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Mushin 12-10-2020 09:19 AM

Newly Diagnosed
 
My diagnosis was small focus of Adenocarcinoma, Gleason score 3+3=6, Grade Group 1, involving <5% of one core out of 12. No Perineural invasion identified. I asked me Urologist if there could be others that were not detected by the biopsy, and the answer was yes.

He scheduled another biopsy for 6 months.

My question is, can just biopsy alone detect all the cancer in ones prostate? Are there alternatives?

IF I can be sure this is really my current situation, my wife and are leaning towards AS.

BTW, I am 56yrs old, black, and in great shape.

Sw1218 12-10-2020 09:34 AM

Re: Newly Diagnosed
 
[QUOTE=Mushin;5507335]...He scheduled another biopsy for 6 months.

My question is, can just biopsy alone detect all the cancer in ones prostate? Are there alternatives?...[/QUOTE]

What type of biopsy did you have and what type of biopsy are you sched. to have? there R some biopsies for the prostate that are more accurate than others, which would give you a better more accurate diagnosis.

Sw1218 12-10-2020 09:42 AM

Re: Newly Diagnosed
 
also look up MRI/ultrasound fusion guided biopsy and in-bore MRI-guided targeted biopsy

Mushin 12-10-2020 10:42 AM

Re: Newly Diagnosed
 
The next biopsy is the same as the last, which is the Transrectal ultrasound guided biopsy.

Thank you.

Southsider170 12-10-2020 10:54 AM

Re: Newly Diagnosed
 
Repeated biopsies as well as imaging,repeated PSA tests, and other tests is what Active Surveillance is about. The idea is to delay and postpone treatment for many years or even permanently, but keep a close enough eye on the cancer that intervention can be still made timely.

Having a followup biopsy within a year of the first biopsy is the usual protocol, because the problem isn't so much in progression, but the idea that higher grade cancers could be missed.

Prostatefree 12-10-2020 11:50 AM

Re: Newly Diagnosed
 
Sounds like you're a candidate for AS. However, the recommendation is to be in a professionally managed AS program and not self guided. There are too many temptations to not follow the protocols in self guided AS.

Most insurance will require the first biopsy be a TRUS biopsy (yours). It can be effective as a frontline screening tool. It is inexpensive and in the office.

Recommendation is move beyond the standard in office TRUS biopsy and second follow up biopsy in a year be a 3T MRI fusion guided biopsy. There are other diagnostic tools that can be used in addition to this that are less invasive. I'm not familar, but others can add in.

For me, it was a TRUS biopsy and done. I was fortunate. If I were to be in any prolonged program such as AS or onging treatment plans I would seek out a cancer center of excellence to coordinate my care across the different disciplines with the most experience with prostate cancer.

I suggest you complete your signature with critical infromation, such as PSA history, family history, etc. There is a lot of knowledge and experience here and the more you share the more useful will be the response.

HighlanderCFH 12-10-2020 08:02 PM

Re: Newly Diagnosed
 
Indeed, it sounds like you might be an ideal candidate for Active Surveillance.

In answer to your question, a biopsy is really the only way to definitively confirm & diagnose prostate cancer. For peace of mind, you might ask your doctor to consider doing a "saturation" biopsy the next time. This usually involves 20 or more cores. The more cores tested the more likely to detect any other tumors.

If all they can find is the one 3+3 with <5% involvement, you might be lucky enough to NEVER need any treatment. It is also helpful to know that 3+3 CANNOT spread to other parts of the body. It is NOT a terminal version of the disease.

Good luck! :)
Chuck

KPJ1 12-14-2020 07:04 PM

Re: Newly Diagnosed
 
I was also exploring options for treatment, and just read two excellent books: Surviving Prostate Cancer (Walsh) and The Key to Prostate Cancer (Scholz). Both of these books would suggest AS for someone in your situation.

ASAdvocate 12-15-2020 06:59 AM

Re: Newly Diagnosed
 
A formal AS program would require an mp-MRI six months after the diagnostic biopsy, and then a confirmatory targeted plus systematic biopsy to reduce the chances that the first one missed more significant cancer.

You have the minimal amount of PCa possible. All the medical associations recommend AS for your pathology. But, you must have the follow up tests to help confirm your risk level.

IADT3since2000 12-16-2020 01:09 PM

Re: Newly Diagnosed
 
Hi Mushin,

Replies have already covered key points except for one: the biopsy cores need to be interpreted by an expert pathologist, not a general pathologist who is busy with all kinds of conditions and medical situations.

Fortunately, there are expert medical pathologists in the mid-Atlantic area, with the Johns Hopkins team arguably able to claim being the best in the world.

If your biopsy was interpreted by an expert, sit tight. If not, get a second opinion from an expert. This is very important, as biopsies read by non-experts are often under graded or over graded.

Good luck.

.Jim
[SIZE="1"]
- - - - - - - - - - - - - - - - - - - - - - - -
21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.[/SIZE]

Mushin 12-20-2020 09:47 AM

Re: Newly Diagnosed
 
Thanks to everyone for their advice. I have a scheduled appointment at John Hopkins at Sibley Memorial for a second opinion.

guitarhillbilly 12-21-2020 07:37 PM

Re: Newly Diagnosed
 
[QUOTE=Mushin;5507573]Thanks to everyone for their advice. I have a scheduled appointment at John Hopkins at Sibley Memorial for a second opinion.[/QUOTE]

Excellent Decision.

