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  • Just received my biopsy results - meet Urologist on Friday. What do I need to know?

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    Old 05-05-2021, 06:32 PM   #1
    MrJohnny
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    Just received my biopsy results - meet Urologist on Friday. What do I need to know?

    It has been a fast two months, but I now know what I’m dealing with. It started as an elevated PSA test at my annual checkup (27.1, follow-up test 19.7) on March 2, leading to an MRI on April 7 and a biopsy on April 23.

    Today I received a message and the results of the biopsy from my doctor. He said he wanted to share them with me to give me time to review before our appointment this Friday to discuss my treatment options.
    Here are the results:

    SPECIMEN(S):
    A: Prostate biopsy, left base x 2
    B: Prostate biopsy, left mid x 2
    C: Prostate biopsy, left apex x 2
    D: Prostate biopsy, right base x 2
    E: Prostate biopsy, right mid x 2
    F: Prostate biopsy, right apex x 2
    G: Prostate biopsy target 1, left apex peripheral zone, 3 o'clock

    FINAL DIAGNOSIS:
    A. Prostate biopsy, left base x 2:
    - Prostatic adenocarcinoma, acinar type
    - Gleason score 7 (3+4; 10% pattern 4)
    - Grade Group 2
    - Extent: Involves 2/2 cores (4 mm, 40%, 4 mm, 30%)

    B. Prostate biopsy, left mid x 2:
    - Benign prostate tissue

    C. Prostate biopsy, left apex x 2:
    - Prostatic adenocarcinoma, acinar type
    - Gleason score 7 (3+4; 30% pattern 4)
    - Grade Group 2
    - Extent: Involves 1/2 cores (1 mm, 20%)

    D. Prostate biopsy, right base x 2:
    - Prostatic adenocarcinoma, acinar type
    - Gleason score 7 (3+4; 5% pattern 4)
    - Grade Group 2
    - Extent: Involves 2/2 cores (2 mm, 15%, 1 mm, 5%)

    E. Prostate biopsy, right mid x 2:
    - Benign prostate tissue

    F. Prostate biopsy, right apex x 2:
    - Benign prostate tissue

    G. Prostate biopsy target 1, left apex peripheral zone, 3 o'clock:
    - Prostatic adenocarcinoma, acinar type
    - Gleason score 7 (3+4; 30% pattern 4)
    - Grade Group 2
    - Extent: Involves 2/2 cores (5 mm, 50%, 4 mm, 50%)

    I'm really trying to understand this so I can have an informed discussion with the Urologist this Friday. A few questions:

    • What is your impression of the biopsy and the 3+4=7? Should I be worried?
    • Does my PSA seem high for a 3+4=7 score?
    • What do the % and pattern 4 after the Gleason score mean?
    • What does the “extent” mean?
    • What does the location of the cancer tell me?
    • I’ve read a lot about a T score but don’t see one written here. Is there a way to determine from these results?
    • How many different types of treatment options are available to me? Do these numbers indicate I will need surgery or are there other options?
    • If you were me, what would you ask the urologist on Friday morning and what treatment would you consider?

    Sorry for all the questions. I want to really understand this so I can maximize my time with the urologist on Friday. Thank you for all the support over the past two months. I really appreciate all the assistance and mental support as well.

    Best regards,

    John

     
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    Old 05-05-2021, 06:59 PM   #2
    HighlanderCFH
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    • What is your impression of the biopsy and the 3+4=7? Should I be worried?

    You have the "good" type of Gleason 7 because a 3+4 is much more "desirable" than 4+3. Seems like most (except the 30%) the lesions are not a huge percentage of grade 4. The 30% is, of course, higher than we'd like to see. But does not mean this cannot be cured.

    • Does my PSA seem high for a 3+4=7 score?

    A double-digit PSA score is definitely a concern. While it is somewhat high, it does not mean that a cure is very possible. I may have missed it, but did the pathologist stage it? If it is T2, or less, it is all still contained within the prostate.

    Basically, your PSA is probably what would be expected with 7 positive cores.

    • What do the % and pattern 4 after the Gleason score mean?

