pathologist report says A core 3+3=6 ,<5% same on F core , G core showed atypical acinar proliferation suspicious carcinoma ..(.ASAP ) all other's negative ...of 12 core biopsy.... so i requested second opinion on report,,,, second report showed A core ASAP ... F core 3+3=6 , <5 % G core 3+3=6 <5 .... confusing ... i am trying to determine correct diagnosis ... doctor says active surveillance.. any thoughts...
second opinion biopsy different than ... - Prostate Cancer N...
second opinion biopsy different than first ...
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aceace12
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AlanMeyerModerator
I'm not an expert but this sounds to me like a case for active surveillance - two or three cores with less than 5% cancer and all of the cancer found was Gleason 6. I agree that the different evaluations of the "A" and "G" cores is surprising and a little disturbing, but they're both still talking about Gleason 6 and less than 5% cancer (which can mean anywhere from 1-4% and that's damned little.
You didn't say what your PSA was. I presume that it's elevated and that was the reason for the biopsy. You also haven't mentioned your age. If you're 50 the report is more concerning than if you're 80, but even at 50 there is a decent chance that you could live another 30 or 40 years without ever experiencing any symptoms of cancer.
Here's a web page on "Prostate Cancer Risk Factors" on WebMD, a pretty good source for medical info I think: webmd.com/prostate-cancer/g...
Here's the first paragraph:
"All men are at risk for developing prostate cancer. About 1 man in 9 will be diagnosed with prostate cancer during his lifetime, but only 1 man in 39 will die of this disease. About 80 percent of men who reach age 80 have prostate cancer cells in their prostate. Besides being male, there are other factors, such as age, race, and family history that may contribute to the risk."
So, unless your PSA is very high, or you have other indicators of more serious cancer, I think your doctor is right and the best thing to do is just active surveillance. The alternatives of surgery and radiation are life changing in ways that you won't like and which, once done, can't be undone. If you need treatment, you should get it. If you can get by without treatment, it's better to get by without it.
BUT! don't neglect the "active" part of active surveillance. Get regular PSA tests and if the PSA goes steadily up, get another biopsy and, if possible, be sure you get it done by someone who is good at it and uses the latest mpmri and ultrasound (or whatever is the best in the future) techniques.
Best of luck.
Alan
thanks for helping me out , sorry for not enough info ...i am 59... PSA has been erratic .. 3.0 then. 3.5 then 3.8 jumped to 4.7 then went back to 3.8 .. this is over a 3 year period ..i have had BPH for about 3 years .... prostititus about once a year ... usually go thru cipro for about 2 weeks once a year ...doc did needle biopsy when it went to 4.7
Incidentally, according to what I've read, the majority of prostate inflammations (prostatatis) are not actually caused by bacterial infections. They may be viral infections, they may be caused by mineral deposits, or they may fall into the category of "unknown cause". The term "prostatitis" just means an irritated or inflamed prostate. So even if the Cipro doesn't bring your PSA down, that's not proof of a cancer problem and may mean that the Cipro isn't doing you any good and you should stop taking it.
Received wisdom says that PSA < 10 indicates "low risk". It's yet another indication that you're a good candidate for active surveillance.
Alan
• in reply toaceace12
Don't get caught up with PSA numbers alone. They are not too bad. My PSA has been all over the place as well in the past 3 years. With that low involvement, you'd probably be offered AS unless you have some other risk factors such as African American, family history, etc.
They both tell you the same thing. You sound like a good candidate for active surveillance.
ok thank you
Wait a few months for the damage from the biopsy to repair, get a 3T MRI, solve the mystery. You may not have a problem at all, a 3T will confirm it.
thanks
great advice i will do this i believe , My Uro did mention MRI as next procedure after next PSA check in 10 weeks.if PSA is high But I think i will tell him do it regardless of PSA result .as you know very hard to deal with mentally...
I think the 2 reports are similar. If you’re concerned about the G core atypical vs. <5%, I had a similar situation. You can have your slides sent to Johns Hopkins for $250 for piece of mind. I also think an the 3T MRI should be recommended to give you more data to see if your a good AS candidate. Ask your Uro.
great advice seems 3T MRI is way to help diagnosis...i will pull up john hopkins on internet in regards how to do that
• in reply toaceace12
Ask your urology staff that you want your slide sense to Johns Hopkins just for a second opinion just for your peace of mind and then that it will make you sleep better. They won’t have a problem with that and they probably do it all the time. My urology office Had no problem with my request.
aceace12• in reply to
Do I need to request the physician name who’s doing the biopsy at John Hopkins and how do I pay ??
• in reply toaceace12
No. Just tell your urologist if they can send the samples to Johns Hopkins. They should know how to do that. Then their results go back to your Uro. And he/she shares with you. Then JH bills you. Out of curiosity, do you live in a big metro area?
aceace12• in reply to
Ok does the web site give price . Or you know it a 250 ,, and I am assuming that probably they don’t file Ins claims
aceace12• in reply to
memphis tn
aceace12• in reply to
just sent doc office to send to John Hopkins , this will be for 3rd opinion .
Keep in mind a 3T Multiparametric MRI will definitely help, but it is not definitive. I had 2 negative ones while having 3+4 gleason PCa.
3T MRI's for prostate cancer are operator dependent, not everyone can do them. Need to find one who has done a lot of them successfully.
