2nd Opinion downgraded 4+3 60%4’s to 3+4 30% 4’s from MD Anderson. Thoughts?

[bl2307]

PSA 18.987

MRI:

32ml

4.5x3.6x3.7

9mm lesion, prostatitis of peripheral gland, BPH of Central Gland. Seminal Vesicles unremarkable; Neurovascular Bundle unremarkable; Lymph Nodes No Pathologically enlarged lymph nodes; Bones No agressive osseous lesions; Prostate Margin Preserved.

A. Right Posterior Medial:

PROSTATIC ADENOCARCINOMA, GLEASON SCORE 6 (3+3), GRADE GROUP 1, TWO SEPARATE FOCI (2 MM AND 1 MM), INVOLVING ONE TISSUE CORE.

B. Right Posterior Lateral:

PROSTATIC ADENOCARCINOMA, GLEASON SCORE 7 (3+4), WITH 10% GLEASON PATTERN 4, GRADE GROUP 2, TWO FOCI (7 MM AND 7 MM) INVOLVING SEPARATE TISSUE CORES.

C. Right Base:

PROSTATIC ADENOCARCINOMA, GLEASON SCORE 7 (3+4), WITH 5% GLEASON PATTERN 4, GRADE GROUP 2, 2 MM FOCUS.

FEW ATYPICAL GLANDS IN SEPARATE TISSUE CORE, SUSPICIOUS FOR PROSTATIC ADENOCARCINOMA.

D. Right Anterior Medial:

Prostatic tissue, no tumor present.

E. Right Anterior Lateral:

Prostatic tissue, no tumor present.

F. Left Posterior Medial:

FOCI OF ATYPICAL GLANDS, SUSPICIOUS FOR PROSTATIC ADENOCARCINOMA.

G. Left Posterior Lateral:

FEW ATYPICAL GLANDS, SUSPICIOUS FOR PROSTATIC ADENOCARCINOMA.

H. Left Base:

PROSTATIC ADENOCARCINOMA, GLEASON SCORE 6 (3+3), GRADE GROUP 1, 1 MM FOCUS.

FOCAL HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA WITH FEW ADJACENT ATYPICAL GLANDS.

I. Left Anterior Medial:

Prostatic tissue, no tumor present.

J. Left Anterior Lateral:

Prostatic tissue, no tumor present.

K. ROI 1:

PROSTATIC ADENOCARCINOMA, GLEASON SCORE 7 (3+4), WITH 30% GLEASON PATTERN 4, GRADE GROUP 2, FIVE FOCI (9 MM, 8 MM, 6 MM, 5 MM, AND 3 MM), INVOLVING SEPARATE TISSUE CORES.

Biomarker Block(s)

Tumor: K2 Normal: D1

Disclaimer

BIG CRIBRIFORM GLANDS PRESENT.

[bl2307]

2nd Opinion is from MD Anderson

[Tall_Allen]

Get a second opinion from Johns Hopkins. It's the only one universally accepted.

[dhccpa in reply to Tall_Allen]

I thought the guy who did the second opinions at JH got forced out a few months ago.

[Tall_Allen in reply to dhccpa]

Epstein left but his lab continues.

[bl2307 in reply to Tall_Allen]

I chose MD Anderson because that’s where I will be getting treatment at more than likely. In addition it is the number one cancer center in the country.

[Tall_Allen in reply to bl2307]

A pathologist has to identify everything from skin samples to every organs of the body. JH has a lab of pathologists who are exclusively devoted and trained in genitourinary pathology. It's all they do and they are very good at it. Their grading is accepted by oncologists everywhere (including MD Anderson).

[bl2307 in reply to Tall_Allen]

Would you suggest getting my PSMA PET Scan at the local Urologist OR get it done at a Cancer Center of Excellence. I’m reading that expertise is crucial.

[Tall_Allen in reply to bl2307]

You can always get a second opinion if there is something equivocal from a renowned PSMA PET radiologist, like Steven Rowe at JH, or Andrei Iagaru at Stanford.

[cfo1]

If any consolation MD Anderson third opinion upgraded my Gleason 9 to a 10.

[bl2307 in reply to cfo1]

How are you doing now?

[cfo1 in reply to bl2307]

PSA has been undetectable and I go for third, hopefully last lupron shot on 20th. PSA test results should be available then or perhaps before on lab website .thanks for asking

[bl2307 in reply to cfo1]

I’m glad that you’re well. How long did they recommend you being on Lupron?

[cfo1 in reply to bl2307]

Recommended 24 mos. Hope this will be my last at 18 mos, depending on PSA in next several months. Take care!