Prostate Biopsy Results

[blueseas45]

Got the results from my prostate biopsy that I had on Oct 7, 2021.

Gleason Grade 3+3 Score of 6 involving 4 of 6 cores.

Region of interest #1, A, needle biopsy:

- Prostatic adenocarcinoma, Gleason Grade 3+3 = score of 6, involving 4 of

6 cores, measuring 6 mm in linear extent, 8% of tissue

- See description

Prostate, right lateral base, B, needle biopsy:

- Prostatic adenocarcinoma, Gleason Grade 3+3 = score of 6, involving 1 of

1 core, measuring 1 mm in linear extent, 7% of tissue

- See description

Prostate, right lateral apex, D, needle biopsy:

- Prostatic adenocarcinoma, Gleason Grade 3+3 = score of 6, involving 1 of

1 core, measuring 1 mm in linear extent, 6% of tissue

Prostate, left lateral base, K, needle biopsy

- Prostatic adenocarcinoma, Gleason Grade 3 +3 = score of 6, involving 1 of

1 core, measuring 1 mm in linear extent, 9% of tissue

Prostate, left lateral mid, L, needle biopsy:

- Prostatic adenocarcinoma, Gleason Grade 3+3 = score of 6, involving 1 of

1 core, measuring 5 mm in linear extent, 42% of tissue

Prostate, left lateral apex, M, needle biopsy:

- Prostatic adenocarcinoma, Gleason grade 3+3 = score of 6, involving 1 of

1 core, measuring 0.5 mm in linear extent, 4% of tissue

- See description

Prostate, left mid base, H, needle biopsy:

- High-grade prostatic intraepithelial neoplasia (HG-PIN)

Prostate, left mid apex, J, needle biopsy:

- Focal glandular atypia, favor adenocarcinoma

- See description

Prostate, right lateral mid, C, needle biopsy:

- Benign prostatic tissue

Prostate, right mid base, E, needle biopsy:

- Benign prostatic tissue

Prostate, right mid mid, F, needle biopsy:

- Benign prostatic tissue

Prostate, right mid apex, G, needle biopsy:

- Benign prostatic tissue

Prostate, left mid mid, I, needle biopsy:

- Benign prostatic tissue

- See description

KL/na

The first container is additionally labeled "region of interest #1" and consists of portions of six cores of tan-white tissue ranging from 0.5 to 1.8 cm in length and each measuring less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in A1.

The second container is additionally labeled "right lateral base" and consists of a single core of tan-white tissue measuring 1.6 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in B1.

The third container is additionally labeled "right lateral mid" and consists of a single core of tan-white tissue measuring 1.8 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in C1.

The fourth container is additionally labeled "right lateral apex" and consists of a single core of tan-white tissue measuring 1.8 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in D1.

The fifth container is additionally labeled "right mid base" and consists of a single core of tan-white tissue measuring 1.8 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in E1.

The sixth container is additionally labeled "right mid mid" and consists of a single core of tan-white tissue measuring 2 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in F1.

The seventh container is additionally labeled "right mid apex" and consists of a single core of tan-white tissue measuring 1.2 cm in length x tubal ligation 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in G1.

The eighth container is additionally labeled "left mid base" and consists of a single core of tan-white tissue measuring 1.5 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in H1.

The ninth container is additionally labeled "left mid mid" and consists of a single core of tan-white tissue measuring 2 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in I1.

The tenth container is additionally labeled "left mid apex" and consists of a single core of tan-white tissue measuring 1.3 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in J1.

The eleventh container is additionally labeled "left lateral base" and consists of a single core of tan-white tissue measuring 1.2 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in K1.

The twelfth container is additionally labeled "left lateral mid" and consists of a single core of tan-white tissue measuring 1.3 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in L1.

The thirteenth container is additionally labeled "left lateral apex" and consists of a single core of tan-white tissue measuring 1.5 cm in length x less than 0.1 cm in diameter. The tissue is marked with hematoxylin and entirely submitted in M1.

KL/ns

[blueseas45]

I haven't talked to the doctor yet, but I take this report as good news for me I think.

