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Gleason 3+4, How did you treat?
Prostate Cancer | Last Active: 1 hour ago | Replies (24)Comment receiving replies
Hello,
70 years old, with biopsy-confirmed CaP (3+4).
Some more information would be appreciated, such as:
PSA history and progression, Multi-Parametric MRI of the prostate report, prostatic volume, % cancer volume, PSAD, histology separately from both lobes, if any perineural invasion is identified, CT scan and bone scan results, if PSMA CT has been done and the outcome reported. Important: Performance status and comorbidities (ASA) with any treatment being received.
Potential options dependent on all above:
1. RP or 2. Hormones + Radiotherapy or 3. Active Surveillance.
Replies to "Hello, 70 years old, with biopsy-confirmed CaP (3+4). Some more information would be appreciated, such as:..."
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@ioamich
PSA progressed from 1.8 to 3.9 in one year
mpMRI at JH was PiRads 4/5, prostate volume 42ccm
Pathology:
1.Prostate, Right Paramedian Apex (biopsy):
Benign prostatic tissue.
2.Prostate, Right Paramedian Base (biopsy):
Benign prostatic tissue.
3.Prostate, Rigth Posterior Apex (biopsy):
Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade Group 2) involving 30% of one (1) core.
10% Gleason pattern 4
The pattern 4 in this case lacks large cribriform morphology.
4.Prostate, Right Posterior Base (biopsy):
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group 1) involving 10% of one (1) core
5.Prostate, Right Lateral (biopsy):
High-grade prostatic intraepithelial neoplasia.
6.Prostate, Right Anterior (biopsy):
Benign prostatic tissue.
7.Prostate, Left Paramedian Apex (biopsy):
High-grade prostatic intraepithelial neoplasia.
8.Prostate, Left Paramedian Base (biopsy):
High-grade prostatic intraepithelial neoplasia.
9.Prostate, Left Posterior Apex (biopsy):
Benign prostatic tissue.
10.Prostate, Left Posterior Base (biopsy):
Benign prostatic tissue.
11.Prostate, Left Lateral (biopsy):
Benign fibroadipose tissue, smooth muscle and ganglia
12.Prostate, Left Anterior (biopsy):
Benign prostatic tissue.
13.Prostate, Target - Left Midgland PZ (biopsy):
Atypical intraductal proliferation (AIP).
no perineal invasion, no CT or bone scan performed
Comorbidities:
CAD - CAC over 1300, distal LAD FFR was last measured 2 years ago and was down to 0.76 indicating stenting should be done but cardiologist said it is unstentable. Heavy plaque burden in multivessels, particularly LAD and RM. 8 years ago was told that I have 20-25%/yr risk of a MACE but so far asymptomatic.
Chronic microvascular ischemia - same mechanism is affecting my brain with white matter disease and lacunar strokes
Rather complicated decision coming up.