determine my next steps. I definitely dont plan on starting treatment now based on the biopsy results...staying on AS and having Urol do periodic PSA and DREs going forward. Have had annual 3TMRIs for last 3 years and nothing much has changed.
BUT what has changed is that my PSA keeps going up. In JUly 2015 it was 6.47% and it has gradually risen over time so that in May of this year it has risen to 12.95% .Im wondering if there is a Genomic test i would be wise to consider or whether it would be a waste of time and money at this point to have one. I do plan to meet with a Rad Onc who specializes in SBRT which is what i think iwould do if i did decide on treatment. Your thoughts on the Genomic Test would be appreciated. Thanks very much for your help..
There are three major genomic tests of biopsy samples - Oncotype Dx, Prolaris and Decipher. They are expensive, and may or may not be covered by your insurance - get pre-authorization. Most likely, they will tell you what you already know - that you are intermediate risk - but there are occasional surprises. There may be many reasons that PSA is rising - the Prostate Health Index (PHI) blood test may be more useful than just PSA.
Thanks Tall...good point on the PHI...i have heard of it but never had it. Im pretty sure Medicare will cover genomic testing for me, but i will definitely check. If i get one of those tests and they dont raise red flags i will almost certainly stay on AS.At 79 ,Im not overly excited about starting treatment when the Life Expectancy tests i periodically take on the Kettering Memorial website continue to show that 98 PC victims out of 100 will live another 10 to 15 years given my statistical numbers.
Thanks for your help.
Wow! This is a great site! Thanks for the replies, good to wake up to such support on a Tuesday morning. I'm in New Zealand, (should have put that in my post,) so things may be different here. I'll read my report again and try to provide more information.
Thanks again.
I'll copy some of the report.
There were 13 core Samples, the 6 on the left were benign prostatic tissue. Two of the seven on the right showed ardenocarcinoma. Tissue involved 20%, perineural invasion not identified, no extraprostatic extension identified. Gleason score 7 (3+4). Grade group 2. Quantitation of tumour unilateral. Then it says tissue involved 10%. So I don't know what the above 20% is all about?
I did lose a lot of my bowel 5 years ago (almost) after an extended right hemicolectomy. I'll make sure they are aware of that if radiation is suggested.
Thanks again for your interest.
How awful to hear that you are afflicted with cancer a second time. Having bowel cancer is significantly worse than prostate and you have survived that. So that's in your favour.
Your biopsy results are also in your favour. Gleason 3 + 4 is intermediate risk, not high. Also good that apparently the cancer is confined in the gland. In the UK an MRI is usually now done before biopsy and could confirm that.
I'm not very knowledgeable about health care systems in New Zealand, but I imagine treatment options will be similar to most developed countries. You may find however that your options are a little limited because of your previous surgery, although it would have more so if your bowel cancer had affected your Sigmund colon or rectum.
How you go about deciding on treatment will depend on your health care system. It's always good to be as informed as possible without overwhelming yourself with technical information. What you simply need to know is the "success" rate for each treatment option, the benefits of each option and their risks.
There is nothing to better, however, the advice of a good doctor who can help you make a decision.
At the end of the day, everyone is different and the choice is a personal one that you will be most comfortable with.
My story is similar to yours, Gleason at biopsy 3 + 4. MRI showed no spread outside the gland. I was advised to have either surgery or external radiation. On considering the pros and cons of both, I elected for surgery and don't regret it.
There is a known tendency for doctors to treat prostate cancer too early or overtreat it. Active surveillance was not recommended for me and I would not have been comfortable with it however. Surgery also resulted in my Gleason being reassessed as 4 + 3 as they were able to look at the whole gland, not just samples from needles. This reaffirmed my choice.
Overall the choice is a balancing act, nothing is absolutely certain, find out what you can, take advice, see what choices are available to you and from all that, do what feels best for you.
Good luck.
Thank you. I've been Dr. Googling, which is something I advise others not to do! It's 3 weeks since the biopsy and 1week since I was told the results. I noticed on the report that the results were available about 4 days after the biopsy, but no word from anyone. I rang the hospital while waiting and she commented, 'no news is good news,' which makes me think that more urgent results are given quickly. Who knows? In the meantime, I'll just wait for the follow up appointment, which she said could be a few weeks. As someone said, 'be patient!' Difficult...
