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Thread: MRI Results

  1. #21
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    Quote Originally Posted by ASAdvocate View Post
    Star, I have been trekking in the jungles of Suriname and French Guiana, and haven’t had the Internet access to read what advice you have received on the many other forums we both frequent.

    However, I do see here that you are choosing between AS and RP. Perhaps you have already seen this new video from medical oncologist Mark Scholz. If not, it is being widely circulated, and it is, IMHO, essential to your decision.

    https://m.youtube.com/watch?v=Pya8N78bR7s
    Thanks...I will check it out and send it to David.
    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. #22
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    Just noticed the OncoDX risk factors, a 1 in 7 chance of high grade cancer and non organ confined. Those are pretty good odds for playing the lottery, not for staring down cancer, imo.

    1 in 7 is the general population risk factor for getting prostate cancer. You can now see they may not be good odds for betting a life with your recent experience of being the 1 in 7.

    This is cancer your betting against. Losing isn't something you get to walk away from.

  3. #23
    Quote Originally Posted by Another View Post
    Just noticed the OncoDX risk factors, a 1 in 7 chance of high grade cancer and non organ confined. Those are pretty good odds for playing the lottery, not for staring down cancer, imo.

    1 in 7 is the general population risk factor for getting prostate cancer. You can now see they may not be good odds for betting a life with your recent experience of being the 1 in 7.

    This is cancer your betting against. Losing isn't something you get to walk away from.
    Those were the exact odds that I was given after getting OncotypeDX results from JHís approval trial of that assay.

    I was happy to see those odds, as were my doctors. That confirmed my suitability for AS.

    A decade later, the odds remain in my favor, with no side effects from treatment.

    Much depends on each personís risk comfort level.
    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.

  4. #24
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    Quote Originally Posted by ASAdvocate View Post
    Those were the exact odds that I was given after getting OncotypeDX results from JHís approval trial of that assay.

    I was happy to see those odds, as were my doctors. That confirmed my suitability for AS.

    A decade later, the odds remain in my favor, with no side effects from treatment.

    Much depends on each personís risk comfort level.
    Much depends on the total profile. There is more to risk assessment than one number. At best, you were 65 at the time of the test, maybe older. He is 51. A cancer that presents 14 years sooner than yours is by its very nature more aggressive. And his larger volume means the differential is even greater than the 14 years.

    Your profile is of the garden variety low risk "you will die of something else" prostate cancer. Already, simply on his age, his is not.

  5. #25
    Quote Originally Posted by Another View Post
    Much depends on the total profile. There is more to risk assessment than one number. At best, you were 65 at the time of the test, maybe older. He is 51. A cancer that presents 14 years sooner than yours is by its very nature more aggressive. And his larger volume means the differential is even greater than the 14 years.

    Your profile is of the garden variety low risk "you will die of something else" prostate cancer. Already, simply on his age, his is not.
    With regard to age at diagnosis:

    More Aggressive Prostate Cancer in Elderly Men [2013, Full Text]

    Men aged ≥ 70 years (n = 3350, 30.2%), had a significantly higher clinical stage and biopsy Gleason grade.
    Definitive Radiotherapy for Older Patients with Prostate Cancer: Experience of a Medical Center in Taiwan [2017, Full Text]

    Compared with younger patients, older patients are more likely to have an aggressive form of the disease at diagnosis, but more often receive conservative treatment, including watchful waiting and primary androgen-deprivation therapy (ADT)
    Impact of Age at Diagnosis on Prostate Cancer Treatment and Survival [2011, Full Text]

    Conclusion
    Older patients are more likely to have high-risk prostate cancer at diagnosis and less likely to receive local therapy
    . Indeed, underuse of potentially curative local therapy among older men with high-risk disease may in part explain observed differences in cancer-specific survival across age strata. These findings support making decisions regarding treatment on the basis of disease risk and life expectancy rather than on chronologic age
    .
    DO ELDERLY MEN (>75) HARBOR MORE AGGRESSIVE PROSTATE CANCER? COMPARISON OF DECIPHER AND PAM50 TESTS AMONG DIFFERENT AGE GROUPS [2019

    CONCLUSIONS:
    Older men with lower grade tumors, as opposed to higher grade tumors, harbored worse disease based on genomic risk models.
    The accepted paradigm of elderly PC patients being treated conservatively based solely on chronologic age, needs to be changed. We provide evidence suggesting the utility of clinical-genomic characterization for better treatment individualization decisions.
    [Emphasis mine]
    Last edited by DjinTonic; 11-14-2019 at 10:55 AM.

  6. #26
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    Posts
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    I detest the waiting also. Thatís why I pray my husband will go ahead and just have it removed after this final biopsy. Iíll pray for good news for you and your family.