    The general thinking is that a secondary 4 pattern of around 3 or 4 percent (or somewhere around there) is a good sign that that particular case of 3+4 behaves more like Gleason 3+3.

    • What does the “extent” mean?
    • What does the location of the cancer tell me?
    • I’ve read a lot about a T score but don’t see one written here. Is there a way to determine from these results?

    I'll leave those last three questions for others to respond to.

    • How many different types of treatment options are available to me? Do these numbers indicate I will need surgery or are there other options?

    Assuming you are no more than a T2 (or sometimes even T3), I would think you are a very good candidate for surgery. You also would be a very good candidate for radiation. I think you probably have a very curable case.

    • If you were me, what would you ask the urologist on Friday morning and what treatment would you consider?

    I would consider surgery because you know, almost immediately, exactly what was in the prostate and if it is all taken care of. I would ask the doctor what he would do if confronted with your case in his own life.

    Best of luck to you, my friend!
    Chuck

    Last edited by HighlanderCFH; 05-05-2021 at 07:04 PM.

     
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    Old 05-05-2021, 07:20 PM   #3
    MrJohnny
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Thanks for the quick reply, Chuck! Good info and advice. I like your question of asking the Urologist what he would do if it was his life!

    I'll be sure and report back after Friday's appointment.

    Cheers, and Thank You!

    John

     
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    Old 05-05-2021, 07:39 PM   #4
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Quote:
    Originally Posted by MrJohnny View Post
    Thanks for the quick reply, Chuck! Good info and advice. I like your question of asking the Urologist what he would do if it was his life!

    I'll be sure and report back after Friday's appointment.

    Cheers, and Thank You!

    John

    You're welcome, John. Also be sure to ask about the staging. If it is still confined to your prostate (and it probably is), you should be expecting a complete cure.

    Will be waiting to hear about the report.
    Chuck

     
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    Old 05-05-2021, 07:54 PM   #5
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    John, did you have your imaging done yet --- MRI or CT? Did it show any evidence of (1) local spread out from the prostate or (2) any enlarged lymph nodes suggestive of metastases?

    Yes, a PSA >10 is concerning and >20 more so. It should be discussed.

    "Extent" in your biopsy report simply means how many of the total cores in that zone were positive for cancer, e.g. 1 of 2, or 2 of 2.

    You should only be discussing treatment options, not choosing one yet! You should meet with a radiation oncologist (RO) for learning about the various types of radiation treament that aresuitable for your status.

    Ask: if RP is your choice, what are the indications now that one or both neurovascular bundles can be spared, given (1) that cancer was found at the prostate base, combined with (2) your imaging results? These two bundles control the blood flow responsible for erections.

    Ask if a genomic test (OncotypeDx or Decipher) should be ordered on your biopsied tissue. This test can evaluate the risk (low, intermediate, high) of developing metastases withing 5 years based on your tumor's RNA. These risk groups cut across ALL Gleason scores!

    Do you have BPH? If so, ask about the effect of radiation treatment on it.

    You doc can tell you your clinical staging (cT).

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 05-05-2021, 08:42 PM   #6
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Quote:
    Originally Posted by DjinTonic View Post
    John, did you have your imaging done yet --- MRI or CT? Did it show any evidence of (1) local spread out from the prostate or (2) any enlarged lymph nodes suggestive of metastases?

    Yes, a PSA >10 is concerning and >20 more so. It should be discussed.

    "Extent" in your biopsy report simply means how many of the total cores in that zone were positive for cancer, e.g. 1 of 2, or 2 of 2.

    You should only be discussing treatment options, not choosing one yet! You should meet with a radiation oncologist (RO) for learning about the various types of radiation treament that aresuitable for your status.

    Ask: if RP is your choice, what are the indications now that one or both neurovascular bundles can be spared, given (1) that cancer was found at the prostate base, combined with (2) your imaging results? These two bundles control the blood flow responsible for erections.

    Ask if a genomic test (OncotypeDx or Decipher) should be ordered on your biopsied tissue. This test can evaluate the risk (low, intermediate, high) of developing metastases withing 5 years based on your tumor's RNA. These risk groups cut across ALL Gleason scores!