First, I am sorry you are having to go through a second cancer. Me too! I had kidney cancer in 2010, caught at stage 1 fortunately. After a biopsy, I had a similar Gleason 7 3+4. Done by my urologist. I requested "second opinion." I saw a clinical oncologist specializing in prostate ca and a radiation oncologist. The clinical oncologist was most helpful, giving me advice without bias toward surgery or radiation. He said that, if it were he, he would choose surgery because it would get rid of the offending gland and permit postop dissection and a better look at the area surrounding the prostate in surgery (nerve bundles, lymph nodes, seminal vesicles) where the surgeon could see microscopically to determine visually spread of the disease. As a result of the pathology, my cancer was given a 7 4+3, which is more concerning. Still, an 80% chance of cure with a T2C stage. I guess I would in your case do what I did, and seek a second opinion or two. I would think you are a good candidate for surgery or radiation with your Gleason, especially the 4, which is semi-aggressive.
Rang the hospital to ask about the wait for a follow up consultation and was offered a cancellation for next Tuesday! Just as well I asked. Will start my question list now.
Hi, things are probably different here in the UK; I had the same scores and level of cancer as you, and the hospital lost no time in giving me a radical prostatectomy. My surgeon (I can't speak highly enough about him) used the "Rhetzius-sparing" technique during removal --you could read up on that, or I could try to explain -- and although I'm still waiting for the all-clear, I'm absolutely delighted that a bare three weeks after the op life has more or less returned to normal: no residual sickness, strong urine flow, etc. The icing on my cake is that I was completely dry after surgery! Happy to talk to you any time. Barney41
Hi Barney 41. Your post read with considerable interest. I am in UK (Scotland) and currently awaiting the results of my mpMRI/Artemis biopsy (Monday 8th Oct). Can you advise further on the "Rhetzius-sparing" technique that you underwent. Is this current within UK HNS? If not, what private hospital did you attend? Any additional information greatly appreciated.
My PSA level has varied over the past 5 months between 24.7and 26.5. A large lesion was identified on the mpMRI scan, which given my PSA levels, is a pretty good indicator that the news I will get on Monday will not be good!
Your assistance appreciated.
StuartS
Hi Stuart,
I'm desperately trying not to sound like a know-it-all, because I don't know much at all, but I'll tell you what I have learnt!
As regards PSA counts, they're not a hard-and-fast yardstick. Some people with high counts don't have cancer at all, and some with low counts do. So don't give up hope, but take a positive attitude and know that even bad news can be dealt with.
Rhetzius was a medical pioneer two or three centuries ago, and he gave his name to an area behind the pubic bone; it has come to be known as the "Rhetzius cave". Some nerves and arteries that help to control continence and potency pass through this "cave". Some surgeons use the Rhetzius-sparing technique for prostatectomy, which avoid this area and pass the tubes and blades via a different route. The chances of a quicker recovery overall, and particularly with dryness and erections, are thereby much improved.
I had my op done on the NHS, and was referred to the Royal Surrey at Guildford. The team there is headed by Professor Christopher Eden (described by some sources as "one of the finest surgeons in Europe"); he has lectured all over the world on this technique. I didn't get him, but my surgeon was Mr Matthew Perry, a man that I now esteem very highly, who cares deeply about what he does. This team have used the approach I just mentioned for about three years, and their track record is excellent. Something like (I stand to be corrected on my figures!) 90% of their patients are totally dry after three months or so, with a few, an unspecified quantity, completely dry from day one. One of the other advantages is their method of catheterisation; it doesn't take the traditional route through the penis, but goes in through the lower abdomen, just above the pubic bone. I can tell you, it was wonderful not having a pipe pulling at my penis! They say that I stand a good chance (not yet realised!) of getting decent erections back in about two years or so.
I don't know how widespread the use of Rhetzius is, you would have to do some research, but if there's a chance you can get referred to a hospital that uses it, my advice is to take it.
Recovery is also dependent on other factors, such as not being overweight, being fairly fit, having a good nourishing diet and particularly having a positive attitude. Having faith in your surgical team helps a lot with this!
