Confirmatory Biopsy Complete

[Chrisopopolis]

My confirmatory biopsy has been completed and the pathologist at UCSF (Dr. Simmons) graded one lesion as 3+4 which is a change from the original 3+3 grade from original biopsy 2 years ago. I was told it was in 5% of the core, but the cell pattern, he felt, warranted the upgraded Gleason score.

The second lesion is 3+3 and smaller than the first. Both have shown up in my 2 MRI’s , the last of which the radiologist concluded there was no change from the first.

Next step is a Decipher genomics test.

The biopsy itself was transperineal, resulted in quite a bit of bleeding from a “false passage” of the catheter and a higher amount of cores, (26 cores).

At this point I am told it is likely that they would continue to recommend active surveillance, subject to the Decipher results.

I am beginning to lean toward treatment, and wondered if I should request 2nd opinion from Dr. Epstein on the Gleason score.

[Tall_Allen]

You can certainly get a 2nd opinion from Epstein.

His feelings don't enter into the upgrading. The current pathology guidelines dictate that the first number in the Gleason score is the most prevalent pattern and the second number is any higher grade pattern, even if it's not the second most prevalent. 5% is pretty minimal and was probably there the whole time (no expansion on MRI). That, coupled with your very few cores with any cancer, even with 26 cores taken, should convince you that AS is safe. But Decipher is prudent

[Chrisopopolis in reply to Tall_Allen]

Thanks for your helpful comments!

[Chrisopopolis in reply to Tall_Allen]

I wanted to also mention that the pathologist noted the G4 portion was the “fused gland” type.