I had been on the site a few months ago inquiring about surgeons in SoCal after my first MRI. Took a bit of detour and changed urologists. I wanted a transperineal biopsy with a local, and he was looking towards transrectal or TP under anesthesia. Nahhhh.
Decided to go with Dr. Uchio at UCI. He has been doing fusion biopsy with Artemis for about 7 years now and quoted me a .1% infection rate. Had biopsy done on 9/18/22, no infection and just a little sore for a few days. No infection…sepsis…ICU, good thing; bad thing is that results came back with some 3 +4.
Questions:
1. Biopsy 2nd opinion:
Urologist had no problem with me sending results to John Hopkins, but felt that they seem to upgrade the results a bit .
Any thoughts from the group?
I seems that just about every resource/opinion I have come across recommends a second opinion on the biopsy and I am leaning in that direction as well.
He is sending my biopsy results to some biomarker companies to get another piece of the puzzle. From my research so far, sounds like a good idea. Will post results when I receive them.
2. Number of Cores on Targeted Biopsy:
There were 4 cores taken from Left target lesion. I cannot remember where I read this but sort of remember one source stating that when multiple cores are taken from a lesion they are counted as one core.
Can anyone confirm or refute that?
Any other feedback/online resources on interpretation of biopsy reports would also be welcomed.
MRI
Prostate MRI at UCI on 08/31/22 revealed a PI-RADS 4 lesion in the RIGHT posterior mid gland and a PI-RADS 3 lesion in the LEFT posterior peripheral midgland. Also had some, understatement maybe, 3 + 3s.
Most recent PSA on 8/19/22 was 3.5. (Was 4.3 nine months ago. First time it has gone down in 10 yrs. of PSA monitoring. Started Vegan diet, no dairy, no booze...lost 20 lbs....ya think that was it?)
DRE: Negative.
PSA Density: .1
Target Biopsy Lesions:
M. PROSTATE, RIGHT PERIPHERAL ZONE (X3), BIOPSIES:
- Prostatic adenocarcinoma, grade group 1.
- Gleason score: 3 + 3 = 6.
- One of three cores are involved. Carcinoma involves
<5% of submitted tissues.
- Negative for perineural invasion.
N. PROSTATE, LEFT PERIPHERAL ZONE LESION (X4), BIOPSIES:
- Prostatic adenocarcinoma, grade group 2.
- Gleason score: 3 + 4 = 7 (5% pattern 4).
- Three of four cores are involved. Carcinoma involves
40% of submitted tissues.
- Positive for perineural invasion.
Finally, was leaning towards RP at first, but after much research, I am leaning the other way towards SBRT. Pending biomarkers report that is. So far Dr. Kishan seems to be the “go to guy’ in SoCal.
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TFU589
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3. You seem to have a lot of cancer in the left peripheral zone (40% of 3 of 4 cores), and even though pattern 4 is minimal (5%), the PNI raises your risk level.
A friend who is a vegan is a member of a group of vegans who get together once a month for a meal at a different vegan restaurant. He has told me that several members were told that nothing more could be done to treat their cancers. They are vibrant and healthy. I do not believe that becoming a vegan will give the same results for everyone but--if surgery, radiation, drugs and chemo worked for everyone --would this site even exist? Think about that.
I had my most recent biopsy (Dec 2021) analyzed by Epstein. I'm so glad I did because the original pathology report stated 3+4 was detected, but didn't say what %. Dr. Epstein's report showed less than 5% 3+4 with evidence of possible PNI. He then had a direct phone discussion with me about it and said there were no studies regarding mortality 10-20 years out for someone my age (57 at the time) with mostly 3+3 and a TINY (less than 5%) amount of 3+4, but said a strong argument could be made for AS esp if yearly MRIs are performed. As long as PSA stays low (not ramping up) and MRIs stay fairly consistent, he'd recommend AS. My next MRI is in Nov.
On another note, I've been vegan now since my diagnosis (July 2017) and after 6 months, my doctor was shocked when the MRI came back showing an entire area (of two) no longer showed any abnormal signs. The recent biopsy confirmed this.
So, is the vegan diet really doing something? I don't have a definitive answer, although I can say I did a TON of research that led me to change my diet and lifestyle. I also started brisk walking for a half hour 6 days a week. Only time will tell if what I'm doing is truly stopping the growth.
In summary, getting the 2nd opinion by Epstein was a game changer for me because my uro was strongly pushing for treatment due to the 3+4 detection, but now that it's less than 5%, we are in agreement that AS is best.
I'm holding out for breakthrough treatments such as Theranostics, "drug factory" seeds (which start clinical trials at Rice University soon, I believe), and other targeted low- to no-side effect treatments.
If my MRI shows any type of progression or spread outside my prostate, then I'll have to reconsider, of course.
So, get the 2nd opinion from Epstein and consider changing your lifestyle to a plant-based diet and at least brisk walking 5-6 days a week in lieu of vigorous exercise (which I'm doing now instead of walking as my primary exercise). Even if it's not really slowing/stopping the cancer, I feel the healthiest I've felt possibly my entire life. I play beach volleyball with 20 and 30 somethings, full-court indoor basketball at my gym, and disc golf (3-5 miles of walking) every week.
I had a very similar change in lifestyle and a very similar change in PSA before treatment. I will probably always wonder if I could have continued with lifestyle improvements and let my body treat the cancer. As it is, I had HRD Brachytherapy in late Sept and it has gone pretty well. I do have a lot of confidence that the UCLA team did achieve a cure in my case which I would characterize as favorable unfavorable intermediate risk.
Thank you all for your feedback. After doing a little more digging on the site, I see that I am not the 1st, 2nd or 3rd guy who has asked about a 2nd opinion from Doc E.
Also, thank you for the feedback/experiences with the vegan/plant based diet.
I had read Bruce Mylrea’s book some time ago. He has PC, and has a good set of research articles in the back of the book. (I am a pure skeptic and always read the original source.)
He seems to be a big fan of the “China Study”, but when you dig a little deeper, like anything else…well google for yourself. I have also seen some other research from “Dean Ornish” and others. So I will continue on my diet and see where it takes me. If anything, it might help me improve my lipids which have never been that bad. At least my docs never felt a need to put me on statins.
He is an NP in NYC. He has a newsletter that brings up some research based advice on PC and overall health. Connected with docs from NYU and has been dealing with PC for many years. Big on the supplements, not a big fan of them, but he does not push them.
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