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Thread: MRI Results

  1. #31
    Quote Originally Posted by star0210 View Post
    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.
    Genomic testing, especially of biopsied tissue, is not a prefect predictor by any means. But we shouldn't confuse genomic risk/prediction with Gleason score. We now know that low, average, and high risk cut across all Gleason scores. For example, despite a very good RP result, I wanted to have a genomics test done on my Gleason 9, which turned out to be low risk for metastases. Prior to genomic testing it was more or less assumed that high Gleason score implied high met risk, and low Gleason score low risk.

    Djin
    Last edited by DjinTonic; 11-14-2019 at 03:15 PM.

  2. #32
    Top User garyi's Avatar
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    Quote Originally Posted by star0210 View Post
    Thanks...I will check it out and send it to David.
    IMHO, you need to take this infomercial with a LARGE grain of salt. Mark Scholz previously wrote 'Invasion of the Prostate Snatchers', has an obvious monetary driven bias, and owns a very expensive, private practice in Marina del Rey, California. Caveat Emptor!
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19, .116 11/19
    We'll see....what is not known dwarfs what is thought to be fact

  3. #33
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    Quote Originally Posted by star0210 View Post
    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.
    Except there is a 1 in 7 risk of high grade disease and non organ confined in this low risk model. My point is someone's parameter for low risk may be more risk than I want to take when it comes to cancer.
    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
    12-08-19 PSA <0.02, Zero Club 3.5 years

  4. #34
    Quote Originally Posted by Another View Post
    Except there is a 1 in 7 risk of high grade disease and non organ confined in this low risk model. My point is someone's parameter for low risk may be more risk than I want to take when it comes to cancer.
    Yes, we each may evaluate risk differently. I would point out that the AS vs. treatment risk isn't all-or-nothing. Extremely few men who have to leave AS programs do so because of mPCa -- at the point of needing treatment they are roughly on a par with men who are either intermediate-risk at diagnosis or low-risk but not AS candiates.

    Djin

  5. #35
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    Quote Originally Posted by DjinTonic View Post
    Yes, we each may evaluate risk differently. I would point out that the AS vs. treatment risk isn't all-or-nothing. Extremely few men who have to leave AS programs do so because of mPCa -- at the point of needing treatment they are roughly on a par with men who are either intermediate-risk at diagnosis or low-risk but not AS candiates.

    Djin
    Now, but it seems more and more relaxed approaches are being offered to low acceptance patients.

    In my commitment to langauge I suggest we rid ourselves of the low, medium/intermeidate, high risk categories and refer simply to the numbers as a percentage or a multible, whichever is most easily understood.

    Would you fly in an airplane with a 16% risk of a crash? Will you accept a treatment path for cancer with a 16% failure rate? Low acceptance patient are at risk of grasping at straws. Just give them the numbers without bias terms such as low or high which imply porofessional judgment.
    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
    12-08-19 PSA <0.02, Zero Club 3.5 years

  6. #36
    Quote Originally Posted by murphy749 View Post
    I detest the waiting also.

    Patience is a virtue for prostate patients.

    If you look at the menu page at cancer forums , you'll see that prostate cancer has more than twice as many postings as the next highest specific cancer.

    The reason why is that PCa usually takes a long time, much longer that most other cancers, even ones which are more popular.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  7. #37
    Quote Originally Posted by Another View Post
    Now, but it seems more and more relaxed approaches are being offered to low acceptance patients.

    In my commitment to langauge I suggest we rid ourselves of the low, medium/intermeidate, high risk categories and refer simply to the numbers as a percentage or a multible, whichever is most easily understood.

    Would you fly in an airplane with a 16% risk of a crash? Will you accept a treatment path for cancer with a 16% failure rate? Low acceptance patient are at risk of grasping at straws. Just give them the numbers without bias terms such as low or high which imply porofessional judgment.
    I don't see a way out of risk categories because (1) numbers aren't usually available, and (2) professional organizations and journal papers/studies use these precisely defined risk categories.

    As I mentioned, it's usually not a life vs death risk like landing safely or falling out of the sky: men who need to leave AS programs do not leave in coffins -- they leave only because they need (or want) treatment. They have lost only the get-through-life-without-needing-to-treat-your-PCa lottery.

    Djin

  8. #38
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    Quote Originally Posted by garyi View Post
    IMHO, you need to take this infomercial with a LARGE grain of salt. Mark Scholz previously wrote 'Invasion of the Prostate Snatchers', has an obvious monetary driven bias, and owns a very expensive, private practice in Marina del Rey, California. Caveat Emptor!
    Yes I know he is pretty anti surgery and while surgery is where we’re leaning, hubby is continuing his research into all treatment options.
    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%

  9. #39
    Quote Originally Posted by Another View Post
    Would you fly in an airplane with a 16% risk of a crash? Will you accept a treatment path for cancer with a 16% failure rate? Low acceptance patient are at risk of grasping at straws. Just give them the numbers without bias terms such as low or high which imply porofessional judgment.


    Every treatment plan for cancer, or any other medical problem, has a chance of failure you know. And oftentimes pretty significant.

    All any of us can do is to consult an expert, and make our own best guess as to what to do.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  10. #40
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    Quote Originally Posted by Southsider View Post
    Every treatment plan for cancer, or any other medical problem, has a chance of failure you know. And oftentimes pretty significant.

    All any of us can do is to consult an expert, and make our own best guess as to what to do.
    True, and there's more information available than low rsk, intermediate risk, and high risk.
    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
    12-08-19 PSA <0.02, Zero Club 3.5 years

 

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