    Do you have BPH? If so, ask about the effect of radiation treatment on it.

    You doc can tell you your clinical staging (cT).

    Djin
    Djin,

    Thank you for your reply and the information. Makes me realize what I don't know and need to know quickly!

    To answer your questions, I did have an MRI. Here is what I believe is the relevant part for your question about spread.
    IMPRESSION:
    1. Based on the most suspicious abnormality, this exam is
    characterized as PIRADS 4 - Clinically significant cancer is likely to
    be present. The most suspicious abnormality is located at the left
    lateral apex at 3-4 o'clock position relative to the urethra and there
    is no evidence of extraprostatic extension.
    2. No suspicious adenopathy or evidence of pelvic metastases.
    Bilateral internal and external iliac lymph nodes measuring up to 5 mm
    are nonspecific.
    FINDINGS:
    Size 3.9 x 3.5 x 4.9 cm- grams
    Hemorrhage: Absent
    Peripheral zone: Heterogeneous on T2-weighted images. Suspicious
    lesions as detailed below.
    Transition zone: Enlarged with BPH changes. Transition zone nodules
    which are circumscribed or mostly encapsulated without diffusion
    restriction. PI-RADS 2. No highly suspicious nodules.

    Lesion(s) in rank order of severity (highest score- to lowest score,
    then by size)

    Lesion 1:
    Location: Left lateral apex at the 3 - 4 o'clock position relative to
    the urethra. Series 7001 image 67.
    Additional prostate regions involved: None
    Size: 11 mm
    T2 description: Heterogenous non circumscribed moderate T2
    hypointensity
    T2 numerical assessment: 3
    DWI description: Focal hypointensity on ADC and hyperintensity on DWI.
    (series 11001, image 22)
    DWI numerical assessment: 4
    DCE assessment: Negative
    Prostate margin: Capsular abutment<6 mm with smooth contour
    Lesion overall PI-RADS category: 4

    Neurovascular bundles: No neurovascular bundle involvement by
    malignancy.
    Seminal vesicles: No seminal vesicle involvement by malignancy.
    Lymph nodes: Bilateral internal and external iliac lymph nodes
    measuring up to 5 mm are nonspecific (series 16001, image 39).
    Bones: No suspicious lesions
    Other pelvic organs: No additional findings.

    I read this, and others on here have informed me that this indicates no spread.

    Thank you for the suggestion about getting a genomic test. I'll certainly do that. Not sure if it is covered by my insurance but I'll look into it.

    I don't believe I have BPH, although the MRI said "enlarged transition zone with BPH changes. Not sure what that means.

    Many thanks, Djin. I appreciate you taking time out of your evening to assist me!

    John

     
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    Old 05-06-2021, 05:39 AM   #7
    IADT3since2000
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Hi Mr. Johhnny and welcome!

    The question you may ask below has some subtleties:

    Quote:
    Originally Posted by MrJohnny View Post
    Thanks for the quick reply, Chuck! Good info and advice. I like your question of asking the Urologist what he would do if it was his life!... John
    Years ago I thought this was a very good question. Then I gradually learned that doctors treating prostate cancer were mostly not that totally objective, unbiased folks I had put on a pillar - my fault, not theirs. I'm convinced that most doctors are talented, hard-working and dedicated to their patients, but that does not exclude a natural bias that comes from their choice of specialty, training, career, and how they earn their money. But the bottom line for me is that surgeons (urologists) overwhelmingly recommend surgery, and radiation oncologists overwhelmingly recommend radiation according to published research. It's kind of like asking a Ford salesman if he thinks a Ford or Chevy is best.

    If you want a good shot at a more objective answer to that question, get an appointment with a medical oncologist who is independent of a surgeon or radiation oncologist you might also see. Medical oncologists are infrequently or rarely involved in early treatment, so they have no ax to grind, and they tend to keep up with research on all types of treatment of prostate cancer. Another route is to get an opinion from a radiation oncologist who is independent of your urologist, not one he recommends to you and with whom he likely has a business relationship such as an informal understanding that you will confirm my recommendation of surgery and I'll send you patients with advanced cases that I would rather not treat.

