Biopsy results of my father. Help wit... - Prostate Cancer N...

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Biopsy results of my father. Help with suggesting what I should be looking at.

DRKC81 profile image

Thank you so much for your inputs. My father finally had his MRI Fusion TRUS biopsy and below are the results. I am doing all the background work on what the course of treatment would be (leaning towards radiation). Your input would be highly valuable when meeting with the RO.

Quick History : My Father is 74 years old and has been having urinary issues in the night and he was on Tamsulusin and Dutasteride, the PSA increased from 4.6 to 10 over the course of 5 years. This year he got his MpMRI and it showed a Pirads 4 leasion (the biopsy showed nothing in the MpMRI pointed location) Below are the biopsy results. The urologist has been very open to options and suggested men in the 70s prefer radiation to surgery but my dad can undergo surgery if he chooses to do so since he is physically very fit. He asked us to talk to the RO. Additionally he said he wanted to do a cystoscopy before to check for blockage and help with it before radiation. So he won't have urinary issues during / post radiation.

Below are the results

Left

A Base : Adenocarcinoma (Gleason 6 (3+3)) Tumor length percent 40%

B. Mid : Adenocarcinoma (Gleason 6 (3+3)) Tumor length percent 10%

C. Apex : Adenocarcinoma (Gleason 6 (3+3)) Tumor length percent 50%

D: Lat Base : Adenocarcinoma (Gleason 7 (3+4)) Tumor length percent 60% (May be PNI)

E:Lat Mid : Adenocarcinoma (Gleason 7 (3+4)) Tumor length percent 65%

F: Lat Apex: Adenocarcinoma (Gleason 6 (3+3)) Tumor length percent 50%

G: Target Area (MRI) Apex : Benign Prostatic Tissue

Right

H Base : Benign Prostatic Tissue

I. Mid : Benign Prostatic Tissue

J. Apex : Benign Prostatic Tissue

K: Lat Base : Benign Prostatic Tissue

L:Lat Mid : Benign Prostatic Tissue

M: Lat Apex: Benign Prostatic Tissue

N: Target Area (MRI) Apex : Benign Prostatic Tissue

Gleason Score : 3+4

Clinical Stage : T1C

PSA 11 ng/ml

Case Comments

A Grade Group 1 , 1 of 1 core involved

B: Grade Group 1 , 1 of 1 core involved

C: Grade Group 1 , 1 of 1 core involved

D:Gleason score 4 is 5% of tumor . Grade group 2

E: Grade Group 2 , 1 of 1 core involved, Gleason score 4 is 5% of tumor. PNI present

F:Grade Group 1 , 1 of 1 core involved

That is all I have, based on the reading on the site , I plan to request them to send the samples to Epstein for second opinion.

Thank you again.

3 Replies

Long term Dutasteride is known to limit the PSA to almost by half. If so, your father's PSA of 10 is in reality somewhere close to 20. Such a PSA value, by itself, places him in the high risk category. There are ongoing trials (Australia was first with it, other parts of the world followed) where a PSMA PET/CT is given to high risk patients before any radical treatment (prostatectomy or irradiation). Something to consider if you can undertake the cost.

thelancet.com/journals/lanc...

bmccancer.biomedcentral.com...

DRKC81 profile image
DRKC81 in reply to Justfor_

Thanks Justfor_ his PSA has never reduced on Dutasteride , so the doctor consider his PSA as an absolute value 11 instead of 22. I don’t think they allow for PSMA PET here in the US but will verify.

I think he should think of that as "unfavorable intermediate risk" because of the high percentage of cores with cancer, the high PSA (doubled because of the dutasteride), and the PNI.

It is also a good idea to rule out metastases using a PSMA PET scan. It is now covered by Medicare. He is at borderline risk for lymph node invasion, and the PSMA PET scan can help decide whether the pelvic lymph nodes should be treated as well. A Decipher test on his biopsy cores can help decide whether ADT is needed with it.

Assuming there are no distant metastases, there are several curative options - SBRT, HDR brachytherapy or LDR brachytherapy. But the decision about monotherapy to the prostate vs a wider field with a boost to the prostate will depend on those other tests.

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