DuginMT 12-28-2020 07:31 PM

Re: Newly Diagnosed
 
I had exactly the same result 14 months ago. Recently, I had another TRUS biopsy and the needles found slightly more Gleason 3. The needles sample less than 0.5% of your prostate, so it is sort of hit-or-miss. I'm leaning toward Cyberknife radiation treatment now. One thing I would like to add: I tried several supplements for a year (Vitamin D3, Curcumin, Lycopene, garlic, oregano, and aspirin) and they did not cure my cancer. Vitamin D3 may slow it, you might consider having your level checked and supplemented if needed. Especially since you have the darker skin, and it is winter. I take 5000 IU/day. Good luck, you have plenty of time to decide what to do.

Prostatefree 12-29-2020 02:54 AM

Re: Newly Diagnosed
 
Vitamins and supplements will not cure cancer. Aspirin, as an anti-inflammatory, may temporarily lower your PSA. Manipulating your PSA is not recommended. It has no effect on the cancer and will adulterate your best cancer fighting tool, your PSA history.

Southsider170 12-29-2020 04:35 PM

Re: Newly Diagnosed
 
[QUOTE=DuginMT;5507761]I had exactly the same result 14 months ago. Recently, I had another TRUS biopsy and the needles found slightly more Gleason 3. The needles sample less than 0.5% of your prostate, so it is sort of hit-or-miss. I'm leaning toward Cyberknife radiation treatment now. One thing I would like to add: I tried several supplements for a year (Vitamin D3, Curcumin, Lycopene, garlic, oregano, and aspirin) and they did not cure my cancer. Vitamin D3 may slow it, you might consider having your level checked and supplemented if needed. Especially since you have the darker skin, and it is winter. I take 5000 IU/day. Good luck, you have plenty of time to decide what to do.[/QUOTE]


Particularly during the Pre-Treatment period for prostate cancer, make sure you tell your doctor what supplements or drugs you have started taking. It can influence a PSA score. Remember that PSA scores aren't specific to cancer- at least for fellows that have a prostate.

Mushin 12-29-2020 05:55 PM

Re: Newly Diagnosed
 
Update: I met with a Urologist at John Hopkins yesterday, for second opinion. I signed the papers to have my slides sent to them. My wife and I have decided that, I should enroll in the AS program at Hopkins for now.

ASAdvocate 01-01-2021 01:30 AM

Re: Newly Diagnosed
 
Excellent. I have been in that program since 2009. It has the best statistics for retention and almost no prostate cancer mortality.

You will be in good hands.

Terry G 01-01-2021 08:42 AM

Re: Newly Diagnosed
 
Sounds like an excellent choice. “Active” is the key here. Best wishes.

Mushin 06-15-2021 04:32 PM

Re: Newly Diagnosed
 
I did an MRI today at Hopkins as part of the AS and my follow up appointment is Monday 28th. Here is the result below. I will appreciate if anyone can help interpret it. My Psa keeps going up and down, 3.81 in January, and 4.7 last week.

Impression
IMPRESSION:
Enlarged BPH gland with a solitary left-sided peripheral zone lesion. No findings of extraprostatic disease.

Features of chronic bladder outlet obstruction with trabeculations

Small volume of free fluid in the pelvis, nonspecific

Dominant nodule lesion #1, overall PI-RADS = 2/5

Overall Assessment Categories (PI-RADS V2):
Likelihood that a clinically significant cancer is present based on MRI parameters
1. Very low (clinically significant cancer is highly unlikely to be present)
2. Low (clinically significant cancer is unlikely to be present)
3. Intermediate (the presence of clinically significant cancer is equivocal)
4. High (clinically significant cancer is likely to be present)
5. Very high (clinically significant cancer is highly likely to be present)

Images and interpretation personally reviewed by: William D. Craig, MD,MBA

Narrative
EXAM: MRI PROSTATE W/WO CONTRAST

INDICATION: prostate cancer surveillance
PSA 4.7
Prior biopsy: Potential focus of neoplasia. No Gleason score given.

COMPARISON: None.

TECHNIQUE:
Imaging at 3 Tesla.
Coil: Body Matrix coil
Sequences: Large field of view images of the pelvis were obtained: axial T2 weighted with fat suppression, 3D T2 weighted, and axial T1 weighted with fat suppression after contrast administration. Small field of view imaging of the prostate was performed
with axial, sagittal, and coronal T2 weighted imaging. Diffusion weighted imaging (DWI) was performed with apparent diffusion coefficient (ADC) mapping. Axial T1 weighted imaging pre-contrast and dynamic contrast enhanced (DCE) imaging was performed
following injection of 0.1 mmol/kg gadolinium IV.

FINDINGS:

IMAGE QUALITY: Diagnostic.

HEMORRHAGE:
No areas of high T1 signal suggesting hemorrhage.

PROSTATE VOLUME:
Prostate measures: 6.1 cm TV x 3.9 cm AP x 6.1 cm CC, volume 76 cc.

PERIPHERAL ZONE:
Some faint patchy areas of decreased T2 signal with a solitary measurable focus

Lesion #1:
- Side: left
- Level: base
- Zone: peripheral zone
- Location: posterior
- Diagram - sector: PZpm
- Size: 6 mm on T2-weighted imaging
- Relation to capsule: does not abut capsule
- Series 501 Image 15

Assessment categories:
- T2 = 4/5
- DWI-ADC = 2/5
- DCE = negative
- Overall PI-RADS = 2/5

TRANSITION ZONE:
Moderate hypertrophy with heterogeneous T2-signal with a prominent median lobe creating mass effect upon the bladder base. No worrisome nodule/lesion seen.


SEMINAL VESICLES: Normal, symmetric.

NEUROVASCULAR BUNDLES: Normal, symmetric.

BLADDER NECK: Normal

MEMBRANOUS URETHRA: Normal

LYMPH NODES: None enlarged.

BONE MARROW: Normal signal intensity.

OTHER: Trabeculated bladder wall.

Small amount of free fluid, indeterminate.

Component Results
There is no component information for this result.


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