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Thread: Location of positive cores in biopsy.

  1. #121
    Experienced User
    Join Date
    Oct 2019
    Posts
    81
    Quote Originally Posted by KarlEmagne View Post
    Star, I'd say the PSA rise is largely due to the biopsy. Took 6 weeks after mine for blood clots to clear and my prostate to cheer up.

    Any updates on the MRI? Getting it done where you're planning on continuing with treatment may make sense. But I understand you're not keen on sitting around Mon-Thu with a Fri before X-Mas departure.

    Agree with others MRIs are probably overrated. No definitive answers, maybe some guidance on hitting the right spots in biopsies and planning surgery if disease isn't organ confined. I passed on a CD with my MRI results to my surgeon and I don't think it made any difference.
    Karl, thanks. I’m thinking it’s up from the biopsy as well. It just doesn’t make any sense otherwise.

    I spoke to his uro’s nurse and she said it would be no problem for uro to order the MRI at our appt on the 27th and should be no issue getting it done before we go to MDA. I like this plan better as it will make our appt there a bit more meaningful since they will have that additional piece of the puzzle.
    Whether they will schedule a second biopsy there or we do it here remains to be seen.
    We do really like our Uro here.
    Wife posting
    Age 51
    PSA 9/2019 - 4.8
    fPSA - 9%
    4K score 12%
    Bx 9/2019
    Final Diagnosis - prostate carcinoma
    Highest Gleason Score - 3+3=6
    Number of cores positive - 4
    Percent of cores positive - 28.6% (4 of 14 cores - 12 samples taken. 2 broke in half)
    Maximum % of tumor in positive cores - 60%
    Overall prostatic tissue involvement - 5.8%
    Perineural invasion - present
    Lymph-vascular invasion - not identified
    Periprostatic fat invasion/extrsprostatic extension - not identified

    Left base - G3+3=6. 4% involved. Perineural invasion present.
    Right apex - G3+3=6. 40% involved.
    Right lateral mid - G3+3=6. 5% involved.
    Left lateral apex - G3+3=6. 40% involved.

    OncoDX score 23. Low Risk.
    High Grade Disease 14%
    Non Organ Confined Disease 16%

  2. #122
    Experienced User
    Join Date
    Oct 2019
    Posts
    81
    We received a denial from UHC in the mail for the OncoDX test. They said it’s not helpful for our situation.
    Wife posting
    Age 51
    PSA 9/2019 - 4.8
    fPSA - 9%
    4K score 12%
    Bx 9/2019
    Final Diagnosis - prostate carcinoma
    Highest Gleason Score - 3+3=6
    Number of cores positive - 4
    Percent of cores positive - 28.6% (4 of 14 cores - 12 samples taken. 2 broke in half)
    Maximum % of tumor in positive cores - 60%
    Overall prostatic tissue involvement - 5.8%
    Perineural invasion - present
    Lymph-vascular invasion - not identified
    Periprostatic fat invasion/extrsprostatic extension - not identified

    Left base - G3+3=6. 4% involved. Perineural invasion present.
    Right apex - G3+3=6. 40% involved.
    Right lateral mid - G3+3=6. 5% involved.
    Left lateral apex - G3+3=6. 40% involved.

    OncoDX score 23. Low Risk.
    High Grade Disease 14%
    Non Organ Confined Disease 16%

  3. #123
    Most < age. 65 health insurance doesn’t cover genomic tests.
    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.

    3/6/19. Pathology - Grade Group 4 Intraductal Carcinoma
    T3aNO, 1 mm EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.

    7 Nodes, SV, SM, PNI, and BNI were negative.

    LVI and Cribriform pattern present.

    Decipher .86 High Risk.

    Post Surgery PSA
    3/25/19 .03. (<1 month)
    4/25/19 <.03. (2 months)
    5/25/19 <.02. (3 months)
    9/10/2019. <.02. (6 months)
    11/27/2019. <.02. T<3. (9 months)

    3 Part Modality Treatment

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

    ADT - started 6/19, end date 6/21.

