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Thread: Pathology report for Biopsy shows Gleason 10. Any advice?

  1. #11
    Experienced User
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    May 2019
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    Quote Originally Posted by Jessew View Post
    HI Michael. Thanks for your reply. Regarding your questions:

    A couple of questions:

    - Are you certain that the latest PSA is 97.2 and not 9.72?
    R97.20 is code for "elevated PSA" and not the actual PSA level.
    DOB: 10/1962

    6-01-15 PSA 2.5
    Having urination flow issue in first half of 2018. Flomax 6/1-6/21 - no help.
    6/25/18 PSA 14.25; Cipro 14 days
    8/1/18 PSA 17.44; rec. Urologist appt
    8/15/19 First Uro appt. + for bacteria. Cipro 4 weeks
    10/2/19 PSA 22.4; Still + for bacteria. Antibiotics 4wks
    12/28/19 PSA 27.5
    1/15/20 Biopsy results 6/12 cores positive - all left side; GS 4+3
    1/18/19 Bone scan and CT scan both negative
    2/15/19 Di Vinci RP
    2/18/19 Path report pT3a, GS 4+3 (60%+35%) 5% GS5, SM +, EPE +; LVI -, SVI -, LNI(9) - ; Tumor size: 3.5cmx3.5cmx1.5cm; single foci left side; right side nerves spared; SM+ at apex limited <1mm; benign prostatic cells at spared right nerve bundle. Prostate size 45gm.
    Cath out at 7 days: 100% continent with some ED; ok with 10mg Cialis.
    Decipher 0.73

    PostOp PSA testing:
    3/26/19 (6 weeks) 0.033
    5/10/19 (3 months) 0.010
    8/02/19 (6 months) 0.019
    8/30/19 (7 months-recheck) 0.024

  2. #12
    Newbie New User
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    Jul 2019
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    Quote Originally Posted by IndyGuy View Post
    R97.20 is code for "elevated PSA" and not the actual PSA level.
    Thanks! That issue is resolved.

  3. #13
    Quote Originally Posted by Jessew View Post
    Thanks! That issue is resolved.
    Good thing the code wasn't 972.0 !

  4. #14
    TY IndyGuy!!! Excellent Detective work and Solution to The Jessew Riddle!

    We can all sleep far better tonight!!!

    MF

  5. #15
    Quote Originally Posted by Southsider View Post
    It would seem pretty unlikely for PSA to go from 10 to 97 in a single month. I suppose if you had the blood drawn right after the biopsy? Trauma to the urinary system can cause a temporary, astounding leap in PSA?

    But your PSA score is definitely not 9.72, as that would indicate they used an expensive ultra sensitive PSA test- which would be pointless before treatment.
    Every PSA I have had done since 2013 was 2 decimal.
    YOB 1957

    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.

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carcinoma
    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)
    9/10/2019. <.02. (198 days)

    ADT - 6/19 - 6/21
    ART - 8/19 - 9/19. (78 Gy, yes, I glow in the dark)

  6. #16
    Jesse, congrats on your treatment facility. Nothing better for peace of mind than getting results quickly. Wish you all the best.
    Last edited by KarlEmagne; 07-11-2019 at 04:11 AM.
    --------------
    DOB 1965
    PM me for PSA graphing service & detailed story
    PSA 6.8 11/17
    PSA 7.5 04/18
    MRI 05/18 inconclusive, PI-RADS3?
    PSA 11.8 01/19
    PSA 10.1 02/19
    12 core random biopsy 02/19 (4+3)=7 suspicion of vascular invasion, grade 4 cribriform pattern, no PTEN loss
    Bone scan negative 04/19
    PSA 13.3 04/01/19 pre-surgery significant urinal symptoms and some ED
    RRP 04/04/19
    pT2c pN0 (0 of 7 lymph nodes positive) pL0 pV0 R0(local) Pn1
    Perineural growth predominantly on right hand side, tumour diameter 15mm 90% G4 10% G3
    Prostatic parenchyma with glandular hyperplasia and chronic granular, partly purulent inflammation.
    PSA 0.14 04/30/19
    PSA 0.02 05/13/19
    PSA 0.008 06/04/19

  7. #17
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Posts
    7,215
    Whew! Looks like your PSA is not nearly as bad as we first thought, Jesse.

    If it is similar to the previous reading, that offers lots of hope. And the other items on the biopsy report also seem to be in your favor, as others have noted.

    If next week's scans come out clean you might stand an excellent chance of being cured even as a Gleason 10.

    As I welcome you to the forum, i'm also happy to note that -- as you begin the road ahead -- we will be here with you every step of the way!!

    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  8. #18
    Jesse, do you have details from a printed biopsy report you could share? You say all cores were Gleason 10 and I am wondering if maybe that's a miscommunication and really *one* core was Gleason 10 and all the others had cancer, too.
    --------------
    DOB 1965
    PM me for PSA graphing service & detailed story
    PSA 6.8 11/17
    PSA 7.5 04/18
    MRI 05/18 inconclusive, PI-RADS3?
    PSA 11.8 01/19
    PSA 10.1 02/19
    12 core random biopsy 02/19 (4+3)=7 suspicion of vascular invasion, grade 4 cribriform pattern, no PTEN loss
    Bone scan negative 04/19
    PSA 13.3 04/01/19 pre-surgery significant urinal symptoms and some ED
    RRP 04/04/19
    pT2c pN0 (0 of 7 lymph nodes positive) pL0 pV0 R0(local) Pn1
    Perineural growth predominantly on right hand side, tumour diameter 15mm 90% G4 10% G3
    Prostatic parenchyma with glandular hyperplasia and chronic granular, partly purulent inflammation.
    PSA 0.14 04/30/19
    PSA 0.02 05/13/19
    PSA 0.008 06/04/19

  9. #19
    Newbie New User
    Join Date
    Jul 2019
    Posts
    5
    Quote Originally Posted by KarlEmagne View Post
    Jesse, do you have details from a printed biopsy report you could share? You say all cores were Gleason 10 and I am wondering if maybe that's a miscommunication and really *one* core was Gleason 10 and all the others had cancer, too.
    Karl- I did receive a copy of the actual final path report. Unfortunately, all the cores taken had the Gleason 10 rating.

  10. #20
    Quote Originally Posted by Jessew View Post
    Karl- I did receive a copy of the actual final path report. Unfortunately, all the cores taken had the Gleason 10 rating.
    Stay positive, Jesse, there may well be some good news coming too. For example, not all high-Gleason cancers have a high propensity to metastasize.

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg., 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
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

 

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