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    Old 12-10-2020, 09:19 AM   #1
    Mushin
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    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.

     
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    Old 12-10-2020, 09:34 AM   #2
    Sw1218
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    Re: Newly Diagnosed

    Quote:
    Originally Posted by Mushin View Post
    ...He scheduled another biopsy for 6 months.

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

    D.O.B. | 12/18/1973
    02.28.2019 | Dx 45
    Elev. PSA | 11.9
    GS | 4+3 = 7
    Treatment | HDR Brachytherapy & 6 mths of Casodex 50mg

     
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    Mushin (12-10-2020)
    Old 12-10-2020, 09:42 AM   #3
    Sw1218
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    Re: Newly Diagnosed

    also look up MRI/ultrasound fusion guided biopsy and in-bore MRI-guided targeted biopsy
    __________________

    D.O.B. | 12/18/1973
    02.28.2019 | Dx 45
    Elev. PSA | 11.9
    GS | 4+3 = 7
    Treatment | HDR Brachytherapy & 6 mths of Casodex 50mg

     
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    Old 12-10-2020, 10:42 AM   #4
    Mushin
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    Re: Newly Diagnosed

    The next biopsy is the same as the last, which is the Transrectal ultrasound guided biopsy.

    Thank you.

     
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    Old 12-10-2020, 10:54 AM   #5
    Southsider170
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    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.

     
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    Mushin (12-10-2020)
    Old 12-10-2020, 11:50 AM   #6
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    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.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    1-15-21 PSA less than 0.02; zero club 4.5 yrs

     
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    Mushin (12-10-2020)
    Old 12-10-2020, 08:02 PM   #7
    HighlanderCFH
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    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

     
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    Mushin (12-11-2020)
    Old 12-14-2020, 07:04 PM   #8
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    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.

     
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    Mushin (12-15-2020)
    Old 12-15-2020, 06:59 AM   #9
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    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.
    __________________
    In Active Surveillance program at Johns Hopkins since July 2009.

    Seven biopsies from 2009 to 2021. Three were were positive with 5% Gleason(3+3) found.

     
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    Mushin (12-20-2020)
    Old 12-16-2020, 01:09 PM   #10
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    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

    - - - - - - - - - - - - - - - - - - - - - - - -
    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.

     
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    Mushin (12-20-2020)
    Old 12-20-2020, 09:47 AM   #11
    Mushin
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    Re: Newly Diagnosed

    Thanks to everyone for their advice. I have a scheduled appointment at John Hopkins at Sibley Memorial for a second opinion.
    __________________
    Born 1964
    Family history of PC- 1 brother, 1 uncle on father's side, 1 uncle on mother's side
    First Biopsy Feb 2020, No PC, 4 of 12 Atypical cells
    Second Biopsy Nov 2020. Diagnosis 11/20/2020, 1 of 12 core, 3+3, Grade 1 PSA Jan 2021 3.81, PSA June 2021 4.7.

     
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    Old 12-21-2020, 07:37 PM   #12
    guitarhillbilly
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    Re: Newly Diagnosed

    Quote:
    Originally Posted by Mushin View Post
    Thanks to everyone for their advice. I have a scheduled appointment at John Hopkins at Sibley Memorial for a second opinion.
    Excellent Decision.
    __________________
    T2a / Gleason Score 8 / PSA at Diagnosis 6.9 /
    1-5 aggressive score : 4
    12 cores= 4 positive
    NBS = Negative
    Pelvic CT= Negative
    Pelvic MRI= Negative
    Age at Diagnosis= 60-65 age group
    Completed 42 IMRT Sessions
    Lupron scheduled for 2 years [Started DEC 2019]

     
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    Old 12-28-2020, 07:31 PM   #13
    DuginMT
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    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.

     
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    Mushin (12-30-2020)
    Old 12-29-2020, 02:54 AM   #14
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    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.

     
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    Old 12-29-2020, 04:35 PM   #15
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    Re: Newly Diagnosed

    Quote:
    Originally Posted by DuginMT View Post
    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.

    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.

     
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