Biopsy Results. Next steps and Opinions.

[Fabio_08]

Hi,

For those who aren't across my journey, I recently had an MRI and was graded as a PI-RAD 5.

After various consultations and discussions, I've now had a biopsy and my results are outlined below.

My specialist seemed fairly optimistic with my results, however I am keen to get the views of the regulars in this group, as well as a run down of what questions I should be asking.

Thanks!

CLINICAL NOTES:

Prostate biopsies.

MACROSCOPIC:

1. 'Right mid anterior'. The specimen consists of three cores of cream tissue measuring between 15mm and 18mm in

length. All embedded. (1 block)

2. 'Right mid mid'. The specimen consists of four cores of cream tissue measuring between 9mm and 20mm in length.

All embedded. (1 block)

3. 'Right mid posterior'. The specimen consists of four cores of cream tissue measuring between 10mm and 21mm in

length. All embedded. (1 block)

4. 'Right base anterior'. The specimen consists of four cores of cream tissue measuring between 9mm and 17mm in

length. All embedded. (1 block)

5. 'Right base mid'. The specimen consists of four cores of cream tissue measuring between 7mm and 16mm in

length. All embedded. (1 block)

6. 'Right base posterior'. The specimen consists of three cores of cream tissue measuring between 5mm and 12mm in

length. All embedded. (1 block). Purple. MXZ L3-17 1-141

MICROSCOPIC:

1. 'Right mid anterior'. Sections show adenocarcinoma, Grade Group 1 (Gleason Score 3+3=6) present in one of the 3

cores and involving 10% of the core

2. 'Right mid mid'. Sections show adenocarcinoma, Grade Group 2 (Gleason Score 3+4=7), with the percentage of high

grade (pattern 4) being 5%, present in one of the 4 cores and involving 70% of the longest core. Pattern 4 has poorly

formed gland architecture

3. 'Right mid posterior'. Sections show prostatic tissue in which there is no atypia or malignancy.

4. 'Right base anterior'. Sections show adenocarcinoma, Grade Group 1 (Gleason Score 3+3=6) present in 2 of the 4

cores and involving 90% of the longest core and 10% of one of the shorter cores

5. 'Right base mid'. Sections show adenocarcinoma, Grade Group 1 (Gleason Score 3+3=6) present in 2 of the 4 cores

and involving 65% and 80% of 2 of the longer cores in a discontinuous manner

6. 'Right base posterior'. Sections show adenocarcinoma, Grade Group 2 (Gleason Score 3+4=7), with the percentage

of high grade (pattern 4) being 10%, present in one of the 3 cores and involving 5% of one of the longer cores pattern

4 has fused gland architecture

SYNOPTIC REPORT FOR PROSTATE BIOPSIES

Tumour Type: Adenocarcinoma, acinar

Grade Group (2014) (Highest Core): 2

Gleason Score (ISUP 2014): 3+4 = 7

Primary pattern: 3

Secondary pattern: 4

Tertiary pattern: -

% High Grade 4/5: 5-10%

Cribriform Architecture: Absent

Location: Right base posterior plus right mid mid

Location Other Involved Sites: Right mid anterior plus right base anterior and mid

Composite Gleason Score (ISUP 2014): 3+4 = 7

% High Grade 4/5: 5%

Intraduct carcinoma: Absent

Number of cores involved: 7

Total number of cores: 22

Perineural invasion: Absent

Vascular infiltration: Absent

Extra prostatic extension: Absent

DIAGNOSIS:

PROSTATE BIOPSIES - ADENOCARCINOMA

- GRADE GROUP 2

[Tall_Allen]

Good report! You are classified in NCCN risk group called "favorable intermediate risk." That means that any of the following are good choices for you:

• active surveillance

• SBRT

• High dose rate brachytherapy (monotherapy)

• Low dose rate brachytherapy (monotherapy)

• Surgery

None require any adjuvant therapy, meaning no hormone therapy or extra radiation.

There are other therapies, like protons, IMRT, HIFU. FLA, cryo, PDT, etc. which are inferior to those above.

You have plenty of time to decide, and a strongly suggest you take your time - a year if you want it. Meanwhile decide not to decide while you collect info and meet with doctors. The first inclination we all go through is "just cut it out." That is certainly the wrong thing to do right now and that feeling will pass over time. I'm not saying that surgery is a bad choice, but it is a bad choice today.

Here's a good general background publication:

nccn.org/patients/guideline...

All options have over a 90% chance of permanently curing you, but you don't have to be cured - your type of prostate cancer is a disease you can just actively monitor for a very long time. Because of the success of Active Surveillance over the last 30 years, many institutions are allowing patients who have small amounts of pattern 4, as you do.

There was one trial that randomized patients to active monitoring (without f/u biopsies), nerve-sparing prostatectomy, or a now outmoded kind of external beam radiation. After 10 years, the results were the same, although the side effects were different. You can read about them here:

prostatecancer.news/2020/02...

You have to meet with specialists in each therapy to find out about it. There are questions to ask at the end of this article. They may help you pick a doctor, but mostly they will educate you:

prostatecancer.news/2017/12...

I'm probably overloading you. Feel free to ask questions.

[rosenjpj in reply to Tall_Allen]

Tall Allen's feedback is always on target. While hearing that you have cancer is very disturbing you have plenty of good options and time to decide. Don't rush and do your homework. Also, if feasible, seek out the world class Cancer Centers that specialize in prostate cancer. They have better docs and much more expertise and resources than most local choices. Keep us posted and ask questions here. This is a very supportive and knowledgeable group.