    ART - Completed 9/26/19. (78 Gy, yes, I glow in the dark)

  4. #124
    In one of your earlier posts you stated he finally had a DRE and nothing was felt. I don't want to rain on your parade about feeling good about that, but be advised a DRE can only feel one side of the prostate. I had DREs every year from age 50 and even the surgeon's DRE after my biopsy felt nothing unusual except that it felt like a prostate that had been biopsied. My Dx was at age 63.
    There is no right or wrong decision for treatment. Make the decision you are comfortable with and can live with and not second guess if all does not go optimally.

    6/2016 PSA 5.1, negative DRE
    6/2016 Urologist PSA 6.0, %free = <10% chance cancer, negative DRE
    12/2016 PSA 7.7, %free = 50% chance cancer, negative DRE
    2/2017 biopsy Hopkins 5/12, 4 3+3, 1 3+4 (5% 4), perineural invasion
    5/17/2017 Open RP by Dr Alan Partin - Hopkins
    5/2017 Pathology 3+4, T2x, +margin (6mm, 3+3), organ contained except unevaluable at +margin, moderate tumor extent
    seminal vesicles, lymph nodes all neg
    Age: 62 @ surgery
    8/2017 PSA < .1
    11/2017 PSA <.1
    5/2018 uPSA .06, standard .1
    8/2018 uPSA .07, standard .1
    11/2018 uPSA .10, standard .1
    12/29/2018 6 month Lupron shot
    1/22/2019 start SRT, 39 treatments, 5 days per week
    3/15/19 ended SRT with no significant side effects
    6/2019 PSA <.02
    11/2019 PSA < .014 (different lab)

  5. #125
    To add to the above, after surgery the pathologist could feel cancer in my prostate and that was with the whole gland in hand.
    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.

    3/6/19. Pathology - Grade Group 4 Intraductal Carcinoma
    T3aNO, 1 mm EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.

    7 Nodes, SV, SM, PNI, and BNI were negative.

    LVI and Cribriform pattern present.

    Decipher .86 High Risk.

    Post Surgery PSA
    3/25/19 .03. (<1 month)
    4/25/19 <.03. (2 months)
    5/25/19 <.02. (3 months)
    9/10/2019. <.02. (6 months)
    11/27/2019. <.02. T<3. (9 months)

    3 Part Modality Treatment

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

    ADT - started 6/19, end date 6/21.

    ART - Completed 9/26/19. (78 Gy, yes, I glow in the dark)

  6. #126
    Experienced User
    Join Date
    Oct 2019
    Posts
    81
    We had a followup with our local Uro this morning.
    He suggested we just get the MRI done at MDA. He said he would trust them more than the radiologists around here.
    I guess I don't understand enough about how MRI's work. I never intended to trust a local radiologist's interpretation of the MRI. But I was under the impression that a 3t machine is a 3t machine is a 3t machine.
    My thought was have it done here, and have MDA interpret the images.
    But it looks like now we will just sit in Houston that week. Meet with surgeon and RO Monday morning and then have MRI Thursday night at 7pm and then drive home on Friday. Uro suggested we contact them and see if they can move the MRI up to the week before since Hubby will already be there that whole week for work. David doesn't think they will do any sort of tests without seeing him first. I said it can't hurt to ask.

    He reiterated his stance on not choosing any type of radiation as a first treatment because of his age. He said many of his patients are people who have underwent radiation and now he's treating them for the aftereffects. He said he himself would never choose radiation. He also reiterated his complete support for AS. It sounded as though he would be comfortable choosing that now without having any further testing. He doesn't see a need to rush for a MRI or a repeat targeted, larger biopsy. I simply said, YOU don't see a need. He chuckled. He understood where we were coming from. We won't be comfortable making that decision until we have more data. At the very least a MRI.

    That may not be correct thinking...or rather maybe we (I) am overthinking it. If it had just been one or two cores positive maybe I would feel better about it. But 4 cores - one in each quadrant - with perineural invasion....I just am not comfortable in believing at this time that something may have been missed. I think David agrees with that also.