If there's anything else you need to know (my fount of knowledge isn't very deep!) just say. I wish you the absolute best of luck with your results,
Barney41
PS … I think Prof Eden also has a private clinic in Basingstoke.
Thanks for the additional info. I am heading for my post biopsy meeting tomorrow we'll armed with a list of questions which are aimed at ensuring that I leave the meeting with all the necessary info on what decisions I have to make going forward. I have added your RP process to my list of RP options for discussion with cancer nurse tomorrow. I will update the site with details as and when.
A very large single malt to settle me tonight!!!
Hi Stuart,
Missed your post yesterday; if I'd seen it I'd have been having that dram with you! My absolute favourite is a 15-year-old Macallan, or if I feel like a sharper edge, a Bowmore or Laphroaig.
I wish you the best of luck with your results. Don't lose sight of the fact that even what seems to be bad news can be dealt with; modern medical practice, a good team and you being positive can work wonders.
Barney41 (Richard)
Hi Richard
Had to have a stiff one or three malts last night when I got home from my post biopsy meeting. Upshot is as I had feared...., with the following as the main items of the de-brief:
MRI Fusion-Guided Biopsy - Artemis 3D- Ultrasound process.
Findings:
Lesion is 2.5cm lying in the anterior gland mostly on the right but seen to cross the midline - it is bulging on one side.
12 core samples taken:
1 left side – no cancer;
3 right side – no cancer
; Three selected targets chosen from imaging:
Target 1 – 4 samples - 1 cancer;
Target 2 – 1 sample – no cancer;
Target 3 – 3 samples - 3 cancers.
Gleeson Score given as 3+4 =7
; Noted as Grade 2;
Stage Rating T3a;
PSA level now 29.9
.
They are scheduling an additional mpMRI
shortly to check that the bulge noted on the original MRI scan has not penetrated the prostate.
Have been briefed on three treatment options, which will clearly depend on the outcome of the next MRI. 1. Surgery RP utilising RALP (Da Vinci) process; 2. External Beam Radiotherapy (Brachytherapy); and 3. Hormone Therapy. Expecting confirmation letter regarding next MRI later this week, so..., back to waiting again.
I mentioned the process that you undertook, and the cancer nurse had not heard of it, but she will speak with the surgeon this week and get back to me. Not too sure if the NHS will fund an exchange of venues for the operation, but they have in the past sent patients from Ayrshire down to London for treatment, so it has been done before.
Not too down regarding the results..., as given my PSA levels, I was expecting the Gleeson score to be higher..., thankfully not!
I am going to post the main biopsy readings on the HealthUnlocked main site so that others can comment and perhaps offer alternative treatment options.
Regards
Stuart
Hi Stuart,
Your results are fairly similar to mine: you had 4 cancers in 12 cores, I had 5 cancers in 18. My Gleason score was 3+4, the same as yours. The differences seem to centre on the lesion you mentioned (I have no knowledge of that), which may account for your more elevated PSA count (29.9 as against my 12.5). MRI scans on me were inconclusive because the images were so poor (I have two metal hips and a metal knee!).
Your treatment, as you say, will depend on your further scans. If the cancer is contained within the prostate gland you may be best served with a prostatectomy. Not all hospitals use the da Vinci, but the use of the robotic procedure seems to give a much better result, in terms of recovery, than the surgeon working in the "old-fashioned" way; so if that's what's being offered to you then you're in luck. If it's spread, then the other treatments will likely be used. There seems to be a greater chance of less pleasant side-effects if they use the various combinations of radiotherapy, brachytherapy and hormone therapy. And that's about the sum total of my knowledge, so not much of an advisor!
I was under the impression (I could easily be wrong) that under the NHS you had a right to choose the hospital to have treatment in. I didn't know any better, so I went with the place that Basingstoke sent me to… and jolly glad too. You may well find a hospital nearer you if you can get the treatment I had, but if by chance you come to this area, so far from home, I'll do what I can to help.
Certainly your results are not cause to be too downhearted; as I've said earlier, what you and a good team can do these days is so different for your quality of life from even a few short years ago. Keep your pecker up!
