Any advice after biopsy?

[Firefly54]

Hi guys. I've been following this community for a little while now and always admired the knowledgeable responses to questions. I've finally reached the point of having PC diagnosed. Will speak to my urologist (surgeon) in a few weeks and also plan to speak with a radiation oncologist. Any advice on what I should ask, and what direction I should be thinking of.

I'm a Gleason 3+4=7, grade group 2. 5% high grade (pattern 4) being 5%. The carcinoma

involves 10%, 10%, 15% and 30% of all cores. There's no cribriform architecture, or apparently any perineural, vascular or extra prostatic infiltration or extension.

I'm not certain if I've got all the info needed, but it's a beginning. I'm living in country Australia.

Thanks

[Tall_Allen]

That's called "favorable intermediate risk" prostate cancer, which means that all radical therapies have about a 90+% chance of curing you. I suggest you talk to specialists in each of the following: surgery, SBRT, and brachytherapy monotherapy. You have plenty of time to interview doctors. This article hass a list of questions at the end that you may want to use:

prostatecancer.news/2017/12...

[Firefly54 in reply to Tall_Allen]

Thanks, much appreciated.

[thierry]

Hi , What do you mean by 2,5 % High grade = 5 % ? If I understand well you have several cores of GS3 and one with very little GS4 ? Yes you are favorable Intermediate risk . As you were , I was diagnosed GS 7 last Feb. : two cores , one 3mm GS3 and one 4 mm GS 3+4 ( 10% of 4 in that core ) I had the choice between IMRT and surgery . I chose IMRT , 38 sessions of 2 Gy each plus short ADT , two Lupron 11,25 mg each three months . Treatment ended . I feel OK , manageable side effects ( I am 68 yo with no co-morbidities ) . I could also have chosen RP , but my diagnosis was so unexpected and rapid , that I was quite shocked at that time and unprepared for RP . Now , 9 months later , I would have gone for RP . Best regards

[Tire2222 in reply to thierry]

Just curious why you would now choose RP? Thanks

[thierry in reply to Tire2222]

Hi , Because I found my treatment too long , because I have doubt about reversibility of ADT ( my T remains near 0 ) ans so a robotic surgery well done with minimal incisions , three days plus a Week difficult , and progressively going better , could have been easier With RT and ADT , it is a bit tricky . Regards

[Tire2222 in reply to thierry]

Thanks very much.

[Firefly54 in reply to thierry]

Thanks Thierry. Not completely certain what "Grade Group" is, but it looks like GS 6 is Grade Group 1, GS 7 is Grade Group 2. What the biopsy showed that is one quadrant has GS 6 in 30% and 20% of two cores; another had GS 7), with pattern 4 being 5%; the third had GS 7, again with pattern 4 being 5%. The carcinoma involves 10%, 10%, 15% and 30% of all cores. Same again for the 4th quadrant, except it only involved 10% of one core.

I'm interested in why you would now go for RP. I also have no morbidities and am almost 66. Were there downsides to the IMRT?

[Firefly54 in reply to Firefly54]

Sorry for not reading your actual reply to the same question. Is ADT always done with IMRT? How did you find it. I do take your point about something done in a few days and recovered from in weeks.

[thierry in reply to Firefly54]

Hello , yes I am French , 68 y.o . with absolutely no comorbidities . We are both Group 2 , intermediate risk , and no matter wether it's low or high . The pathology report sometimes give some more info about the cells GS4 , are they really poorly differentiated , are they cribriform or not ? cribriform meaning agressive tumor . I had the choice between the two thérapies . IMO RP would not have been worse than RT in the sense that you can improve your situation quickly after OP , contrary to the choice I made which is too long to getting better . Take your time , read the biopsy report again and again and stay in good shape and you will make your decision . Once again I am not happy with IMRT 76 Gy and six months ADT I just ended now . Best regards

[EaNa]

Hi. I'm kind of in the same situation as you except my Gleason is 4+3 (intermediate unfavorable). I had my biopsy a month ago, still trying to decide which path to take. It's not an easy decision, but you have some time. I've tried to analyze this from the math side, looking at statistics and trying to figure out which approach gave the best shot at longevity and backup scenarios (those were my priorities, you have to decide your own). A good place to start is obtaining your nomogram or Partin table or whatever the equivalent is in your country. Ask your Urologist to explain what the different figures mean. You're going to hear a lot that your decision should be based on whatever you feel most comfortable with (or least frightened by) according to the possible side effects. I made a list of the risks and side effects for each option and let it sink in for a while. I keep adding to the list as I think of more things or from research. I think eventually one will weigh more than the other and the answer will be clearer.

[Avanti123 in reply to EaNa]

Hello EaNa. I just got back from the hospital where I was given a very similar diagnosis to yours, Gleeson score of 7 (4+3), stage 1. Apparently the cancer is contained which is the main thing I wanted to hear. Now got the same happy choice as you: Radiotherapy or surgical removal of the prostate. I'm erring on the side of the Brachytherapy but I haven't had much time to think about it yet. Which way are you leaning at present and what is your reasoning? Best regards, Allan.

[EaNa in reply to Avanti123]

Hi Allan. Thanks for sharing. I've been studying this for about 2 mo. and there is no clear answer, both options seem equally good for you and I, but the side effects and logistics couldn't be more different. Besides the regular staging circumstances that may be similar between cases, you can't ignore the subtle personal differences, preferences and even hunches that in the end are just as important as all the facts and figures you encounter in your research.

Prostatectomy has all the possible risks and side effects of surgery and on top of that, because of where the G4+3 is located I'm facing the very possible loss of natural erection. Fortunately, I have a very supportive wife so this is less of a factor than it might otherwise be.

I like the idea of having results right away, which is only possible with RP. I don't like the idea of dragging initial treatment for months as it would be with RT. In addition, I see higher risk of coming down with Covid-19 by having to make multiple visits to the hospital than it would be for surgery. Because I have some pulmonary scarring from asbestos, coming down with Covid right in the middle of a 6 month treatment might be worse than the cure. The RO said that interrupting RT is not a good idea.

Initially, RT looked more attractive because it seemed like the least invasive, but I was later convinced by my Oncologist that in order to maximize RT efficacy he recommended a combination of hormones, EBRT, AND Brachytherapy, so keeping it "noninvasive" would only be a matter of degree. For some reason that I can't logically explain, I am less worried about a RARP than I would be over an operation for Brachytherapy. I have nothing to base that on except a hunch.

I have some urinary retention symptoms and was warned by my urologist that radiation would only make it worse and I instinctively believe that even though the RO said that wouldn't necessarily be the case.

I also have inflammatory bowel symptoms and fear that radiation might worsen that as well even tough the RO said that would not necessarily be the case. Again, going on a hunch.

I also think, possibly incorrectly, that salvage options after RP are safer than for RT. I might get some flack from others over this statement, but I don't think anyone can guarantee their argument one way or another, so again, in the end hunches are important.

I also have a small umbilical hernia that has been bothering me for years and the surgeon said he could repair that as part of the operation (small consolation price).

Probably the most important reason: I don't want to take the chance of having to do surgery or any other type of treatment after radiation (if necessary), whereas I think radiation after surgery would be less problematic, or going on hormones as a third option if everything else fails. Again, do the research and make your own determination.

Even then, I'm convinced that results 10 years after either option is about the same, that is what EVERY EXPERT I've discussed this with has told me.