[Tall_Allen in reply to blueseas45]

Yes, you seem to be a perfect candidate for active surveillance. I strongly suggest you do it as part of a program rather than doing it on your own. The next step will be be biannual PSA and a comfirmatory mpMRI-targeted biopsy within a year.

[blueseas45 in reply to Tall_Allen]

Thanks Tall_Allen. Will do. Appreciate the help.

[blueseas45 in reply to Tall_Allen]

We are doing the watch till my doctors appointment on Feb. 21 2022 . I will be getting a PSA test one month before the doctor visit. Has anyone had the SBRT radiation? Sounds like my urologist thinks this is my best route to go. Any pros and cons on this please.

[Tall_Allen in reply to blueseas45]

I had it 11 years ago. It is fine, but active surveillance is better.

[blueseas45 in reply to Tall_Allen]

Thanks Tall_Allen. Sounded like if my psa stayed under 10 I could just monitor it and have psa tested every 3 months

[Tall_Allen in reply to blueseas45]

No. I think enrolling in an active surveillance program is important. Otherwise, get treatment.

[blueseas45 in reply to Tall_Allen]

I am a little confused by this?

[Tall_Allen in reply to blueseas45]

When patients try to do it their own, It often fails. Get with an established program.

[blueseas45 in reply to Tall_Allen]

Ok thank you very much.

[Justfor_]

If you had an mpMRI first, it is highly possible that you would had skipped (for now) biopsy.

[blueseas45 in reply to Justfor_]

Hi. I had the mri first and they recommended the biopsy.

[Justfor_ in reply to blueseas45]

Doesn't make sense to me. You had a typical quadrant biopsy (i.e.12 cores). If there was any lesion detected during the mpMRI, additional cores should had been taken. If no lesions were detected the high specificity of mpMRI leads to skipping biopsy.. Are you certain that you had an mpMRI in contrast to an ordinary MRI. If yes, what was your reported PIRADS number?

[blueseas45 in reply to Justfor_]

Study Result

Impression

Findings concerning for a neoplastic process right lateral transitional

zone at the level of the mid gland, for which directed biopsy should be

considered.

PIRADS 4

PIRADS v2 Assessment Categories

PIRADS 1 - Very low (clinically significant cancer is highly unlikely

to be present)

PIRADS 2 - Low (clinically significant cancer is unlikely to be present)

PIRADS 3 - Intermediate (the presence of clinically significant cancer

is equivocal)

PIRADS 4 - High (clinically significant cancer is likely to be present)

PIRADS 5 - Very high (clinically significant cancer is highly likely to

be present)

*Reading Radiologist: on 09/15/2021 at 12:52 PM

Narrative

MRI PROSTATE WITH AND WITHOUT CONTRAST

HISTORY: Elevated PSA

TECHNIQUE: Multiparametric images of the prostate are obtained on a 3T

MRI. Dynamic contrast enhanced (DCE) imaging performed with 15cc

Dotarem IV contrast. 3D reconstructions were performed on independent

workstation.

FINDINGS:

Comparison: No prior prostate imaging studies

Volume: 46 cc

Transition Zone Description: Inhomogeneous, primarily low T2 Signal

Intensity. There is enlargement of the median lobe. There is an

ill-defined focus of confluent low T2 signal right lateral transitional

zone at the level the mid gland. This demonstrates mild diffusion

restriction. Directed biopsy should be considered.

Peripheral Zone Description: No discrete suspicious mass or diffusion

restriction identified within the peripheral zone.

Lesions: Right lateral transitional zone, mid gland

Seminal Vesicles: Grossly symmetric. No mass identified.

Nodal Disease: No abnormally enlarged lymph nodes identified.

Neurovascular Bundles: Grossly intact.

Prostate Margin: Grossly intact.

Bones: No suspicious abnormal signal intensity identified.

Other Pelvic Organs: No mass lesion identified.

Component Results

There is no component information for this result.

General Information

Ordered by

Collected on 09/15/2021 12:42 PM

Resulted on 09/15/2021 12:52 PM

Result Status: Final result

This test result has been released by an automatic process.

