Biopsy confirms prostate cancer in 12 out of 12 cores

Posted by deku @deku, Nov 7 8:20pm

Hi, all. It appears my initial post ("Journey begins - age 51, PSA 72" https://connect.mayoclinic.org/discussion/journey-begins-age-51-psa-72/) was not premature after all. Based on my biopsy results, I am officially diagnosed with prostate cancer (prostatic acinar adenocarcinoma). I missed a call from my urologist to discuss my test results and interpretations, but I have the full pathology report. In case anyone is interested, I'll outline below. I don't have any specific questions, I'm just sharing at this point and feeling generally numb about the whole thing.

12 out of 12 cores (systematic biopsy) show prostatic adenocarcinoma; my six grade groupings are 2 at 8 (4+4), 2 at 7 (4+3), and 2 at 7 (3+4). Percentage of pattern 4 is 71-80%, with approximately 81% of the total combined core samples (137mm out of 169mm) identified as cancer. Intraductal carcinoma could not be determined, with at least one of the samples showing an IDC component that "cannot be excluded". Additional words listed were "invasive carcinoma", "cribriform pattern favored", and "cribriform glands present".

Without having discussed with my doctor yet (aside from Dr. Google), I'm guessing this is not exactly ideal. I already have an abdominal CT scheduled for tomorrow, and an urgent order in for a full body bone scan which I hope to get scheduled ASAP. I plan to ask my doctor about other scans as well. Based on these results and other symptoms, I fully expect that it has already metastasized, so it's a matter of determining where and how much.

Ironically, I feel calmer and less anxious now than I did before seeing the pathology report. I feel more concerned about how this will affect my family than how it will affect me. But regardless, we will share the journey and figure out next steps together.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

@deku

Thanks for your support. I'm just trying to keep it together by focusing on the clinical aspects and cold facts and not on what this might mean for me as a person and for my family. Part of me is terrified, but I'm trying my best to suppress that for now until we know more facts and have a plan and a path forward. As many have pointed out, a PSMA-PET scan would be helpful (I plan to speak with my care team today about whether that is an option for me), and in the meantime I know I am possibly getting ahead of myself in assuming it has spread - which we can't know for certain yet.

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Almost everyone who has a PC diagnosis is terrified and wonders how long they will live. Will they be around in five years? What’s going to happen?

The fact is most people who get prostate cancer live quite a long time after the diagnosis and die of something else. My father died of it in 2008. I remember when he told me Lupron stopped working. That was the only drug they had at the time. These days they have multiple drugs and treatments past Lupron. They make a major difference in life expectancy for PC patients

On top of that, they’re developing new drugs all the time, if your cancer reoccurs after many years, there will be plenty of new treatments so you can live even longer.

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You sound good. Your focus sounds good. You should expect good with those!
I also support PSMA Pet scan ASAP! You know that more information is more ammo to help attack the PC.
Do look forward to the long life you desire and certainly deserve.
All of us and the Good Lord are with you.
God Speed, brother!

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It's ok to let yourself be scared. I suggest setting aside some time for it every day at first, then shaking it off and going on with the rest of your life. Giving yourself time and grace to process these emotions is an important part of adjusting to your new life.

But I do advise against too much doom scrolling on the internet. It's natural to want to learn more, but as others have mentioned, even recent publications can be based on reviews of 15-year-old data, and PCa treatment/survivability have improved dramatically since back then.

A 2022 study, for example, might turn out to be discussing cases from 2007 or 2008.

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Just attended a UCSF webinar about Gleason and cribriform issues. If you have large cribriform (over .25mm) that means your cancer is very aggressive even if you only have a Gleason 3+4. Chance of Metastasis with large cribriform is very high. You need to find out if your cribriform is large.

They mentioned that intraductal cannot be determined. You want them to determine that because if it is there, it means that you have large cribriform or at least the equivalent high risk. They also say that your biopsy slides should be reviewed by a Genito urinary pathologist, they know better what to look for.

Here is a graph which shows some of what’s going on.

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I would strongly recommend that you don't suppress your emotions. I tried to do that and it made things worse. You don't have to be emotional in front of your family if that's too much right now, but maybe go on a walk someplace quiet and peaceful outdoors, or go sit in a beautiful old empty church or some other peaceful place and just let it out. You will feel better and if you keep things bottled up it may all come crashing out at once in a way that's not so great (see my initial posts on this forum if you want some examples).

On the plus side, it sounds like you are doing everything right so far and there is a wealth of information available here as well as lots of good people who can help you out and share their experiences. We're all in different places and different stages but everyone here has something to contribute that can help you out.

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I suggest that you consult with Dr. Eugene Kwon at Mayo Rochester. I was diagnosed 6 years ago at age 51 with Gleason 9 metastatic and am doing well. Still working full time. Had chemotherapy, radiation treatment and have been on ADT plus abiraterone for 3 years. Stay strong and don't be discouraged!

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Information that is available and may be helpful:
Prostate Cancer Foundation (pcf.org) free downloadable or hard copy Patient Guides.
Patrick Walsh MD's book Surviving Prostate Cancer (Barnes & Noble, etc)
We are all with you in spirit, hope and love.

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I would like to second the PSMA scan immediately. It is much better than regular MRI/Catscan and a great tool for use with a PC.
Also, you are young and have many, many years ahead of you. You can beat this! In my over 40 years as an Episcopal Priest and taking the cancer journey with many people, the one thing in our arsenal that helps defeat cancer is a positive attitude. If you are positive, a fighter, and an active advocate for yourself, you will beat this.
And don't forget, you have all kinds of positive energy coming from each and every one of us who are on this journey with you.

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@topsz

near to mayo Rochester. Which Dr did you use and are you satisfied? Looking for a Dr this is on the cutting edge. Thank you.

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Dr Eugene Keon’s team is phenominal

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@billfarm

Dr Eugene Keon’s team is phenominal

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Sorry got spellchecked. Dr Eugene Kwon. My friend had surgery with dr Igor frank and did well also.

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