Should my doctor know who has the 3t MRI machines in my area
Your doctor probably has a go to organization for MRIs. You might want to look in your area for the best MRIs.
There may not be any that can do a clear prostate MRI. Some urologists can do fusion biopsies, which require good MRI data. Where are you?
I went to Dr. Joe Busch, Chattanooga, TN., I live in south Florida. He does 3T MRI's with in-bore biopsies. He hit my very small G5 part of my small G 4+5, he's good.
This site won't let me do more than 2 lines. Joe Busch, 423-622-4700. Jeannie Holder will answer and schedule. You need a script from your doc.
Busch will also give second opinions on your MRI's.
Atlanta,
" Emory Hospital Radiation Department in Atlanta was excellent. Dr. Sharif Noor did the procedures. They do a 3T MRI with contrast one day and read the results. If nothing large enough to show up with contrast is found, they cancel the biopsy"
Are you saying you had two negative MRI ‘s but you had Gleason score 7 on needle biopsy
Yes. And a 7 on pathology after RP. The MRI operators were part of a prestigious program known for their abilities. This is common occurrence.
• in reply toaceace12
I think this is possible unfortunately. My first MRI showed 2 lesions and I'm actually waiting for results from by second MRI taken last Friday.
aceace12• in reply to
Is this the 3 t MRI ??
• in reply toaceace12
In both cases, yes the 3T. I’m in Atlanta and go to the Emory healthcare system.
aceace12• in reply to
are the lesions consider tumors ?
• in reply toaceace12
Yes as I understand it. MRI results have its own numeric scoring system from Pi-Rad 1 to 5. 5 being worst.
• in reply to
Followup MRI showed no focal abnormalities consistent with PI-RADS 3, 4, or 5 lesion. No evidence for extraprostatic disease, pelvic lymphadenopathy, or enhancing bone lesions. My surgical uro said good news and that previous lesions a bit more insignificant. Plan is to do quarterly PSA checks and repeat MRI in 12 months. I see my regular uro in March and I'm sure will be in agreement. I wouldn't have been due for a repeat bx until next year so we'll see. Moving right along.
aceace12• in reply to
wow great news for you ... glad to hear it !!!!!!
DarrylPartner
Here ya go healthunlocked.com/active-s...
In my opinion, based on research, a Gleason 3+3(6) is not an aggressive form, and suggests active surveillance: a biopsy once a year.
• in reply toJeff85705
AS protocol is actually becoming more flexible even in the past 2 years. In my case since my 2017 biopsy, I have a PSA every 3 months, an 3T MRI in 2017, a confirmation biopsy in 2018, and an repeat 3T MRI just this month. If the data is ok, biopsies going forward are being stretched out every 2 years.
did 3TMRI confirm original diagnosis ?
• in reply toaceace12
The MRI done 4 months after biopsy dx indicated 2 lesions. My urologists though it would be a good idea to get the MRI done to see if I was a good candidate for AS and not just look at the biopsy alone and it was decided I’d be a good candidate.
ok, thanks, im really confused as to why if we all are on active AS why it seems that everyone getting checked seems to be getting worse in regards to their plan of action . unless im reading wrong . My doctor told me it make take 30 years to even grow 1cm and i would probably die from something else.
thanks geat info....
i knew what you meant .. thanks
I didn't know about direct access to JH, but I had my urologist's office do the transfer. Good to know down the road. JH actually downgraded a few of my core involvements on my second biopsy. My wife has been a vegetarian for 18 years and me a 50/50 vegetarian, so it wasn't that hard to go 100% once I learned more about plant based protein which I was already eating. For what it's worth, the urology surgeon I've consulted with who is the chairman of Urology at Emory University in Atlanta said I should limit meat to no more than 2 times a week. Anyway, he and my regular medical urologist have both been adamant against surgery since the beginning and at present, so I'm lucky I think about avoiding surgeons wanting to push surgery but it certainly happens.
aceace12...I have heard from many sources how good Dr.Busch in Chattanooga is for MRIs and 2nd opinions. Im currently waiting for a 2nd op of my Dec 2018 T3Mri by the Natl Cancer Inst which is free fyi....Dr.Peter Choyke...depending on what it shows and my meeting with my Urol to discuss where i am i will probably either go see Busch or send him the same MRI for a 3r opinion. The kind of change my MRI showed vs the prior 3 makes me somewhat suspicious and before i decide to start any treatment, even if my Urol recommends it, I'm going to be absolutely sure the last one is accurate. That said everyone in the Prostate Cancer field i have ever seen recommends Johns Hopkins as the best place for a biopsy 2nd opinion. The $250 charge is covered by Medicare ...not sure about private insurers and you can call them directly to arrange if you prefer. Finally, like you i have been confused by many of the terms more experienced PC patients use. The book ..The Key to Prostate Cancer by Dr.Mark Scholz helped me a ton to feel more knowledgeable about all aspects of PC...i know it is about $15 but it was well worth it for me to use as a reference book going forward. I got mine on Amazon. Good luck to you . It is beyond scary to be at the beginning of the PC journey....almost as scary as being at the point where you have to decide on whether to start treatment or not and if so what kind is the best fit for you. You have a real advantage of discovering a valuable site like this one early in your journey. There are some other good ones as well. Good luck.
Thanks
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