Kind regards,
Richard
Hi again,
I just looked up about choosing your hospital with the NHS. What I said about being able to choose is correct in England, but it appears not to be the same in Scotland, though there may be room for negotiation under certain circumstances.
Richard
Hi Richard
Thanks again for your input..., always good to get information from those ahead in the process. I still await a response from the hospital regarding both the RP process you undertook, and whether they can transfer me 'across the border' for the treatment. Appears that I have strayed from the 'straight and narrow' of the normal patient response to being confirmed with PC...; firstly having requested a process that they were unsure of, and secondly, requesting information on selecting an NHS hospital for the treatment external to Scotland. They have gone back to the drawing-board I feel, and advised that they will get back to me. I will give them one week then start rattling cages again.
I am not too despondent about the post biopsy information, as it could have been a lot worse, but I am hoping for an early MRI and bone scan so that I can move forward with the appropriate treatment.
Additional updates as and when.
Best regards
Stuart
The specialist referred me to an Oncology Radiologist, but for a discussion only, not for treatment. I've no idea when that will be or what to ask him at the moment. So I'll be patient if possible. I have to ring the hospital in a week to see if there is any progress. But she said that my case was discussed yesterday by 'the team.' Along with quite a few others I suppose. I am classed as semi urgent. Waiting time here for treatment in that category is about 12 weeks, national guidelines say 4 weeks, but for a chat may be much sooner. We shall see...
I might have written this somewhere else, but ... The rt finished on 1 Feb. and was 60 Gy in 20 fractions. I have no idea if that's a low or high dose in 20 days and it's hard to get information. I saw the specialist mid March and he said nothing much, just come back in three months with a PSA test result. So, he didn't seem concerned about anything. I was able to resume testosterone injections as they treat men with normal levels and my levels are below normal without them. The expected side effects have been and gone. I now am trying not to worry about PSA tests, I'm told it takes about 18 months to drop and the first one might not be that different. Next thing is root canal work next Monday. Such fun!
Just reading over these again. Thanks to everyone! My PSA was 3.1, 4 months post radiation and I'm seeing the consultant again in about 5 hours. That's a drop from 7.4 last July. I keep wondering if it might have increased from that, as there was an 11 month gap until the last test, or about 5 until the rt started. Not much point wondering I guess. I think he'll be pleased with the 3.1 PSA and will tell me to come back in 3 months with another result, hopefully lower still! And so it goes on .... Best wishes to all.
The consultant was ok about the 3.1 PSA and wants it done again after 6 months. I asked about what happens if it goes up then and he told me, but it's too much to remember! Anyway, best to think about that if it does happen. He discharged me as well and we both said we didn't want to see each other again. Nothing personal. So, all good ATM.
I could get the PSA checked every 3 months as I have card which allows multiple tests. My Dr said 3 months but shrugged his shoulders when told the specialist said 6. Also, the specialist said that the reading of 7.4 July '18 might well have been higher just before rt which was Jan this year. Sadly, I'm obsessed with numbers and statistics. I liked the 96.7% chance (I think) of surviving for 5 more years from now. Anyway, 3.1 PSA 4 months after rt is keeping everyone happy, so wait 6 months, or 3 and be positive!
And a bit more. I got the report from the consultation and it was completely wrong, with someone else's medical history. Much worse than mine, including a coronary bypass graft. I have the correct one now and it says annual dre. I'm told by the Cancer Society that means one year after rt (Feb. 2020) not a year after the last one which is Oct. this year. I've also been told on another site, that another dre won't be appropriate. I was also told at the consultation PSA in 6 months, Dr thinks 3 months. Too much conflicting advice. I might just take the advice which suits me, I.e. PSA in 6 months and no more dre's.
Talked to Dr yesterday. PSA in 3 months and no dre. He said there's not much point as it is probably nothing like to the touch as it was before rt. I think he said it will be a shrivelled blob. Maybe that's not what he said. He did say that as the PSA had dropped, it should continue to drop. He mentioned the possibility of a bounce though.
Huh! I queried the dre follow up and heard back from my specialist that yes, I should have an annual dre. From diagnosis, biopsy (which was the last dre in October,) or after rt early Feb? I'll 'sit on it' for a while I think and concentrate on upcoming root canal work. Huh again!
