I was diagnosed with PCa in October with G6 in 5 of 12 cores. Prolaris molecular score was 4.3 which is more aggressive than patients in the same risk category (low/very low risk). I had a follow-up MRI in November but it was inconclusive with a single PIRAD 3 lesion.
After doing a lot of research and getting great advise here (especially from Tall Allen), I decided to go with Memorial Sloan Kettering and Dr. Behfar Ehdaie. I have also been following a plant-based, whole foods diet since my diagnosis and my last PSA in January 2021 was 3.6 ( down from 5.5 in in March 2020).
I had my follow-up biopsy on 5/26 at MSK. The experience was night and day compared with the first one done by my local uro doc. MSK is a world class institution and you can tell the moment you walk in the door. I can't say enough about the professionalism and compassion of the entire staff. Based on everything I read here and elsewhere, I had a transperineal biopsy instead of transrectal procedure to minimize the risk of sepsis. Also, unlike the first time, I had general anesthesia for this procedure which made it sooo much easier. Recovered quickly from typical symptoms (blood in urine and semen).
RESULTS: Systematic biopsy of 10 cores. 7 were benign. Two were G6 (6% and 45% with carcinoma) and one was G7 (3+4). The core with 3+4 was 50% with carcinoma of which 2% was G4+. Based on the G7, my NCCN risk changed from low/very low to Intermediate/favorable risk. The doctor ordered another Prolaris report to see how aggressive my cancer is compared with the norm for intermediate/favorable risk. I will visit with Dr. Ehdaie on July 2 to discuss his thoughts moving forward. I also asked for a second opinion from Jonathan Epstein at Hopkins on the pathology report. Hopefully we will have the Prolaris and Epstein report by the time I meet with Dr. Ehdaie.
The Doctor's initial assessment is that I can stay on AS since 1) the G3+4 was present in only one core; 2) the percent with g4+ in that core was low; 3) the other two cores with carcinoma were G6; and 4) 7 of 10 cores were benign.
I look forward to continuing on this path assuming there are no negative consequences from the Prolaris or Epstein reports.