Newly Diagnosed Prostate Cancer

[STY1953]

Thank you in advance for your inputs.

- Most recent PSA was 7.82 (Sep 2021)(rose from 3.0 over last 2 yrs)

- TRUS Biopsy results from Sep 2021:

- 12 cores (6 right/6 left)

- 6 on left and 4 on right were all benign

- 1 core on right base had 20% involvement 4.3mm 3+4 GL

- 1 core on right mid had 20% involvement 3.0mm 3+3 GL

- No perineural invasion/No tumor in the extraprostatic adispose tissue

- Stage T1c

I am in excellent health and had no symptoms leading up to diagnosis. I live in the Houston Texas area and my urologist is part of Texas Oncology. I did not have an MRI prior to biopsy. Urologist recommended that my next step is to talk to their Radiology Oncologist to get her inputs. I meet with her on Monday.

Thanks again for your inputs.

[Tall_Allen]

Your first step should be to have your biopsy slides sent to Epstein's lab at Johns Hopkins for a second opinion. His opinion is the gold standard:

pathology.jhu.edu/patient-c...

He will tell you:

(1) if the GS 3+4 is correct

(2) and if so, the percent that is pattern 4

If it is a very low percent pattern 4, you may still be a good candidate for active surveillance.

It is very important that you make no treatment decisions for at least 3 months. Your type of PCa is very slow growing, so there is no rush.

You may find this to be helpful:

nccn.org/patients/guideline...

After you get Epstein's report, let's discuss further.

[STY1953 in reply to Tall_Allen]

Thank you very much Tall. I will do that. My urologist also reiterated that I shouldn’t be in a hurry to make a decision.

[Justfor_]

You started on the wrong foot IMO. MP MRI is the starting point since some years now.

[STY1953 in reply to Justfor_]

Thank you for your input. Given where I’m at, would getting an MP MRI be of value to help me decide on a course of action? Or is it mainly a pre-biopsy tool?

[Justfor_ in reply to STY1953]

You will have to wait a couple of months post biopsy because the latter has created hemorages within the gland which will create MRI imaging artifacts. Current beliefs have MP MRI providing a higher lesion detection rate compared to the random sampling of a 12 core blind biopsy. In case the MP MRI detects something more/different than what you already are aware of you will have to have a new guided biopsy. Biopsies have a small but not insignificant chance of going wrong, so they are not something to be taken lightly.

My biopsy comprised 20 cores sampled, 8 left, 9 right and 3 on suspecious areas. 2/8+2/9+2/3 for a total of 6 were found involved. Just an example on the occurance score with prior knowledge regarding where to search for.

[STY1953 in reply to Justfor_]

Great inputs. Thanks.

[leach234]

I’d have surgery over radiation!

[maley2711]

If you would like to feel more confident that your biopsy result reflects the worst of the cancer in your prostate, you might ask for an MRI......which might /might not find a more concerning area not sampled in your 1st biopsy. I did an extensive study of studies, and found that , for men for which an MRI reveals an area of concern, 25% additional significant cancer cases are found. For instance, if an MRI reveals an area of concern , biopsy of that area only might find a Gleason 4+4 area, and that would BIGLY impact the advice you would receive. Nothing is more important than the most accurate diagnosis !!!!

[1Ubspaine]

First, you are fortunate to be in a major healthcare market which equates to better care.I am impressed that your urologists has immediately referred you to a RO.

In my case, earlier this year deciding between surgery and radiation was a real mind game for me. Not easy as I feel in the “either is fine” zone as I expect you might also(or best case, surveillance as TA suggests).

I waited two months and had an MRI, then proceeded with treatment.

Sounds as if your early diagnosis will give you a number of choices which is positive.

[CarverD]

Your case is almost identical to mine (GL 6 (3+3), GL 7(3+4) 20%, GL? found with MRI after TRUS). After 9 months of research and appointments with 5 doctors I opted to have my case transferred to a top teaching hospital 3 hours from home. I had HDR-BT mono therapy completed 1 year ago. I am very happy with the outcome and have relatively no issues and none that affect QOL. Take your time and research the various treatments. Have Dr. Epstein's lab re-evaluate your slides. Choose the path you feel you can live with if the worst case occurs (for me that put surgery at the bottom of the list). If your 7(3+4) holds up as accurate you will have just about every treatment available to choose from - all treatments, including AS, have potential side effects, some worse than others.

If you would like to chat more or have questions that I can answer feel free to reach out directly.

Regards. - doug

[HopingForTheBest1]

When it comes to biopsies all Urologists should be recommending the use of the MRI Fusion Guided procedure. It is much more targeted and accurate.

[dadzone43]

Enjoy the varied input from others. Remember, though: it is ALL opinion. Nothing more. I admire your urologist's advice. Take your time. Get informed. Gather as much _fact_ as you can. Then decide.

[Cooolone]

TA "NAILS" it...

Take his advice and understand this is the most helpful!

Accurate "DIAGNOSIS" is the first and most important step in this game.

DO NOT concern yourself with what comes next, until you get there, meaning until you have your 2nd opinion. Possibly additional testing or whatnot, maybe a 2nd opinion via Oncologist's at a Major Cancer Center and one of Excellence...

DO NOT fall into the mistake of thinking what might be the best treatment, or trying to fit a shoe to the foot! The foot must be fitted to the correct shoe. Too many times newly diagnosed patients make the mistake of using a hammer when a feather may be due, or vice/versa! And it happens because they read this or that about a treatment. Worst is hearing the word "cancer" and wanting to do something, anything, to get rid of it and making a rushed decision when with Prostate Cancer, there is time plenty of time to make decisions for almost all patients with the exception of a very small percentage of patients.

So take a few breaths, and relax, it's hard, I know, but take the time to educate yourself so you can and will be an active participant in your care. Being your own advocate and not just accepting blindly what's thrown at you. And remember to breathe, take breaks, don't dwell on this too much or let it control you, your thoughts or life!

Best Regards

[Tony666]

The worst part of figuring out what to do for me was that every doctor pushed their own treatment. The urologist wanted me to go immediately for surgery. The radiation onchologist wanted to radiate. Bottom line is that the patient must decide. So take your time, get different opinions, read as much as you can and then decide what is best for you.

[aceace12]

second opinion from Epstein is a must... good luck

[Hidden]

Keep in mind the first biopsy took samples from only an insanely small portion of your prostate. it is like a needle in a haystack, literally. That's why they use the MRIs now. and even then they miss things. so yeah, the PSA is something to watch closely while you consider your next move.