My PC Diagnosis 2022

[21Cruiser]

I am 56, the last couple of years my PSA kept going up. I scheduled a biopsy for January 5th 2022. I got my test results of the biopsy on January 17th, 2022. A nurse called me and said "the biopsy was group 1 prostate cancer, will discuss with you further on follow-up. This is the lowest aggressiveness". At the time this didn't seem to me that I should be concerned so I didn't do any research on the subject. I had 2 places on the biopsy: B. Prostate, right base, needle biopsy - Prostate carcinoma, Grade Group 1 (Gleason 3+3) involving 5% of the needle biopsy and D. Prostate, right lateral base, needle biopsy - atypical small acinar proliferation (ASAP) suspicious for carcinoma. I had my follow up consultation with my urologist on the 28th.

The consultation was a complete blur to me, I'm glad my wife went so she could fill in the blanks. He started off by telling me about the Gleason grading of 3+3=6 and 5+5=10 and there used to be a different grading system, at this time I am thinking WTF, I don't know what any of this means!

Now the Dr starts explaining what treatment he recommends Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) and that he would be doing the procedure. My wife helped me remember this. He explained all of the side effects of RALP and I remember telling him that I didn't like any of the side effects.

My brother in-law told me to ask about Brachytherapy (internal radiation), at the time I didn't know what it was called so I asked about radiation pellets inserted in the prostate. He told me that this wasn't used that much anymore. After doing some research, it appears that this type of radiation is still being done. My wife seemed to feel like the urologist was kind of pushing RALP. He informed us that if you do RALP first then if that doesn't get it all then I could do radiation and hormone therapy.

During the 2 weeks after the diagnosis I went through the first four stages of "The Five Stages of Grief", (Denial, Anger, Bargaining, Depression) and then Acceptance.

I have a consultation with an oncologist in March, in the meantime I am doing research to help me determine my best options.

[treedown]

Welcome. Your doing it right. Take time, learn. You found a great place for answers, we have all been in your or your wife's seat Your urologist only offered what he can provide. You need a Radiation Oncologist consult. You need to fully understand what your disease characteristics are. You need to deal with your new normal psychologically. As my Medical Oncologist said, your in this for the long haul. You have time to make the right decision for you based on what you related in your post.

[21Cruiser in reply to treedown]

Thanks

[Faith1111]

Your wife will be your best advocate. Research, research, research. Get the best medical oncologist you can. You have come to the right place for information. There are men on here that know as much or more than your doctor. You are young as is my brother. There is a lot of hope and science is making progress. Stay calm. You will be ok.

[21Cruiser in reply to Faith1111]

Thanks

[Danish-patient Moderator]

Because you have kept a close look at the PSA development, your issue has been discovered at a early stage and you are in a good position to aim for a cure.I myself would always go for the surgery - cancer removed from the body will not trouble you in the future. The suggested surgery has a very good chance of curing you.

When the cancer appear at a young age - I was 52 at the diagnosis - it is, or can become, the aggressive type, that definitely should not be ignored.

[Woodstock82]

Don't get rushed into any particular treatment. Take your time to research the treatment options, their effects, and their side effects. Consult a radiation oncologist. Consult a medical oncologist. Surgery is traumatic in its own right. Radiation is traumatic in its own right. Hormone therapy is traumatic in its own way. Don't make things worse than you have to. With Gleason 3+3=6 there is not much urgency. Indeed, I would expect most oncologists to recommend Active Surveillance for a while.

[Hope4Happiness]

The results you posted are a bit vague, but if you had a 14-core needle biopsy, and the result was one core malignant with a Gleason score of 6 at 5%, you should not be considering any treatment at this time.

Can you post the full results of your needle biopsy?

[21Cruiser in reply to Hope4Happiness]

7/11/19 PSA 3.48

10/10/16 PSA 4.55

9/26/19 PSA 7.54

10/18/19 PSA 7.07

3/13/20 PSA 5.75

9/27/21 PSA 10.92

12/10/21 PSA 8.65

Prostate biopsies 1/5/22

A. Prostate, left base, needle biopsy -

Benign prostate tissue

B. Prostate, right base, needle biopsy -

Prostate carcinoma, Grade Group 1 (Gleason 3+3) involving 5% of

the needle biopsy

C. Prostate, right anterior, needle biopsy -

Benign prostate tissue

D. Prostate, right lateral base, needle biopsy -

atypical small acinar proliferation (ASAP) suspicious for

carcinoma (please see comment)

E. Prostate, right mid, needle biopsy -

Benign fibromuscular tissue

F. Prostate, right anterior #2, needle biopsy -

Benign prostate tissue

G. Prostate, left mid #2, needle biopsy -

Benign fibromuscular tissue

H. Prostate, left base, needle biopsy -

Benign prostate tissue

Comment

D. The right lateral base prostate needle biopsy contains a small

focus of small acini with cytologic and architectural atypia.

