How many cores? And follow-up with results received

That is highly unusual. My husband's urologist ( who is far from being good) took 12 plus extra 4 cores from the lesion itself. Since your PSA is low if all cores come back as benign it is highly unlikely that he missed something extremely different in that one core. IF however that one core comes back with 3+3 - make sure that you have MRI every year and biopsy repeated in 2 years latest, and of course - watch your PSA.
Wishing you the best of luck 🍀

You are correct only doing one core from that PIRADS-4 lesion Is quite unusual. Usually, they take at least three from that spot. Hopefully, he found some other spots that are equally useful to find out what’s going on?

Come back and tell us what the biopsy found. Posting the full biopsy in this forum really gives us some information from which we can give you non-medical doctor opinions, from our experience, seeing many other biopsies. We can discuss how treatment proceeded for other others with similar results. Just gives you information with which you can talk to your doctor.

There are people who think that random biopsies are unnecessarily risky and one should do them only targeted. Mark Scholz made that case in one of his videos. A PSA of 1.36 with prostatitis sounds very low to me, I would not be too worried.

I will upload the pathology report as soon as I get it. I am also going to file a complaint with Moffitt and request the department head review my biopsy as well. I want to wait for the results before doing anything. Thank you for listening and responding. When I questioned the doctor he told me “there is no standard”. So frustrating.

From my Two Biopsies I had 12 the first time and 24 the second time. Both times they did the prostate MRI to locate the regions to take the cores and then did some random sampling. During the second biopsy they spent a longer time doing the MRI because there were areas of concern that needed to be viewed. Taking one core is really odd. I would definitely ask for a better justification and/or get a second opinion.

I am concerned with the "Perineural invasion identified". Ironically, my Pi-rads 4 lesion is benign, but the doctor at Moffitt only took 1 core from the lesion itself. I am going to request an appointment at Mayo in Jacksonville for a second opinion, but here are my results. Thoughts? Thank you!

A. Right lateral base:

Benign prostatic tissue

B. Right medial base:

Benign prostatic tissue

C. Right lateral middle:

Prostatic adenocarcinoma, Gleason score 3+3 = 6 (Grade Group 1 ), involving 1 of 2 cores and 10% of submitted tissue.

Maximum linear length: 2 mm
Perineural invasion identified.

D. Right medial middle:

Prostatic adenocarcinoma, Gleason score 3+3 = 6 (Grade Group 1 ), involving 60% of 1 core .

Maximum linear length: 7 mm

E. Right lateral apex:

Prostatic adenocarcinoma, Gleason score 3+3 = 6 (Grade Group 1 ), involving 5% of 1 fragmented core.

Maximum linear length: 1 mm

F. Right medial apex:

Prostatic adenocarcinoma, Gleason score 3+3 = 6 (Grade Group 1 ), involving 70% of 1 core.

Maximum linear length: 8 mm

Perineural invasion identified.

G. Left lateral base:

Benign prostatic tissue.

H. Left medial base:

Benign prostatic tissue.

Additional deeper levels examined.

I. Left lateral middle:

Benign prostatic tissue.

Additional deeper levels examined.

J. Left medial middle:

Benign prostatic tissue.

Additional deeper levels examined.

K. Left lateral apex:

Benign prostatic tissue .

Additional deeper levels examined.

L. Left medial apex:

Benign prostatic tissue

M. Prostate, ROI #1, PIRADS-4:

Benign prostatic tissue

PNI is very common and usually not considered an adverse feature. Definitely get the second opinion and also talk to your urologist at Moffitt. You may be a candidate for active surveillance with only Gleason 6 cores. But two of the four have a high volume, which may be a concern.

Get a second reading of your biopsy too, ideally before seeing someone at Mayo. Johns Hopkins is a good place for that.

@topf Won't Mayo do a second opinion on the pathology and/or their own tests?

@justme129 They might, one would need to adk. But Hopkins is considered the gold standard for biopsy readings by my understanding.

@topf Ok, I will do that. Thank you very much.