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Thread: Location of positive cores in biopsy.

  1. #21
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    Quote Originally Posted by Another View Post
    star0210,

    Read AceVA's signature closely. Note the large difference between diagnostic values and actual pathology after surgery and subsequent treatment. This disparity between what it appears to be and what it turns out to be is a risk for everyone, but especially for younger men who present early.

    I am not attempting to be gloom and doom, but making clear diagnosing this disease accurately is difficult and not something to depend on.

    There is a sticky above for abbreviations.
    Thatís definitely my concern....whatís there in the parts that arenít biopsied?

  2. #22
    Your husband appears to see his choice as AS or RP(removal), and that is causing his hesitation in exploring treatment.

    His choices are not so either-or. According to the 600,000 patient SEER database, newly diagnosed men are choosing active surveillance, surgery, and radiation in equal numbers. Certainly, the several types of radiation should be researched.

    The two advanced types or radiation, SBRT/Cyberknife and proton beam, are showing very low recurrence rates. Brachytherapy, which comes in two forms, is well proven and many men report no significant side effects.

    For now, the plan to wait and have an MRI targeted biopsy makes perfect sense to me. Then again, with neither treatment nor progression over ten years, my experience is different from most of the others here.

    I recommend that you buy Dr. Mark Scholzí new book The Key to Prostate Cancer. He interviewed 30 prostate cancer experts and presents their descriptions of the treatments that they provide for men at different risk levels.
    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.

  3. #23
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    Quote Originally Posted by OldTiredSailor View Post
    I can appreciate your husband's thought process at PSA=4.5 / age 51. You can see from my signature how I managed my 4.0 at age 63 (but I was very fit and physically active so thought of my self as "just a little past middle age") when I was so busy sailing our boat and riding my mountain bike throughout the Cascade and Sierra Nevada mountains. I had no time to deal with Prostate Cancer and 4.0 is such a small number (or so I thought at the time!) My long time primary care physician (PCP) was an internist and also had little interest in educating me about PCa.

    The PSA value went up and down over the next two-years and I and my PCP continued to pretend there was no problem. And, I continued to greatly enjoy life while exploring the US West Coast on our boat and bicycling thousands of miles a year. I had retired at age 52 (1999) and was bound and determined to get the most out of life while I was still "young" and physically able. My wife retired in 2013 and she and I then got really serious about exploring on our boat and bicycling all over Southern California. It was very easy to "forget" my rising PSA. During the 2013 - 2017 time frame neither of my new San Diego PCP's thought it necessary to have my PSA tested, despite knowing my PSA history.

    As you can see, it all caught up with me in summer 2018 and I am now waiting on Decipher to tell me if my 8-year roll of the dice (2010/PSA=4.0 to 2018/PSA=9.2) will have long term consequences. I do know that I lived my life to the fullest extent possible during that time and never thought about my cancer that I was allowing to grow. At this point, 14-months post-RP with a slowly rising ĶPSA, I have no regrets about waiting to treat my PCa at age 71 rather than in my early-60s when prudence would have dictated initial treatment.

    Now that I am over a year beyond surgery and have a pretty good idea about the long term side effects - I've 'gotta tell your husband that I have almost NONE!

    I play competitive pickleball at a high level with "kids" 20-years younger than me for two or three hours every day. I ride my street bicycle long distances at high work rates just as I always did. My erections are not as firm as they were prior to the surgery but they are functional and my wife of 45-years says she has no complaints or concerns. I do suffer very minor bladder leakage when lifting heavy objects or straining my gut while working. But, I don't wear any kind of pad or protection and my underwear stay dry almost all the time.

    At this point - it is almost as if I had never been treated for PCa.

    SO - life will go on after treatment and, most likely, that life will be pretty much the same as you two knew before treatment.

    When to start treatment is a difficult choice and knowing what I know now about the long term side effects of RALP - I probably would have opted for treatment at age 63 rather than 71.

    You are taking the right approach to your husband's PCa condition so keep asking questions and collecting information!
    Thank you for sharing. We are boaters too....power though, not sail. We spend a lot of time out on the water and doing the great loop is on our bucket list for when we retire.