Back to the Test Results page

[Justfor_ in reply to blueseas45]

PIRADS 4 and GS 3+3 are NOT compatible. I have a friend that received a guided biopsy after two mpMRIs one year apart. The first one scored PIRADS 3 and the second was upgraded to 4. Back to his guided biopsy it found NOTHING. His urologist told him that with a negative biopsy he could do nothing. YET, for the last year his PSA has been advancing and his free PSA declining. Latest consult with his urologist he told him: " There is something we are missing here"

Stay vigilant, biopsies missing the lesions are not uncommon. Watch your PSA + free PSA quarterly, this was my sdvice to my friend and would re-itterate it to you.

[blueseas45 in reply to Justfor_]

Thanks for your information. I see my urologist tomorrow Monday the 18 of October. I will talk to him about these numbers.

[EdinBmore]

Agree with TA. Your case sounds much like mine. AS with active monitoring. I continued on AS until my PSA rose and Gleason went from 6 to 7. If I had it to do over again, I would have sought treatment sooner (to avoid the ADT, IMRT and brachy boost that happened later). Hope you have a better ride than I did. Good luck to you.

EdinBaltimore

[Chrisopopolis in reply to EdinBmore]

Hi,When you say you would’ve sought treatment earlier, do you mean that you would have liked to of been on a structured active surveillance program earlier?

I am going in for my confirmatory biopsy this morning at about the the 2 year mark in my AS program.

[EdinBmore in reply to Chrisopopolis]

I was dx in April 2011. In retrospect, I am glad that I did AS but as my PSA rose, I think I should have sought treatment sooner than I did (in 2018). If I had sought treatment earlier, I could have avoided ADT. Hindsight is 20/20 (once again).

[Chrisopopolis in reply to EdinBmore]

Thanks. What treatment option would you have had in 2018 that would have avoided ADT , brachyboost and IMRT? Or was it just the ADT you would have avoided?

[EdinBmore in reply to Chrisopopolis]

Over 7 yrs, my PSA rose from 4.5 to 23. I think that the uro - a Hopkins uro, no less - should have recommended treatment when the PSA was less than 10. By waiting, I ended up in a higher risk for recurrence cancer category which required more types of treatments, including ADT (which I reacted to horribly). Although highly respected, I think that Hopkins dropped the ball, so to speak. I sought treatment at a local hospital where I received ADT, IMRT and bracy boost. The treatment was based upon the NCCN guidelines for one with my profile.

[addicted2cycling in reply to Chrisopopolis]

Chrisopopolis wrote --- " ...I am going in for my confirmatory biopsy this morning at about the the 2 year mark in my AS program. "

Hoping for a GOOD report for you 👍

[dadzone43]

Nothing to add but best wishes for your good fortune.

[EdinBmore in reply to dadzone43]

Thanks! So far, so good. PSA has been steady at 0.02/0.03 since 2019. No PSA "bounce" ...yet. T is back to pre-treatment level but still not very high (<250). Some lasting side effects (wt gain, loss of muscle mass, genital shrinkage) but I'm still on this side of the Earth.

Good luck to you as well.

EdinBaltimore

[blueseas45 in reply to dadzone43]

Thanks

[aceace12]

is this second opinion from Johns Hopkins. ?

[EdinBmore in reply to aceace12]

I was a Hopkins patient for 7 yrs. Head of urology was my doc but I think he missed the boat in not recommending treatment sooner (like when PSA was under 10). I moved from Hopkins to a local hospital with a Chesapeake Urology group there. I was disappointed with Hopkins uro, and the RO I was referred to there was one of the worse docs I've ever encountered. And, knowing that Hopkins is a teaching hospital there is always the possibility that the doc doing the treatment is a student.

Good luck to you as well.

EdinBaltimore

[aceace12 in reply to EdinBmore]

ok good luck

[Murk in reply to EdinBmore]

That's a shame EdinBmore... I had the opposite experience with Hopkins but maybe its because I was adamant about immediate treatment. Also second opinions are key no matter where you go and who you see. Just my two cents

[aceace12]

ok good luck

[blueseas45]

05-19-2021 PSA was 9.1. New PSA 01-25-22 PSA 5.7. Going to specialist for Cyber Knife discussion. I think it's time I do something before this cancer gets into my bones