Biopsy Question: Suspicious for focal intraductal carcinoma

[LemonPan]

Hello again. I'm posting once again asking for your help. Thank you in advance.

My husband's biopsy report came up in the portal. We haven't spoken to his doctor yet.

May I ask for your help understanding one part? The line " Suspicious for focal intraductal carcinoma".

I've done a google search and I don't understand what it means. It sounds very bad. Are there any therapies for this?

It was a targeted biopsy. 12 samples were taken. The remaining 10 are benign tissue and one is showing PIN.

Here's the section from the report that shows cancer.

Prostate, MRI target left posterior base; biopsy:

Adenocarcinoma:

Prostatic Adenocarcinoma

Prostate Cancer Grading:

Primary Gleason grade: 4

Secondary Gleason grade: 3

Total Gleason score: 7

Grade Group: 3

Tumor Quantifications:

The total number of cores identified is 3

The total number of cores with carcinoma is 1

The specimen is fragmented

The percentage of tissue with carcinoma is 12%

The linear amount of tissue with carcinoma is 2.5 mm

The percentage of Gleason grade 4 and/or 5 is 60 %

High Risk Lesions:

Suspicious for focal intraductal carcinoma

Again, thank you. I read all about Gleason scoring. So I thought I was prepared. Now I'm totally overwhelmed.

[Tall_Allen]

When intraductal prostate cancer (IDC-P) is identified along with Gleason pattern 4 or 5 , it indicates a higher risk. But this was only a focal (microscopic) amount, not enough to be definitive. You may wish to still treat this as "unfavorable intermediate risk," or you may treat it as "high risk." A Decipher genomic test may help you decide which.

If high risk, you should discuss radiation dose intensification, and longer adjuvant ADT with his radiation oncologist.

[LemonPan in reply to Tall_Allen]

Thank you. Thank you. Thank you.

I knew that I didn't understand the google results I was seeing. It didn't help the first one I hit on mentioned something like a 29% survival rate at five years.

[rscic in reply to LemonPan]

Always remember any survival numbers are from patients who do not have all the treatment options which are available today.

Also remember it can take a year from when a scientific paper is submitted for publication to the time it is actually published.

Lastly, median survival (50% live longer than this number & 50% live less long than this number) might be a better general number to know than "average" (aka "mean").

Just some thoughts.

[LemonPan in reply to Tall_Allen]

Oh. Another question. I've read again and again that we don't need to rush to make a treatment decision. His follow-up is scheduled in three weeks.

With Gleason 7 (4+3) is it okay to wait that long? Or should I push to have that moved up?

Sorry to pepper you with these questions. I will be reading more in the coming days/weeks.

[Tall_Allen in reply to LemonPan]

Yes, you can certainly take your time and meet with specialists. Several months is no problem:

prostatecancer.news/2016/08...

[LemonPan in reply to Tall_Allen]

Great. Thank you for the reassurance.

[LemonPan in reply to Tall_Allen]

Question for you Tall_Allen.

We are at MSK. I'm looking at doctors now. Dr. Zelefsky seems impressive. I'm not really sure who else to look at for the next steps. If you have any insight, I welcome it.

Thank you.

[Tall_Allen in reply to LemonPan]

Zelefsky is the best.

[LemonPan in reply to Tall_Allen]

Thank you! I'll call his office now.

[j-o-h-n in reply to LemonPan]

I'm a MSK'er and Dr Z. who was (is) in charge of the rad. dept was the one who did my toasting many years ago. Equip. in those days were not what they are today. Dr. Z knows his stuff and you can see him on some videos....

youtube.com/watch?v=qLgXTJ7...(Not working as expected?)

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 04/15/2021 1:23 PM DST

[aceace12]

always get second and third opinion on any procedures .....

good luck

[LemonPan in reply to aceace12]

That's our plan. Thank you!

[Hidden]

Hit it hard. Either remove the prostate or use the strong radiation. I tried Tulsa-Pro on my 4+3 with a core involving intraductal and it knocked it back for awhile but came back.

[LemonPan in reply to Hidden]

I really appreciate this. We will talk to both the urologist and the RO. It's too soon to say but we are leaning toward radiation. (Too soon to say because we only lightly read about it prior to the biopsy)