    If you do ask that question to your urologist and get a reply that he prefers surgery because that's what he does and believes in, but that radiation these days (modern radiation) is at least as good as surgery, you have found one of the minority of urologists who is keeping up with research outside his field and is objective.

    I hope to have time to respond further about your situation.

    ….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.

    Last edited by IADT3since2000; 05-06-2021 at 10:16 AM. Reason: Changed "the" to "that".

     
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    Old 05-06-2021, 06:59 AM   #8
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Welcome Mr. Johnny glad you found us and sorry as well. Your biopsy clearly rules out active surveillance and some form of treatment is necessary. Every treatment has unwanted side effects and it’s important to find the treatment that will cure the cancer with side effects you can live with. This site will help. Another site that provided good information to me was prostatecancerfree.org. The data is a little dated but the success graphs by risk level helped especially when I started by ‘clearing’ the chart and adding one treatment choice at a time. I’m biased towards radiation and believe every newly diagnosed guy should understand the radiation options before making a treatment choice.
    __________________
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    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
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    PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8

     
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    Old 05-06-2021, 10:20 AM   #9
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Good work so far! Your PSA is very high for what the biopsy reveals. I suggest a second opinion on the biopsy results. And, the genetics testing recommended by Djin.

    You want to treat this.
    __________________
    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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    Old 05-06-2021, 11:11 AM   #10
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Hi again John.

    Here are more questions for the urologist:

    Is the pathologist who interpreted the biopsy specimens an expert specializing in prostate cancer pathology or a general pathologist, and should I get a second opinion from an expert pathologist?

    (My layman’s hunch is that this pathologist knows what he or she is doing because the report is appropriately thorough and detailed, but that is not a guarantee of expertise.)

    A related question is whether the urologist knows that the radiologist who interpreted the scan is highly experienced or not? This was an important issue several years ago, but now most large cities and major institutions have radiologists who are good at interpreting mpMRI images (multiparametric MRI: anatomy, water diffusion, blood environment). You might also want to contact the radiologist’s office directly and ask. I posted about that topic here at https://www.healthboards.com/boards/cancer-prostate/1050315-lessons-2020-pcri-conference-2-selecting-your-mri-radiologist.html .

    I too feel a consultation with a radiation oncologist is important to give you a good sense of the options, and indeed, there are a number of options within the field of radiation. In general, surgery and radiation are about equally (highly) effective for this type of situation (favorable intermediate-risk Gleason, possibly high-risk but fairly likely also intermediate risk PSA based on suspected boost from BPH and infection (variance, especially substantial decrease) as well as cancer, and likely organ confined disease, meaning that PSA caused by the cancer is probably lower than the levels showing in the test, and that is what really counts). I too like the idea of further genetic/biomarker testing.


    Because both radiation and surgery can do the job cancer-wise, the prospects for burden from long-term side effects should weigh heavily in your decision. Ask both the surgeon and radiation doctors about the odds of each typical long-term side effect, and also about the probabilities for different degrees of severity for each, as well as countermeasures to prevent or handle the side effects if they occur. Research has established figures for these questions, but hopefully the doctors will give you a good sense for what to expect. In general, many patients have no significant long-term side effects, but many have some that are quite mild, such as surgery patients needing to wear a pad a day for very mild urinary incontinence. Radiation side effects were awful a couple of decades ago, but there has been vast improvement, and now the odds are down to a handful of percentage points for most of the side effects, with SpaceOAR gel successful in reducing the odds of rectal side effects to a really low level. Ask each doctor about side effects from the other specialty: ask the radiation guy about surgery, and vice versa. While you will probably need at least a grain of salt to season the answers, they might provide you with leads and food for thought. The book “The Key to Prostate Cancer,” Mark Scholz, MD, and 29 others, has several chapters that go into these issues. There is more to be said about talking to a radiation oncologist, but let’s put that aside for now.

