I have come to the next fork in the road of my prostate cancer journey and I seek the wise counsel of the members of this group.
Here are my stats and the latest chapter of my story:
2/3/22 - mpMPRI : PI-RADSv2 Category 5.
5/10/22 - Transperineal Biopsy 12-core template + fusion targeting of Left PZ lesion.
(7) Benign;
(1) ASAP, right posterior medial
(4) Gleason 6 (3 + 3 ):
10%, right posterior medial; 25%, left posterior lateral; 50%, left posterior lateral; 40%, left lateral wing
(1) Gleason 7 (3 + 4), "involving 1 of 1 core and
40% of the tissue, discontinuously. - 10% of pattern 4 is identified"
"Summary of additional features:
Perineural invasion: absent
Intraductal prostatic adenocarcinoma: present"
5/25/22 - My urologist delivered my cancer diagnosis. I was prepared to hear Gleason 3 +4 . . or worse. The presence of "intraductal" sent me into a mild panic after only the briefest of research.
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6/3/22 - 2nd Opinion from Dr. Epstein at Johns Hopkins
He evaluated the (1) ASAP as "benign prostatic tissue with partial atrophy".
He reduced the % involvement of 3 of the 4 Grade 6 cores: 10%, 20%, 10%, 30% (vs. the original report of 10%, 25%, 50%, 40%)
He downgraded the Gleason 3 + 4 to "Gleason 3 + 3 =6 (Grade Group 1), involving three (3) cores (10%, 60%, 50%)"
There is no mention of the presence of intraductal adenocarcinoma in his report.
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I am already deeply indebted to the members of this group.
I had no idea that there was more than 1 type of biopsy and I left my first Cancer Center of Excellence which scheduled a TRUS and was not able to offer a TPB. I knew from the advice I received here that I would send my biopsy slides to Dr. Epstein for review even before I received my results. The importance, the necessity, of a 2nd opinion on my pathology report was confirmed.
My job now is to get my diagnosis as 'right' as may be possible before I decide on a treatment course. I don't think I have enough information to assess the extent and aggressiveness of my cancer.
I was discouraged from getting a second read of my pathology from my Second Cancer of Excellence and so I have decided to go to another Cancer Center for diagnosis and treatment.
I may have just been unlucky in my experience at Cancer Centers in Philadelphia. Nonetheless I am giving up on hometown options. I am thinking Hopkins and/or MSK as my next stop(s) to figure my cancer out.
I ask for your help in learning what other tests may help me better assess what I have now and what I may face over time. Your recommendations about where to go and who to see would be greatly appreciated as well.