Thoughts on Treatment Options and Second Opinions

[rlafford]

Story so far: 3T Multiphase MRI found a 1.4cm lesion in the right mid anterior transition zone, corresponding to: PI-RADS assessment category 4. So my urologist performed a MRI Ultrasound Fusion 14 core biopsy. 4 cores were through the lesion. Results: 3 cores graded "- Prostate tissue with a small focus of atypical glands, suspicious for carcinoma.

- Separate high-grade prostatic intraepithelial neoplasia."

One core - Prostatic adenocarcinoma, conventional/acinar type, involving two (2) of fragmented cores (see Comment). - Gleason score: 3 + 3 = 6 (Grade Group 1).

- Tumor quantitation: Two (2) small foci, 5% of the total specimen.

Lesion #1 (right mid anterior transition zone) - Prostatic adenocarcinoma, conventional/acinar type, involving four (4) of four (4) cores (see Comment). - Gleason score: 3 + 4 = 7 (Grade Group 2; less than 5% Gleason pattern 4).

- Tumor quantitation: 30% of the total specimen.

Comment: The Gleason pattern 4 in this case lacks cribriform morphology. Case has received departmental consultation on 06/30/2022

My uro is setting up appointments for both surgical and radiological consults.

Should I ask that samples be sent for a second opinion ie. Epstein at Johns Hopkins?

Thoughts on treatment options based on biopsy findings? My uro seems to lean towards removal but I'm fearful of the unintended consequences.

[Tall_Allen]

You can never go wrong with a second opinion from Epstein.

You appear to be a good candidate for active surveillance. Suggest you talk to an AS specialist.

[rlafford in reply to Tall_Allen]

Thanks for the reply. I will definitely do this.

[CarverD]

2nd opninion from Epstein at Johns Hopkins is a very good plan.

Less than 5% pattern 4 is a strong indicator that active surveillance is warranted.

If you "just can't live with that" you should research focal therapies before opting for surgery or radiation treatments. Sounds like your uro works with a surgeon and will always recommend removal regardless of the possible side effects. My uro did the same; with 20% pattern 4 I opted for HDRBrachytherapy and couldn't be happier with the results.

[rlafford in reply to CarverD]

Much appreciate your thoughts and experience.