Diagnosed today

[FMOH_N]

I have followed this site for several months. Today I got my biopsy results. 3 out of 10 confirmed cancer in peripheral zone right side GS: 2 x 3+3 and 1 x 3+4 (GP4 - 40%) . MRI for a month ago detected malignity tumor of size 1.2 cm, PI-RADS 4. No sign on pelvis area and neighboring lymph nodes. Clinical stage: T2/T3? pstage?

Histology reporting:

core 1: prostate tissue with adenocarcinoma, Gleason grade 3+3 score 6 grade group 1, 8/13 mm

core 2: prostate tissue with adenocarcinoma, Gleason grade 3+3 score 6 grade group 1, 0.5/13 mm

core 3: prostate tissue with adenocarcinoma, Gleason grade 3+4 (40%) score 7 grade group 2, 9/12 mm

cores 4 to 10 : negative.

I am 59 years and Dr. strongly recommend removal of the whole gland by DaVinci. But I am not sure how to choose the way forward, what treatment, and hoping that I can get some advice here.

Any guidance and suggestion is highly appreciated.

I am also wondering about the quantity and amount of GP4 in tumor? 40% is reported on one core, does it mean the quantity of GP4 is min. 40% or it maybe higher?

[Tall_Allen]

The first step is to take a deep breath, and decide not to decide about anything yet. You have plenty of time - easily a year with your diagnosis.

Send your biopsy slides to Jonathan Epstein at Johns Hopkins for a second opinion. He is the gold standard.

pathology.jhu.edu/patient-c...

If confirmed, you have a type of prostate cancer called "favorable intermediate risk." Many men with this diagnosis choose active surveillance. That is a reasonable option if there isn't much cancer (which appears to be your case) and the percent pattern 4 is low (which Epstein will tell you.)

If not active surveillance, your best treatment options are surgery, SBRT, and brachytherapy monotherapy. They all have excellent odds of curing you - over 90%. But their side effects differ. It is a good idea to make appointments in specialists in each of those, before you make up your mind.

Here are some questions you may want to ask them:

prostatecancer.news/2017/12...

prostatecancer.news/2017/12...

prostatecancer.news/2017/12...

[FMOH_N in reply to Tall_Allen]

Many thanks TA. % pattern 4 is 40%

[Tall_Allen in reply to FMOH_N]

If Epstein confirms that, you will be better off with treatment. This may interest you:

prostatecancer.news/2018/10...

[FMOH_N in reply to Tall_Allen]

% of Gleason pattern 4 is important and have major affect on BCR. Even 2 cores are 3+3, but one is 3+4 with %GP4 of 40%

ncbi.nlm.nih.gov/pmc/articl...

[WilsonPickett]

My diagnosis was similar. The surgeon lobbied for surgery, and the radiation oncologist lobbied for radiation, SBRT. Along with doing my own extensive research as per Tall Allen’s recommendation, one thing that the radiation oncologist said to me that stuck was “If the outcomes we’re statistically the same, why would you have an invasive procedure when you could have a non-invasive procedure?”Ultimately that comment and my own research resulted in me going with SBRT. That was 18 months ago. So far so good. PSA numbers continue to decline.

[CarverD]

I agree with TA - take a breath and relax if you can. I had an almost identical diagnosis, 3 tumors with 30% pattern 4 in one. After many months of research, meeting with doctors, and attending online forums I opted for HDRBrachytherapy. Little to no side effects @ 2.5 years post treatment. Fell free to message me if you want. Best of luck

[Smarks42]

I also agree with TA and others here. I am Gleason 3 +4 with 5 positive cores. I was originally scheduled for an RP, which I canceled, and I'm now at the front end of IMRT. My biopsy was first read by Sarapath here in Sarasota, then I sent it to Moffit Cancer Center in Tampa. A second biopsy reading by experts can be so important. Consider these differences in my pattern 4 percentages, the higher numbers all coming from Sarapath, the lower ones from Moffitt: 20% vs 10%, 30 vs 10, 10 vs 5, 30 vs 5, and 35 vs. 10. I suggest that unless Epstein or some other expert sees something new and different, consider getting a genomic Decipher report. Yes, you probably will need treatment, but if the Decipher number is low, you might still be a candidate for AS. In my case, when my pattern 4 percentages came back so much lower from Moffitt, I thought that if my Decipher score was also low, maybe I could get on AS. This was not to be, as my score came back at .68--at the low end of their "high risk" category. But I'm still glad I did the Decipher, because I was then more confident than ever that I needed treatment. I wish you the best of luck!

[tsim]

Let me guess, urologist?

[930911]

I was diagnosed over a year ago & my first reaction was to take quick action to get rid of the cancer. TA is right, take a deep breath & research. PC is slow growing & you have time. My urologist also highly recommended surgery. After researching I cancelled my surgery & I sought out second opinions. With your Gleason score & the PC being only on one side, you may be a candidate for Nano Knife. I was very interested in it but didn’t qualify due to the fact my PC was on both sides. I ended up having SBRT in March of this year at MSK in NY they call “Precice”, five treatments & no hormone treatments. All went very well & I have very minimal side affects so far. As stated above get a decipher score as well to see how aggressive the cancer is, if low risk it opens the door for more options. Nano Knife & Precise are both none invasive methods of delivering radiation & are still done under clinical studies so you need to ask about them. It’s a lot to take in, best of luck & Godspeed.

[addicted2cycling in reply to 930911]

930911 wrote -- " ... Nano Knife & Precise are both non invasive methods of delivering radiation ... "

NO Radiation with NanoKnife ---

" ... The NanoKnife System has received FDA 510(k) clearance for the surgical ablation of soft tissue. The NanoKnife System utilizes low energy direct current electrical pulses to permanently open pores in target cell membranes. These permanent pores, or nano-scale defects, in the cell membranes result in cell death. The treated tissue is then removed by the body's natural processes over a matter of weeks, mimicking natural cell death. Unlike other ablation technologies, the NanoKnife System does not achieve tissue ablation using thermal energy. The NanoKnife System consists of two major components: a Low Energy Direct Current, or LEDC Generator and needle-like electrode probes. Up to six electrode probes can be placed into or around the targeted soft tissue. Once the probes are in place, the user enters the appropriate parameters for voltage, number of pulses, interval between pulses, and the pulse length into the generator user interface. The generator then delivers a series of short electric pulses between each electrode probe. The energy delivery is hyperechoic and can be monitored under real-time ultrasound... "