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Decipher risk: prostatectomy RP vs radiation.
Prostate Cancer | Last Active: Mar 14 11:09am | Replies (75)Comment receiving replies
There are some things missing in your explanation of your choices.
Did you get a PSMA pet scan? That is sort of essential to decide between radiation and surgery because if you have spread outside the prostate, then you probably want to do radiation. You do say it’s contained to the prostate as that is a result of having the PET scan?
Another very important question is Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive. In some cases, radiation is the best solution.
In my case, I decided to have surgery at 62 because my father had radiation and died of prostate cancer. At the time Lupron was the only drug available, these days we have a wide range of drugs that can keep the cancer suppressed.
Have you had genetic testing? That can be important to find out whether or not other drugs are available for treatment.
You don’t mention how many cores were taken in the biopsy and how many were 3+4 or 3+3. Also, what percentage of the 3+4 was tumor and what percentage of it was a four. If those percentages are very low, you could consider active surveillance. There are a number of videos you can look at that discussed that.
The decipher test is used more often these days to figure out whether or not a case is aggressive. Your result of .61 is high but we have people that are 98, 99 and even 1, which are truly aggressive. It can be a factor in deciding about active surveillance, but the percentage of four is another major issue.
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@jeffmarc
Jeff-those are really good questions and things that I don't understand yet (cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions).
My understanding is that it is contained to the prostate and not in the sheath.
My hope is that by doing surgery, it might buy some time for additional drug treatments to be approved for any possible recurrence.
• On the biopsy, short version: The tumor is noted in 9 cores of a total of 24 cores examined and
represents approximately 5% of the entire available tissue.
• On the pet scan, short version;
1. No PET evidence of metabolically active nodal or visceral metastatic disease.
2. Mild focal radiotracer uptake in the left lateral prostate mid gland, likely related to the biopsy-proven malignancy.
•I had a Decipher test, but just have the number and not the report yet. I don't know if that tells the gene makeup or not?
•Haven't had any gene testing beyond that. But, am waiting on Prostect test results to show toxicity for low-dose IMRT.
I'll put more of the biopsy information below; not sure how to read all of it. Thank you for these really good tools....I need to learn more about what is buried in the test results. Not sure how to interpret all of it.
Thanks!
BIOPSY RESULTS
A. RIGHT BASE PROSTATE BIOPSY:
- BENIGN PROSTATIC TISSUE
B. RIGHT LATERAL PROSTATE BIOPSY:
- BENIGN PROSTATIC TISSUE
C. RIGHT APEX PROSTATE BIOPSY:
- BENIGN PROSTATIC TISSUE
D. LEFT BASE PROSTATE BIOPSY:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7, GRADE GROUP 2,
INVOLVING 3 OF 6 CORES REPRESENTING APPROXIMATELY 5% OF BIOPSY MATERIAL
E. LEFT LATERAL PROSTATE BIOPSY:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7, GRADE GROUP 2,
INVOLVING 5 OF 6 CORES REPRESENTING APPROXIMATELY 15% OF BIOPSY
MATERIAL
F. LEFT APEX PROSTATE BIOPSY:
- PROSTATIC ADENOC
ARCINOMA, GLEASON SCORE 3+4=7, GRADE GROUP 2,
INVOLVING 1 OF 4 CORES AND REPRESENTING APPROXIMATELY 10% OF BIOPSY
MATERIAL
COMMENT:
The tumor is noted in 9 cores of a total of 24 cores examined and
represents approximately 5% of the entire available tissue.
Properly controlled multiplex immunohistochemical stain PTRIP
(P504S/HMWK/p63) is performed on parts C, D and E. In Part C, PTRIP
shows no diagnostic evidence of adenocarcinoma. In parts D and E,
PTRIP supports the diagnosis of adenocarcinoma which is noted in
several foci of both specimens.
•••••••••
This is the PET scan data:
PET-CT SCAN:
Accession Exam Completed Date/Time
PT15515321 PETCT PROSTATE (SKULL BASE TO MID THIGH)
----------------------------------------------------------------------------
PET-CT SCAN:
COMPARISONS: No direct comparisons in PACS at the time of this dictation.
CLINICAL INDICATION: Prostate cancer, high risk, staging
prostate cancer
QUALITY OF STUDY:Good
FINDINGS:
Head/Neck:
No abnormal focal radiotracer uptake in the head/neck region. Expected radiotracer uptake in the bilateral lacrimal and salivary glands.
No metabolically active cervical adenopathy.
Chest:
No metabolically active mediastinal, axillary or hilar adenopathy.
No metabolically active pulmonary lesions.
Abdomen/Pelvis:
Expected radiotracer uptake in the liver, spleen, small bowel, kidneys, ureters and urinary bladder.
No metabolically active retroperitoneal para-aortic, iliac or inguinal adenopathy.
Mild focal asymmetric radiotracer activity in the prostate left lateral mid gland with SUV max 3.0. This is likely related to the biopsy-proven malignancy.
Musculoskeletal:
No suspicious focal metabolically active osseous lesion.
IMPRESSION:
1. No PET evidence of metabolically active nodal or visceral metastatic disease.
2. Mild focal radiotracer uptake in the left lateral prostate mid gland, likely related to the biopsy-proven malignancy.