    If it were me, I would go with what is known as SBRT radiation, which can be delivered within two weeks in as few as four or five sessions (usually five), and may or may not also involve four months of ADT (androgen deprivation therapy), the usual range until recently for intermediate-risk cases, but arguably not necessary with SBRT and appropriate patients. I would choose it because of its proven high effectiveness and fairly low level of side effects. As a second choice, I would go with IMRT (Intensity Modulated Radiation Therapy), which is what I had, and which may have a slightly lower level of effectiveness but an arguably even lower level of side effects. That said, surgery would also be a reasonable choice.

    ….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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    Old 05-08-2021, 09:10 AM   #11
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    An update:

    Yesterday I had my meeting with the urologist from the University of Minnesota Urology to discuss the results of my biopsy. The conversation went well, here are some of the key points of our discussion. Would welcome your thoughts on our meeting.

    • The first part of or discussion focused on explaining the results of the biopsy, which I have previously posted in this thread. I appreciated the thoroughness and detail of his explanation, as he made no assumptions about my knowledge.

    • With a Gleason 3+5=7 plus my initial PSA of 27.1 and 7 of 14 cores positive we need to act on this. He briefly gave me a history of what Gleason scores are and explained how/why treatments/surveillance are chosen based on each situation. He says my situation needs treatment and that I have two options RP or radiation of EBT plus hormone.

    • He asked if I have a radiation oncologist. If not, they could set me up with one at the University of Minnesota.

    • He said as a surgeon he is partial to surgery, but many men are comfortable with radiation and have experienced good results. He wants me to have all the information on both types of treatment and the decision will be mine after I have met with an oncologist and discussed radiation treatment, side effects, potential outcomes and my personal case. I found it comforting that he didn’t push surgery and says he wants me to be informed, his job is to help educate me and answer questions and he is here for surgery if that is my choice.

    • We then discussed what RP is, how its done, side effects, all potential outcomes.

    • He is scheduling a pet scan as soon as possible, perhaps as soon as this week if scheduling allows. He felt it would be good to do this additional bone and pelvis scan due to high PSA, number of positive cores, etc.

    • Once the results of the scan are back, I will meet again separately with him (urologist) and the radiation oncologist to review results, then I will make my decision.

    • I did ask about the genomic test, as suggested to me. He said that it is a good test and useful, especially when deciding treatment in lower grade cancers. Given that we will do full treatment (my words, not his) he thought we didn’t need to do genomic testing.

    I’m sure I’ve left some things out. Typing this at home and my notes are at the office. I have some answers now and a few more questions that I imagine will be answered by the pet scan. Then, discussion with the oncologist and it will be time to make a decision on treatment.

    Are we on the right track?

    John

     
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    Old 05-08-2021, 09:18 AM   #12
    DjinTonic
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Yes, you're on the right track. Just a typo: you are 3+4, not 3+5. A genomic test on RP tissue will be more accurate than on biopsied tissue, and if you choose RT a test on the biopsied tissue can wait.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 05-08-2021, 12:47 PM   #13
    MrJohnny
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Quote:
    Originally Posted by DjinTonic View Post
    Yes, you're on the right track. Just a typo: you are 3+4, not 3+5. A genomic test on RP tissue will be more accurate than on biopsied tissue, and if you choose RT a test on the biopsied tissue can wait.

    Djin
    Thank you, Djin. Yes, that was a typo. I am 3+4=7.

    One quick question, are you aware of any statistics about pet scan findings that correlate with Gleason scores or PSA levels?

    Cheers,

    John

     
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    Old 05-08-2021, 02:18 PM   #14
    DjinTonic
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Did he say what kind of PET scan it wtll be? Some newer ones are very good at locating any sources of PET outside the prostate, be it local spread or mets.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 05-08-2021, 07:18 PM   #15
    MrJohnny
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Quote:
    Originally Posted by DjinTonic View Post
    Did he say what kind of PET scan it wtll be? Some newer ones are very good at locating any sources of PET outside the prostate, be it local spread or mets.

    Djin
    Djin,
    He did not specify. Is there a specific type I should ask for?
    Thank you,
    John

     
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