    Other than that, he said come back in 3 months. Sigh.
    Wife posting
    Age 51
    PSA 9/2019 - 4.8
    fPSA - 9%
    4K score 12%
    Bx 9/2019
    Final Diagnosis - prostate carcinoma
    Highest Gleason Score - 3+3=6
    Number of cores positive - 4
    Percent of cores positive - 28.6% (4 of 14 cores - 12 samples taken. 2 broke in half)
    Maximum % of tumor in positive cores - 60%
    Overall prostatic tissue involvement - 5.8%
    Perineural invasion - present
    Lymph-vascular invasion - not identified
    Periprostatic fat invasion/extrsprostatic extension - not identified

    Left base - G3+3=6. 4% involved. Perineural invasion present.
    Right apex - G3+3=6. 40% involved.
    Right lateral mid - G3+3=6. 5% involved.
    Left lateral apex - G3+3=6. 40% involved.

    OncoDX score 23. Low Risk.
    High Grade Disease 14%
    Non Organ Confined Disease 16%

  7. #127
    Top User
    Join Date
    Aug 2016
    Posts
    1,929
    It is common for professionals to perform their services in a complete fashion. It provides a single source of responsiblity and allows consistent preferences through out the entire proccess. Healthcare is a team approach. Nuances and preferences are important. The ability to read an MRI improves when the setting, equipment, operators, and methods and procedures are consistently and rigoursly maintained from beginning to end. It's not a right way or wrong way, but their way.

    I'm with you on your diligence. I'd act with what you already know, so I certainly agree with more agressive diagnostics if it's what you want to proceed. It will be interesting to see MDA's approach compared to your current care giver. I do not see your husband as an AS candidate. You may want to know or find out more before you proceed, and it requires more time and another biopsy, but that is distinct from entering an AS program.

    In your language, consider instead of something may have been missed, there may be more to know or find. Something missed implies a mistake. Something more to know or find implies the deligence and tenacity this malady demands and acknowledges the limits of present technology. It's important to stay present to the fallibilities of our best efforts.
    Born 1953
    family w/PCa; grandfather, 3 brothers
    07-12-04 PSA 1.90
    07-10-06 PSA 2.02
    08-30-07 PSA 3.20
    12-01-11 PSA 5.69 Internist recommends urologist, I say no
    05-16-12 PSA 4.76 manipulate w/diet & supplements
    12-11-12 PSA 5.20, Health system changes to 3 years on testing
    03-07-16 PSA 7.20 Internist adamant on urologist
    DRE smooth, enlarged
    03-14-16 TRUS biopsy-prostatic adenocarcinoma 1%-60% across 8 of 12 samples, Gleason 3+3=6
    03-31-16 MRI pelvis w/o dye
    05-04-16 DaVinci prostatectomy, nerve sparing, Dr. Kent Adkins - recommend
    Final Path; weight 65g, lymph nodes, seminal vesicles, capsule, margin all negative, Gleason 3+4=7, Tumor volume 35%, +pT2c
    Catheter out - 16 days
    Incontinence at 6mos is minimal – no pad
    Cialis 3x/wk & Viagra on occasion
    Begin self-injection needle therapy for erections, stop after 6 due to onset of Peyronie’s
    Erections 100% - 14 months
    5-21-19 PSA <0.02, Zero Club 3.5 years

  8. #128
    star, Another and I respect each other, but rarely agree. This is a time for agreement. Like Another, I don't see AS as being a durable choice with his pathology.

    The one caveat that I would add to the advice you have been given about radiation is not that there have been later side effects and cancers, but rather when those patients were treated, and with what machines and protocols. If they were treated with EBRT before 2005, then, yes, there were those issues.

    That is not the case today, especially with IMRT, SBRT, and protons. Make sure that you understand this distinction, and the lower toxicities of newer RT.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  9. #129
    Experienced User
    Join Date
    Oct 2019
    Posts
    81
    Quote Originally Posted by Another View Post
    It is common for professionals to perform their services in a complete fashion. It provides a single source of responsiblity and allows consistent preferences through out the entire proccess. Healthcare is a team approach. Nuances and preferences are important. The ability to read an MRI improves when the setting, equipment, operators, and methods and procedures are consistently and rigoursly maintained from beginning to end. It's not a right way or wrong way, but their way.