    Thanks
    Murphy
    Husband 56 DX PC 8/14/19 All DREís normal - prostate 34 cc
    2018 K4 -8% 7/10/19 Free PSA


    PSA
    1/11/16 -2.6
    2/27/17 -3.4
    6/12/18 -4.1
    1/10/19 -4.53
    7/10/19 -5.24

    12 core biopsy 8/8/19
    5 cores positive

    Diagnosis: Adenocarcinoma , G6 ( grade group1) with perineurial invasion

    Left Base 1core 80% involvement (14mm) G6
    Left Mid 1 core 90% involvement (15mm) G6
    Left Apex 2 cores 10% (2mm), <5%(0.5mm) G6
    Right Mid 1 core <5% ( <0.5mm) G6

    9/24/19 Oncotype DX Genomic Score 17

    MRI 11/9/19 3 lesions Bi- Rads 3

    Artemis Biopsy 11/20/19 18 cores / 10 positive cores

    Left Mid - 2 core 20% , 5% Gleason 6
    Left Base - 2 cores 70%, 5 %
    Left Apex - 1 core 5%
    Right Apex - 1 core 30%
    Right Mid - 1 core 10% 3+4 = Gleason 7 with cribriform pattern 45 %
    Left base Peripheral Zone - 2 cores 20%,10% Gleason 6
    Right Mid Peripheral Zone - 1 core 5% Gleason 6

  7. #27
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    Currently, Genomic testing is not included in one's biopsy or surgical staging. Although this "study" did not assess or extrapolate the fate of older men with low grade tumors but high risk genomic profiles, the implication is there may be untapped prognostic information in the genome. Also, does this make the case that younger men with low risk disease should undergo genomic testing as part of their decision to opt for active surveillance or move straight to treatment?

    Also note:

    "Source of Funding:
    Decipher GenomeDX"

  8. #28
    Quote Originally Posted by Semiramide View Post
    Currently, Genomic testing is not included in one's biopsy or surgical staging. Although this "study" did not assess or extrapolate the fate of older men with low grade tumors but high risk genomic profiles, the implication is there may be untapped prognostic information in the genome. Also, does this make the case that younger men with low risk disease should undergo genomic testing as part of their decision to opt for active surveillance or move straight to treatment?

    Also note:

    "Source of Funding:
    Decipher GenomeDX"
    Whether or not a man of a certain advanced age with given PCa lesions needs treatment is an issue that's separate from the incidence of high-grade or aggressive lesions. If age is correlated with more higher-grade lesions, it seems to me that genomic testing for the propensity to metastasize is just what is needed.

    The question of genomic testing for young men considering AS is one now at the forefront -- see the recommendations of the various professional groups in this regard. When I asked my uro/surgeon if he makes use of genomic testing for AS candidacy he said yes, and he finds it especially useful for G7 (3+4) men with small amounts of pattern 4. While genomic testing on biopsied tissue does not always find the high-risk disease that may be confirmed after a RP, G6 men who do results high-risk for aggressive potential can certainly take that into account in their AS decision: the general >50% chance that you can remain on AS for life obviously decreases if you learn you are no longer low genomic risk.

    It is more frequent than not that a journal paper discussing risks at any point of the PCa trajectory (diagnosis, treatment, post-treatment, post-recurrence) ends with a statement that genomics needs to be brought into the picture.

    With regard to the funding, I would say that vast majority of the papers on the various genomic tests are funded by the respective companies -- who else is going to spend big bucks to validate a test? Whether the test is recommended by professional groups and confirmed as useful in non-commercial studies afterwards is a separate question. If we look at medications, I'll point out again that (very) big buck for most Phase I and II clinical trials is from big Pharma. No one would spend public funds to test a drug whose patent will be private, especially since most of these drugs never make it past the Phase I stage.

    I'm not necessarily defending this model, but just pointing out the way things are.The FDA grants or denies approval of medications based on data collected in industry-funded studies. A study, regardless of its funding, has to withstand review by the journal and then the, scrutiny, and confirmation/contradiction by the research community on its own merits. Disclosures are just that, and not hidden information revealed by a Freedom of Information inquiry.

    Djin
    Last edited by DjinTonic; 11-14-2019 at 02:21 PM.

  9. #29
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    It makes my point. Early detection Early treatment. Wait until you are 70 to be diagnosed and you will be too late unless you are not at risk and don't have a serious cancer.

    More appropriate to this post is a study of early cancer in young men.

  10. #30
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    Join Date
    Oct 2019
    Posts
    82
    I don’t even know how much stock or importance I put on David’s genomic test results.
    He has a low risk score of 23. They tested his G6...I wouldn’t ever expect that to be high risk.
    Doesn’t tell us crap about what else there might be in the prostate that wasn’t tested. I think I would have preferred not doing it on that initial TRUS biopsy but rather wait until after the next biopsy where there will be more to look at.
    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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