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Thread: Not great news...

  1. #51
    Quote Originally Posted by Nonquixote View Post
    Neither of them have any idea what my treatment choice will ultimately be. My question to both was, "would you have the biopsy done?" To which both responded with an unequivocal "yes".

    Obviously a biopsy can present a less than complete picture, especially a random biopsy. To that end this next biopsy will be a fusion biopsy across the entire prostate, 16 needles. This will be the last.

    No doctor has suggested that my PCa shows any indication of being aggressive. Yes, younger men have a higher chance of having aggressive PCa, but there is no evidence that mine is aggressive. The half dozen docs that have given me a DRE have all said that they feel no abnormalities. Is it possible because of the volume of PCa that mine is aggressive and formed recently? It's possible, but no core shows that. It's also possible that my PCa has been slowly growing over years. Hard to know for sure since my last PCA was my only PCA. Ever.

    So what is it specifically that annoys you the most? Taking some time to research and gather additional information before making a decision? Or is it my tentative method of treatment?
    Just chiming in to say that you can feel only a small portion of the prostate on a DRE -- it's even been proposed that it be eliminated from PCa screening entirely! (That seems foolish to me--my doc felt a nodule, and we went on to another biopsy which found G10 cancer. When I asked him if he would have insisted on a biopsy based solely on my PSA increase if he had not felt the nodule, he shook his head side to side in a "hmmm" gesture and he paused, looked at my PSA rise and said "Well, we certainly would have discussed it.") So a positive DRE is fortuitous for finding canse; the opposite, a clear DRE, means little.

    You say "No doctor has suggested that my PCa shows any indication of being aggressive" That was, and probably still is, true of G6 on the average. However (1) we know from G6 men who opt for RP that a fair number of them are at diagnosis already harboring higher-grade lesions, and (2) genomics is revealing that some men have G6 with characteristics that make them high-risk for higher-grade lesions currently or in the future. Uros do have intuition base on experience, but they don't have psychic powers. The larger the prostate and the more G6 tissue found, the less good a AS candidate you are.

    Knowing what I know now, if I had had a B6 biopsy and been told I was a candidate for AS, I would have a genomics test done first thing.

    Djin
    Last edited by DjinTonic; 07-14-2019 at 10:29 PM.

  2. #52
    Quote Originally Posted by DjinTonic View Post
    Just chiming in to say that you can feel only a small portion of the prostate on a DRE -- it's even been proposed that it be eliminated from PCa screening entirely! (That seems foolish to me--my doc felt a nodule, and we went on to another biopsy which found G10 cancer. When I asked him if he would have insisted on a biopsy based solely on my PSA increase if he had not felt the nodule, he shook his head side to side in a "hmmm" gesture and he paused, looked at my PSA rise and said "Well, we certainly would have discussed it.") So a positive DRE is fortuitous for finding canse; the opposite, a clear DRE, means little.
    Obviously at least in my case it meant little. The PCP that did my first DRE prior to either my PCA3 test or my biopsy felt nothing either. Absence of evidence is not evidence of absence.

    AS is not an option for me, but I was considering an Oncytype DX test after my next biopsy. Regardless, I will be choosing a path for treatment after the results of my next biopsy.
    Dx at age 56
    Maternal uncle with PCa
    Gleason Score of 6 (3+3)
    6 of 12 biopsies positive 5%, 5%, 15%, 20%, 20%, 40%
    Awaiting next biopsy for mass that was missed on right side
    Adinocarcinoma
    Perineural invasion: present in 2 cores
    PSA 2.4 Free PSA .4, PCA3 Positive 53H
    Prostate volume 32 mL
    Currently researching treatment options

  3. #53
    Senior User
    Join Date
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    470
    Quote Originally Posted by DjinTonic View Post
    Just chiming in to say that you can feel only a small portion of the prostate on a DRE -- it's even been proposed that it be eliminated from PCa screening entirely! (That seems foolish to me--my doc felt a nodule, and we went on to another biopsy which found G10 cancer. When I asked him if he would have insisted on a biopsy based solely on my PSA increase if he had not felt the nodule, he shook his head side to side in a "hmmm" gesture and he paused, looked at my PSA rise and said "Well, we certainly would have discussed it.") So a positive DRE is fortuitous for finding canse; the opposite, a clear DRE, means little.

    You say "No doctor has suggested that my PCa shows any indication of being aggressive" That was, and probably still is, true of G6 on the average. However (1) we know from G6 men who opt for RP that a fair number of them are at diagnosis already harboring higher-grade lesions, and (2) genomics is revealing that some men have G6 with characteristics that make them high-risk for higher-grade lesions currently or in the future. Uros do have intuition base on experience, but they don't have psychic powers. The larger the prostate and the more G6 tissue found, the less good a AS candidate you are.

    Knowing what I know now, if I had had a B6 biopsy and been told I was a candidate for AS, I would have a genomics test done first thing.

    Djin
    Just chiming in, my pathology said, On palpation, an area of firmness is not identified.” That with the gland on the lab table.
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 R-LESS (Robotic Laparoendoscopic Single Site Surgery) outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)

    ADT - 6/3/19
    ART - 8/5/19

  4. #54
    Top User
    Join Date
    Aug 2016
    Posts
    1,645
    I'm not annoyed. My caution is stated. You declared your treatment choice is decided and you will consider changing if only one fact changes - G6. The one fact is not 100% reliable.

    I recommend your treatment choice be based on your entire profile each and every time you evaluate and make it until the time you initiate it.

    It is an automatic human bias to make a choice sooner than later to create a sense of resolution or a sense of peace. In doing so we are able to dismiss consideration of all the facts in combination thinking we have simplified our choice to one data point.

    Second, what is certain from your biopsy is a high volume of cancer. This is indicative of a more aggressive cancer. Typically this is accompanied with PSA gaining velocity to support it. You do not have this history. There is a small cohort of men who present a low PSA number with more aggressive cancer. You have both; a high volume and low PSA. All of this at a young age.

    I suggest you consider adding more weight to these facts than the G6.

    Finally, why would a higher Gleason score cause you to reconsider your treatment choice? A respect for cancer and our limits in diagnosing it suggests your treatment choice fit the possibility of a higher gleason score.

    Prostate cancer is multifocal and the newly discovered lesion has a high probability of being the same as the previously biopsied ones. The value in the second biopsy is the fact it increases the chances of more accurately revealing the nature of your cancer than finding the lesion to be different than the others, ie you now have 24 samples vs 12. There is a possibility (statistically 1 in 5) the first 12 missed a more aggressive cancer. Add your other risk factors and I will suggest those odds are greater.

    I think it is unnecessary for you to make your choice at this time even if you make it conditional. It reinforces an unnecessary bias that has to be mentally unwound before choosing again.

    I suggest your treatment choice be made for a minimum of an intermediate grade cancer. I am not suggesting a specific treatment, but a specific way of considering it.
    Last edited by Another; 07-15-2019 at 03:57 PM.

 

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