Hello. I am one of these health anxiety people, so I apologise in advance. My biopsy last year showed G7 (3+4) Intermediate Favourable and I had 60 gy in 20 fractions in January. My PSA was 7.4 July '18 and dropped to 3.1 early June this year. My consultant said it could have been higher than 7.4 by the time rt started. I shall have another test in September. My question is whether it will continue to drop from the 3.1 this time. Of course, nobody knows and we are all different etc, but generally, does it usually keep going down with each test from some of your own results? I know it can take up to two years to reach its nadir (?) and I have heard of the 'bounce' thing. I try not to worry and take it as it comes etc, but I have had a scare from bowel cancer. Thankfully I've passed 5 years from that so now have to put up with this new one! Sorry again, I just wondered what to expect. Thanks.
I’m sorry to hear this Toad! But, sounds like you’re a fighter and survivor! #respect! If you’re in the “favorable” category, you probably didn’t have high volume involvement in your core biopsy samples.
I’ve been diagnosed with Gleason 7 and am in the intermediate unfavorable category.
You will probably require bone scan and MRI, to rule out spread (doubtful with favorable).
According to the National Comprehensive Cancer Network guidelines, you would probably be under surveillance, or 6 month PSA checks and (I think) yearly biopsies.
Since I am in “unfavorable,” the guidelines call for two types of radiation (brachytherapy and external beam) or surgery. Hope this helps and I pray the best for you. Keep posting!
I saw the consultant today and he assured me that all was well and don't worry about the .2 drop. Wait 6 months before the next PSA test and a Dre next June. Ok by me! Best wishes to all. John.
My diet was in stages. If I ate what I did today I would fail. My path was to cut out dairy (cheese butter milk) and lower fat. I weighed 185 at the time of diagnosis. I cut out fried foods (French Fries) they were only occasional and red meat (again at the time only occasional. Bread became only whole wheat and I was picky about the sources and added sugar. I scrutinized food labels for prepared foods. Salad Dressing always on the side. Be vigilant on fat and sugar calories! Assume what is on the label may not be what is on the plate on prepared foods. Potatoes are out. Dark colors are in so all the blueberries strawberries and blackberries you can eat. NO JUICING it then becomes sugar. Eliminate dried fruit as we eat too much and get too much sugar. The operating principles are fat sugar and calories feed prostrate cancer. Cut off the food supply! Be positive! My decision was to come out of this “better” than I was before. That attitude and intention has been of vital importance. I’m grateful have shedded some relationships that were not healing and focused on healing. I’ve been open and blessed to find help and angels who are willing to share and help in my journey. “It’s been said goals are for losers systems are for winners” you can find a summary of the thinking by Scott Adams on line (yes the cartoonist) a book on diet by Lugo talks about diet and fasting. This is enough for now. Get the app “My Fitness Pal” it will measure total calories fat and sugar.DON’T Take on too much change ar once. Find support of professionals PLEASE. I’ve come through this and am very grateful. It’s a shock and hard to imagine but trust. Be well.
Unlike a lot of men on this site, I don't receive HT. The cancer, Intermediate Favourable, was treated with 60 Gy in 20 fractions last January. My testosterone levels are low without regular boosts and I have Sustanon injections every three weeks, as they treat people with normal levels now. (?)
My PSA dropped from 7.4 to 3.1 four months after RT then to 2.9 three months later. I was disappointed with the latest small drop but was assured that it was fine. Next test in March. (It could have been higher than 7.4 as there were no further tests for a few months from diagnosis until after RT.)
Is there anyone who had similar RT for G7 (3+4) with normal testosterone levels and results of PSA ltests as the months passed after treatment?
P.S. I worry a lot, unfortunately.
This was copied from another site. Sorry if you've read it before. It seems as if radiation treatment while testosterone is at normal levels is acceptable these days ...
Now I have to decide whether to wait 3 months or 6 between PSA tests. As it has dropped albeit slightly the last two times from 3.1 to 2.7, I'm leaning towards 6 months. Partly because I freak out at every test, partly because Specialist is ok with 6 (Dr prefers 3) and partly because I don't want to leave the house if I don't have to these days. Even though restrictions have been eased recently. So ......... ?
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