Biopsy Results -- Treatment time

[Hope4Happiness]

After being diagnosed with Gleason 6 PCa in August 2017 and being on AS for about four years, my latest biopsy at MSKCC, unfortunately, showed Gleason 7 (3+4).

This four-core biopsy was targeted at a specific transition zone because an MRI showed a PIRADS-3 lesion. Here are the results:

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DIAGNOSIS:

1. Prostate, right tzone MRI lesion (4 cores):

Adenocarcinoma:

Prostatic Adenocarcinoma

Prostate Cancer Grading:

Primary Gleason grade: 3

Secondary Gleason grade: 4

Total Gleason score: 7

Grade Group: 2

Tumor Quantifications:

The total number of cores identified is 4

The total number of cores with carcinoma is 4

The percentage of tissue with carcinoma is 40%

The linear amount of tissue with carcinoma is 20 mm

The percentage of Gleason grade 4 is 10 %

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I'm thinking it's good that the Gleason 4 part is rather low (10%), but that 20mm amount of tissue with cancer is a bit much.

I was thinking about having these slides sent to Epstein, but the previous two times I did this, the results from Epstein matched what was stated by MSKCC exactly. I'm guessing I should just trust MSKCC at this point.

I would surely appreciate any comments or perspectives on all this. I think my curative options are pretty wide -- surgery or some type of radiation should do the trick here.

Thanks!

[Tall_Allen]

AS for 10% pattern 4 is still possible. Decipher?

[Hope4Happiness in reply to Tall_Allen]

Thanks for the reply, Tall_Allen ! I'm scheduled to speak with Dr. Ehdaie on Thursday. I'll ask him about the Decipher test. Dr. Ehdaie has been my AS doc for the past four years.

About three years ago, I met with Dr. Michael Zelefsky to discuss MSKCC's version of SBRT. I'll be considering that option for treatment. How do you think "MSK Precise" -- their form of hypofractionated radiation therapy -- measures up against SBRT at other health facilities?

[Tall_Allen in reply to Hope4Happiness]

It's the same - they are just branding it for marketing.

[Hope4Happiness in reply to Tall_Allen]

My Decipher test score just came in this week: .22

[Tall_Allen in reply to Hope4Happiness]

With a score that low, I think Dr. Ehdaie will give you the option of sticking with AS.

[Hope4Happiness]

Update, 8/21 -- Well, after much research, discussions with both surgeons and radiation oncologists, and discussions with my wife, I have decided to proceed with MSK Precise (SBRT) as a treatment for my G7 prostate cancer. Treatment will start in October 2021.

It took a lot of thinking, but after considering effectiveness rates, side effects, and quality of life, I believe this course of treatment is the best for me.

I'd like to thank all the folks on this message who contacted me and offered information via replies and messages.

I plan to keep a journal of my journey as I hope the info gleaned might help future patients.

Thanks!