However, the number of atypical acini is insufficient for a

diagnosis of adenocarcinoma, but is highly suspicious.

Intradepartmental consultation is obtained.

Microscopic Examination

B. High molecular weight cytokeratin/AMACR immunocytochemical

stainis performed on the right base needle core biopsies and

Accession Collected Date Received Date

SS-22-0001290 01/05/2022 06:49 01/05/2022 12:16

Microscopic Examination

demonstrates absent basal cell staining with HWMK and positive

staining for racemase (AMACR) in atypical acini. These findings

support a histomorphologic impression of adenocarcinoma.

Gross Examination

Specimen B is submitted in two cassettes labeled B1-B2

Specimen C is submitted in two cassettes labeled C1-C2

Length/

No.of Range

Pieces (cm)

A. Left Base 1 0.3

B. Right Base 7 0.4-1.3

C. Right Anterior 6 0.1-1.1

D. Right Base Lateral 1 0.5

E. Right Mid 1 0.2

F. Right Anterior #2 1 1.7

G. Left Mid #2 1 0.7

H. Left Base 5 0.3-2.0

TB /TB

Specimen

A. Left base

B. Right base

C. Right anterior

D. Right base lateral

E. Right mid

F. Right anterior #2

G. Left mid #2

H. Left base

Prostate biopsies 11/1/19

__________________________________________________

Length/

No. of Range

RIGHT Pieces (cm) Diagnosis

A. Base 2 0.3-1.2 benign

B. Lateral Base 2 0.2-1.7 benign

C. Mid 1 1.7 benign

D. Lateral Mid 1 1.6 benign

E. Apex 1 1.3 suspicious for carcinoma

F. Lateral Apex 1 1.4 benign

___________________________________________________

Length/

No. of Range

LEFT Pieces (cm) Diagnosis

G. Base 1 1.1 benign

H. Lateral Base 1 1.2 benign

I. Mid 1 0.7 benign

J. Lateral Mid 1 1.4 benign

K. Apex 1 1.6 suspicious for carcinoma

L. Lateral Apex 1 1.7 benign

[SeosamhM]

Remember that, despite it all, you are in the driver's seat - you get to choose your treatment path. That being said, it is difficult to choose that perfect path because we cannot see into the future and each man's journey through PCa is different. To get control of this whirl of horrible news, attempt to categorize the information through research - I think that couple's research (like I did with my wife) keeps the family on the same page as much as possible and you can discuss the options that will be given you (and the feelings that follow!). However...

IMO (right now!) you should first focus on metastasis and rule that out through imaging (unfortunately, mets were ruled "in" for me after going through this at 49, five+ years ago...). Demand this and don't be sidelined - a simple clean CAT or PET bone scan brings a lot of relief, and a baseline scan now is warranted. In this way, future scans can reference past results and quickly differentiate between "normal" advancement of middle-aged arthritis or benign kidney cysts (real world examples, for me) and metastatic PCa.

Metastatic PCa is a different beast and as a younger guy you want that out of the picture and your mind ASAP! Then you can concentrate on prostate-specific treatments, systemic treatments like ADT, longer term preventative treatments (e.g., immunotherapy like Provenge), trial treatments, and everything else the medical community is coming out with for PCa.

AND...genetic testing (right now!). Find out if there are additional risks for progression or treatments that may work better.

As has been told to you, this is a long haul and it doesn't mean a hard death sentence. At the start of this, many of the stats available at the time for APCa gave me 3% at 5 years; as I approached 5 years, it was 30% in some studies... I actually suspect its higher than that now, partially thanks to my experience of moving the curve!

Based on my metastatic journey, my hope for you is sky high - the potential for putting your condition into the very, very long term is great. In the meantime, fight this thing and don't forget to live! Good luck. - Joe M.

[21Cruiser]

One side effect of surgery that my urologist didn't mention and I almost never see discussed is Changes in Penis Shape.

There is a risk of developing a curve in your penis or a slight shortening of the length of your penis.

I found this statement on a pamphlet from urologyhealth.org. When I visited their website I didn't see this listed. I just don't think it's right that this isn't discussed more.

[randonneur]

Having had an RP four months ago, I can tell you that my penis is a bit shorter than before the operation. But it's also a dynamic situation, and I see my penis continuing to change - in a good way I think. With the help of Viagra I'm having penetrative sex with my wife, and we both agree that week by week I seem to be getting a bit more firm when we have sex. My urologist tells me that it takes 1-1.5 years to get to the final penis rehabilitation as far as sex goes. I'm optimistic!

[Hope4Happiness]

Only an 8-core biopsy? Still, given the results of your biopsy -- one core at G6, 5 % -- I would think Active Surveillance is appropriate at this time. A confirmatory biopsy should be done in about 9 months -- this biopsy should get a 14-core sample. You might not currently have enough carcinogenic tissue for a genomic test, but do see if it is possible. Address all this in your upcoming meeting with your oncologist.