  4. #24
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    Quote Originally Posted by ASAdvocate View Post
    Your husband appears to see his choice as AS or RP(removal), and that is causing his hesitation in exploring treatment.

    His choices are not so either-or. According to the 600,000 patient SEER database, newly diagnosed men are choosing active surveillance, surgery, and radiation in equal numbers. Certainly, the several types of radiation should be researched.

    The two advanced types or radiation, SBRT/Cyberknife and proton beam, are showing very low recurrence rates. Brachytherapy, which comes in two forms, is well proven and many men report no significant side effects.

    For now, the plan to wait and have an MRI targeted biopsy makes perfect sense to me. Then again, with neither treatment nor progression over ten years, my experience is different from most of the others here.

    I recommend that you buy Dr. Mark Scholz’ new book The Key to Prostate Cancer. He interviewed 30 prostate cancer experts and presents their descriptions of the treatments that they provide for men at different risk levels.
    I know my husband ordered a few books but I don’t know which ones. I will suggest that one if it’s not one he’s already ordered.
    He’s researching all available treatments but (as of now) he’s not leaning towards radiation as a primary treatment. We are still wrapping our heads around this. It’s just a week today that we received the diagnosis. Already it feels like so much longer than that! His uro did stress to us that we have time and don’t need to make any decisions right away. He wasn’t even going to order the MRI until sometime after the new year. Hubby’s met his deductible for the year so he said he just as soon take advantage of that and do as much as he can testing wise before the end of the year so Dr said December. Seems like a lifetime away to me!

  5. #25
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    Quote Originally Posted by OldTiredSailor View Post
    Just look at my signature!

    tumor was 20-times the size TRUS biopsy and 3TmpMRI reported
    tumor was bi-lateral rather than one side as reported by biopsy
    there was extra capsular extension despite MRI saying capsule was intact
    prostate was twice size reported by biopsy and MRI

    Urologist doing biopsy had over 25-years experience and had done "many, many thousands" of similar procedures.

    3TmpMRI was at a state of the art facility and read/interpreted by a radiologist who had worked with my urologist (MO) for "decades" while managing prostate cancer in thousands of cases.

    The only way to really know is get in there and look around (IMHO!)
    Thatís super scary! That also makes me wonder how accurate the genomic testing is given it can only test the positive biopsied cores. Sigh.

  6. #26
    Top User
    Join Date
    Aug 2016
    Posts
    1,940
    Often not very. AceVA's biopsy genomics was low risk. It was actually high risk.

    Every piece of info is important, but you can't hang your hat on any one piece. Look at them all.

    I recommend Walsh's book.

  7. #27
    Based on what you posted there is slightly less than a 50% chance the cancer is organ contained.
    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)

  8. #28
    Quote Originally Posted by Duck2 View Post
    Based on what you posted there is slightly less than a 50% chance the cancer is organ contained.
    Can you cite the nomogram, study, or other published criteria that supports your conclusion?
    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. #29
    Quote Originally Posted by star0210 View Post
    ...
    He’s not afraid of dying in the next 5-10 yrs with a low risk non aggressive contained G6.
    No one dies from prostate-confined PCa, G6 or otherwise.

    That said, have you though of sending your biopsy slides to Dr. Epstein at JH for a second pathology opinion? That's usually prudent when considering AS. Weighing what may have been missed by the biopsy is one concern; making sure what was found is actually G6 is another.

    Djin

  10. #30
    Experienced User
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    Quote Originally Posted by DjinTonic View Post
    No one dies from prostate-confined PCa, G6 or otherwise.

    That said, have you though of sending your biopsy slides to Dr. Epstein at JH for a second pathology opinion? That's usually prudent when considering AS. Weighing what may have been missed by the biopsy is one concern; making sure what was found is actually G6 is another.

    Djin
    Yes but the slides have been sent off for the genomic testing so we can’t until they come back. I was wondering if it might be better to wait and send the next biopsy results which would be more samples instead of this one. Thoughts?

 

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