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fritzo avatar

Decipher risk: prostatectomy RP vs radiation.

Prostate Cancer | Last Active: Mar 14 11:09am | Replies (75)

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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.

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Replies to "@jeffmarc Jeff-those are really good questions and things that I don't understand yet (cribriform, Seminal vesicle..."

@fritzo
Your biopsy information looks good. They don’t appear to have found any of those aggressive things I mentioned, though a biopsy of the prostate after surgery is more informational. In my case, my PSA was 3+4 before surgery and 4+3 after.

Your comment about Additional drug treatments in the future is actually here already. Eight years ago, my cancer came back after surgery and radiation and I went on ADT for 2 1/2 years and when it failed and I became castrate resistant, I went on Biclutamide For a little over a year and then Zytiga for 2 1/2 years. I stopped taking it and went on Nubeqa Which has kept me undetectable for 27 months. So after 16 years, the drugs that are available today have made a major difference in my survival. There are a number of drugs that are going to be coming out in the next few years that are going to work when what I’m taking now stops working. I was reading about one study where they are turning cancer cells back to normal cells so there are lots of options available in our future. You are just starting and there is a long path ahead of you.

Now that I’ve seen your biopsy and you’ve had multiple 3+4 active surveillance is definitely not in the picture, especially with the .61 decipher.

The decipher score does not decide whether or not you can have nerve sparing surgery. It all depends on where the cancer is located in the prostate. This is something you can ask your doctor about.

After my surgery, I had no incontinence and complete ED. There are a lot of solutions for that today between an implant and injections you can use that can get a very satisfying erection. If you do have incontinence issues, they usually don’t last long and there are multiple solutions.

You definitely want to get genetic testing, talk to your doctor. They can easily do it. It’s covered by insurance.