    I'm with you on your diligence. I'd act with what you already know, so I certainly agree with more agressive diagnostics if it's what you want to proceed. It will be interesting to see MDA's approach compared to your current care giver. I do not see your husband as an AS candidate. You may want to know or find out more before you proceed, and it requires more time and another biopsy, but that is distinct from entering an AS program.

    In your language, consider instead of something may have been missed, there may be more to know or find. Something missed implies a mistake. Something more to know or find implies the deligence and tenacity this malady demands and acknowledges the limits of present technology. It's important to stay present to the fallibilities of our best efforts.
    You are correct....words do indeed matter.
    We, too, are interested to hear MDA’s take on the situation. I’m still working on the patience thing. I had it in my head that we could have the MRI beforehand and then the appt at MDA would actually be meaningful. Now I have to adjust my thinking and muster up more patience.

    I read another post where someone went to a consult with MDA with a similar but not the same situation and it seemed they were really pushing proton therapy as apparently they have some big new beautiful proton center that they just invested a gazillion dollars into. It will be interesting to see if they push that for us as well.
    Wife posting
    Age 51
    PSA 9/2019 - 4.8
    fPSA - 9%
    4K score 12%
    Bx 9/2019
    Final Diagnosis - prostate carcinoma
    Highest Gleason Score - 3+3=6
    Number of cores positive - 4
    Percent of cores positive - 28.6% (4 of 14 cores - 12 samples taken. 2 broke in half)
    Maximum % of tumor in positive cores - 60%
    Overall prostatic tissue involvement - 5.8%
    Perineural invasion - present
    Lymph-vascular invasion - not identified
    Periprostatic fat invasion/extrsprostatic extension - not identified

    Left base - G3+3=6. 4% involved. Perineural invasion present.
    Right apex - G3+3=6. 40% involved.
    Right lateral mid - G3+3=6. 5% involved.
    Left lateral apex - G3+3=6. 40% involved.

    OncoDX score 23. Low Risk.
    High Grade Disease 14%
    Non Organ Confined Disease 16%

  10. #130
    Experienced User
    Join Date
    Oct 2019
    Posts
    81
    Quote Originally Posted by ASAdvocate View Post
    star, Another and I respect each other, but rarely agree. This is a time for agreement. Like Another, I don't see AS as being a durable choice with his pathology.

    The one caveat that I would add to the advice you have been given about radiation is not that there have been later side effects and cancers, but rather when those patients were treated, and with what machines and protocols. If they were treated with EBRT before 2005, then, yes, there were those issues.

    That is not the case today, especially with IMRT, SBRT, and protons. Make sure that you understand this distinction, and the lower toxicities of newer RT.
    You are the person of all the AS proponents I see around the internet whose opinion I value the most. I’m not a fan of zealots of any stripe or people so hung up on their own beliefs and biases that they refuse to be open minded about anything else. You are definitely not like that which I greatly appreciate.

    That is why I don’t like your comment. Lol

    We are definitely not taking the Uro’s opinion as gospel. As I just said to Another, we are very curious to see what MDA will recommend. I do think at this time, if treatment is necessary, hubby is still leaning towards removal.
    Wife posting
    Age 51
    PSA 9/2019 - 4.8
    fPSA - 9%
    4K score 12%
    Bx 9/2019
    Final Diagnosis - prostate carcinoma
    Highest Gleason Score - 3+3=6
    Number of cores positive - 4
    Percent of cores positive - 28.6% (4 of 14 cores - 12 samples taken. 2 broke in half)
    Maximum % of tumor in positive cores - 60%
    Overall prostatic tissue involvement - 5.8%
    Perineural invasion - present
    Lymph-vascular invasion - not identified
    Periprostatic fat invasion/extrsprostatic extension - not identified

    Left base - G3+3=6. 4% involved. Perineural invasion present.
    Right apex - G3+3=6. 40% involved.
    Right lateral mid - G3+3=6. 5% involved.
    Left lateral apex - G3+3=6. 40% involved.

    OncoDX score 23. Low Risk.
    High Grade Disease 14%
    Non Organ Confined Disease 16%

 

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