Johns Hopkins Upgraded Biopsy Results

[Chasbearcat999]

Here is what they sent me today.

Diagnosis

UROLOGIC PATHOLOGY CONSULTATION SERVICE

1. Prostate (Biopsy, S23-1681, 5/24/2023):

1-6) Benign prostatic tissue.

7) Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade Group 2), discontinuously involving 100% of one (1) core, 20% Gleason pattern 4.

NOTE: The diagnosis of carcinoma is supported by the failure of immunoperoxidase staining for high molecular weight cytokeratin and p63 to demonstrate basal cells in the atypical glands. Also favoring the diagnosis of cancer is that stains for racemase (a marker preferentially expressed in prostate cancer) are positive.

8) Benign prostatic tissue.

9) Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group 1), involving 20% of one (1) core.

NOTE: The diagnosis of carcinoma is supported by the failure of immunoperoxidase staining for high molecular weight cytokeratin and p63 to demonstrate basal cells in the atypical glands. Also favoring the diagnosis of cancer is that stains for racemase (a marker preferentially expressed in prostate cancer) are positive.

10-12) Benign prostatic tissue.

13) Prostatic adenocarcinoma, Gleason score 4+3=7 (Grade Group 3), discontinuously involving 60% of one (1) core, 60% Gleason pattern 4.

NOTE: The diagnosis of carcinoma is supported by the failure of immunoperoxidase staining for high molecular weight cytokeratin and p63 to demonstrate basal cells in the atypical glands. Also favoring the diagnosis of cancer is that stains for racemase (a marker preferentially expressed in prostate cancer) are positive.

14) Prostatic adenocarcinoma, Gleason score 4+3=7 (Grade Group 3), discontinuously involving 30% of one (1) core, 60% Gleason pattern 4.

15) Small focus of prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group 1), involving less than 5% of one (1) core.

The pattern 4 has in areas a large cribriform morphology.

Grade Groups range from 1 (most favorable) to 5 (least favorable).

Previously I was 3+4=7. I assume I'm now 4+3 and treatment options change.

[Tall_Allen]

Treatment options don't really change - it's still prostatectomy or radiation - but the odds of having a recurrence are less if you go with radiation:

prostatecancer.news/2018/10...

[Chasbearcat999 in reply to Tall_Allen]

Thanks Allen! I haven't done as much research as you, but in doing what I have, I can't find a scenario for PCa that a prostatectomy is warranted.

[Tall_Allen in reply to Chasbearcat999]

For favorable risk patients, radiation and prostatectomy provide equal results. It's a very personal decision. Here are questions to ask oneself:

prostatecancer.news/2017/12...

[Chasbearcat999 in reply to Tall_Allen]

Thank you. I saved that. At this point I am only considering radiation. Now the issue is deciding the RIGHT type of radiation and the right doctor. Like everyone, I want to lessen my chances of dying from this while weighing the costs of ultra aggressive therapies that deeply impact QOL.

[groundhogy]

The thing about brachy is that the radiation emits from inside the prostate. It does not have to pass through and dose other tissues and organs as it travels to the prostate.

Because of this, they can turn up the volume on brachy, where in external rad, they have dose limiting because of the other tissues.

[groundhogy]

Here is a good website to compare your odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see your odds of 10-20 yr survival, etc. based on the treatment you pick.

prostatecancerfree.org/comp...

It is best viewed on computer or just print it on paper. Not so viewable on phone.

[1Ubspaine]

So get to a good R.O. Preferably at a major hospital system. If anyone recommends 40 radiation treatments, immediately run to a new R.O.

Some R.O. Still this quantity just to run the billing up.

Good luck to you.

[Atdabeach in reply to 1Ubspaine]

I wouldn't assume that an RO recommending more sessions is just running his bill up! There are many approaches to EBRT, generally tailored to the details of the patient's cancer. Some cases can get by with a handful of Cyberknife treatments, for instance, while others (like me) might need 40+ treatments to cover a larger area.