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Decisions to be made after biopsy confirmation of prostate cancer.
Prostate Cancer | Last Active: Nov 12 5:31pm | Replies (9)Comment receiving replies
Note to all who replied/commented on my post. I am deeply appreciative of your inputs. They will help guide me in my meeting with the Urologist, and whatever follows. I was writing a response/reply earlier, but somehow lost it when a text message came in and bumped my writings somewhere into the ether, never to be seen again. In re-reading my post and the reports on my MRI and subsequent biopsy, I discovered that I somehow included erroneous info. The MRI noted two PI-RADS 3 lesions, not 4. Sorry for the mistake. The following is directed in response to some specific comments/suggestions from @brianjarvis.
There was no mention of the terms "extracapsular extension, seminal vesicle invasion or perineural invasion." The only related comment was "Seminal Vesicles: Normal." And no, I did not get a 2nd opinion on the MRI or biopsy specimens. There was no mention of the term "cribiform pattern," but specimen N below included the term "INTRADUCTAL CARCINOMA." Detailed results of the positive specimens in the biopsy are as follow:
5 of 14 specimens were positive.
E. Right Lateral Mid Needle Biopsy ADENOCARCINOMA, GLEASON SCORE 3 + 3 = 6 involving 50 % of the specimen (1 of 1 core(s) positive). Grade Group 1. Ends not involved by the tumor.
G. ROI, Right Apex Peripheral Zone Needle Biopsy ADENOCARCINOMA, GLEASON SCORE 4 + 3 = 7 involving 10 % of the specimen (1 of 2 core(s) positive). Gleason 4 comprises 80 percent of the cancer. Grade Group 3. Ends not involved by the tumor.
I. Left Mid Needle Biopsy ADENOCARCINOMA, GLEASON SCORE 4 + 3 = 7 involving 3 % of the specimen (1 of 1 core(s) positive). Gleason 4 comprises 80 percent of the cancer. Grade Group 3. Ends not involved by the tumor.
L. Left Lateral Mid Needle Biopsy ADENOCARCINOMA, GLEASON SCORE 3 + 4 = 7 involving 5 % of the specimen, discontinuous (1 of 1 core(s) positive). Gleason 4 comprises 5 percent of the cancer. Grade Group 2. Ends not involved by the tumor.
N. ROI, Left Mid Peripheral Zone Needle Biopsy ADENOCARCINOMA, GLEASON SCORE 4 + 3 = 7 involving 10 % of the specimen (2 of 3 core(s) positive). Gleason 4 comprises 70 percent of the cancer. Grade Group 3. Ends not involved by the tumor. INTRADUCTAL CARCINOMA.
If any additional thoughts come to mind, please don't hesitate to share. I am a "sponge," trying to soak u as much info as I can. A heartfelt THANK YOU to all.
Replies to "Note to all who replied/commented on my post. I am deeply appreciative of your inputs. They..."
@georgemc
Intraductal can be a serious problem. According to USF doctors, it usually includes cribriform, But since they didn’t mention it, it probably doesn’t. You might wanna get a second opinion on your biopsy, There’s some great doctors that can tell you if there are differences in what you’ve been told and what actually is there.
Here is a couple of doctors that can give you really great. Second opinions on your biopsy..
Dr. Epstein biopsy
https://advanceduropathology.com
Dr. Zhou
Send an email to Ming.zhou@mountsinai.org to inquire about a second opinion and ask for his specific instructions for the process.
At the advanced prostate cancer ancan.org Meeting yesterday, they discussed intraductal a lot. It is an aggressive issue. it is a feature of aggressive prostate cancer that is associated with a higher risk of recurrence and progression.
The fact that your biopsy shows that the percentage of four is 70% and 80% Also points to an aggressive case. I suspect they found some fives, but it was very small percentage. That would be shown somewhere else in the biopsy report.
I would imagine they were talking about doing radiation, And that makes the most sense at your age. Surgery and radiation have the same long-term results but radiation is a lot easier on people. You don’t end up with the incontinence problems and usually don’t have ED problems right away
Because of the aggressive issues, they probably are going to talk about doing ADT, But that can be really hard on somebody that is 90, It can really diminish the quality of life. If that comes up, tell them you would rather be on Nubeqa (Darolutamide) Which has a lot fewer side effects, but works really well. That can control your cancer and stop it from growing and spreading. If they insist on ADT, tell them you want Orgovyx, It has fewer side effects and is a pill you take every day. When you stop taking it, your testosterone comes back quicker and you feel better sooner.
I’m not giving you medical advice. I’m just telling you about different options. This will give you things to talk to your doctor about and you have knowledge that you can use when you’re discussing your cancer treatment.
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@georgemc That’s good that most of those terms are not mentioned in the MRI or biopsy reports. Some of those terms are indicators of more advanced disease.
> You should ask your medical team about the significance of the “intraductal carcinoma” finding.
The term “adenocarcinoma” is simply the official word for cancer.
> Regarding specimens G and I: Gleason 4+3=7, with “4” comprising 80% of the cancer. That 80% is on the high end. You should ask your doctor if that % has any significance and does it warrant treatment being stepped-up?
> Regarding specimen L: Gleason 3+4=7, with “4” comprising 5% of the cancer. That 5% is on the low end. (Specimens G, I, and N are more concerning.)
> Regarding specimens N: Gleason 4+3=7, with “4” comprising 70% of the cancer. That 70% is on the mid/upper end. You should ask your doctor if that % has any significance and does it warrant treatment being stepped-up?
Intraductal carcinoma —> ask your doctor about this.