Newly diagnosed

It doesn’t look too bad actually. Must’ve meant they have referred to things that I have never seen referred to this way before giving percentages versus saying you do or you do not have something.

The way this is phrased is confusing. Does a 10% pattern refer to 10% pattern 4. Normally, they would tell you what percent is a four the rest is a three. I would ask for clarification on this.

Lesion 3+4 10% pattern & 45% involved area

Percentages for these items are quite confusing. Normally, they say you have it or you don’t. Was 23% Extraprostatic extensions Meaning that you have them or that there is a percentage chance you have them. 74% Oregon confined does that mean it’s not completely confined or is it a 74% chance that it is completely confined?

Are they getting out that you need a prostatectomy in order to figure out what the real numbers are

Lymph 1%
Seminal vesicle 2%
Extraprostatic Ext 23%
Organ confined 74%

I would want to ask the doctor for an explanation of this information.

It is possible you could go on actress surveillance. Here is a video from a doctor that talks about it for people that have intermediate diagnosis Like you have.

Excellent Fred Hutch doctor video: Dr. Claire de la Calle

Active Surveillance for Intermediate Risk Prostate Cancer w/ Dr. Claire de la Calle | Ep. 288

@ireland1964

You might want to use your biopsy material for a Decipher test which doctors do use for treatment choices. A telehealth second opinion might also be helpful. I too had 3+4 Gleason with a higher PSA and chose a built in MRI radiation machine for treatment; less healthy tissue exposure so less side effects. The two in the market are the Mridian and the Elekta Unity. No doctor will be able to predict, in YOUR body, how quickly a tumor will grow.

Those % numbers seem to be some sort of staging nomogram. Given variables like Gleason score, PSA, T stage, and whatever else was available and/or required for the given nomogram, it would spit out the % likelihood of whatever, i.e. 2% seminal vesicle invasion would be found later, even though things look good now.

Papers I found discussing things like this tended to be 20 or so years old. Obviously, the pathologist doing this biopsy seems to be doing something with one.

@jeffmarc
Thanks for your input and video link
Those are great question
I do know the 10% pattern relates to the 4 on my 3+4 Gleason and the 35-45% refers to involved area which I assume indicates 35-45% of the biospy sample is a 4.
What seems weird is that result states "No tumor in the extraprostatic adipose tissue" but another section states EPE is 23%. Also that the "organ confined" at 74% seems to indicate how probable the cancer is contained which I assume means there"s a 26% chance it's NOT. Throw in the part that states NO Perineural Invasion makes this even more difficult to understand.
I don't really get the sense my Urologist gets too involved with these results and I'm basically here waiting to see if this Prolaris test comes back with anything.
It seems like the world of "intermediate risk" is not very clear and would love to find somebody that could offer an unbiased opinion on this.

@bens1
My report shows a Prolaris test was also ordered. Does the pathologist generally decide whether to order this or the Decipher?

@ireland1964
You might wanna get a second opinion from a pathologist that it has looked at hundreds of thousands of biopsies. I know a bunch of people that have gone to this guy and he is really good. You can call him before you sign up for a second opinion and discuss it, and you can then speak to him for quite a bit of time after to go over what he’s found. He does, however, charge $500 for a biopsy review. He will arrange to have whatever he needs sent to him for the review.

Dr. Jonathan Epstein biopsy
https://advanceduropathology.com

@ireland1964
Frequently a Doctor will request this. Not the pathologist in particular, The urologist or radiation oncologist is usually the one that does it. It depends on which test the doctor likes some will use the Prolaris otherwise will use Decipher or ArteraAI.

If you get involved before they order it, then you can be part of the decision.

I know one person who has had all three tests.

@ireland1964 - with EPE, on my pathology report, I have one section that identifies “focal EPE,” meaning it was just beginning to break through the prostate cap, but hadn’t actually made it to any other neighboring tissue.

Further down, though, I have another section that plainly states “no EPE observed.”

Yes? No? Maybe?

During my most recent PSA follow-up, I asked about this, and I think the NP said it had something to do with EPE being found in one area of my prostate, but not in the other.

I’m not really a details person, so I don’t remember everything she said about it, but she did tell me not to get too worried about it, that since everything else came back negative and they actually downgraded my cancer from a 3+5=8 to a 3+4=7, and changed me from intermediate unfavorable to intermediate favorable, I had a lot to be happy about.

@ireland1964 The higher number indicates percentage of core with cancer (35%, 45%). The 10% pattern indicates the percentage of the total (i.e. 3.5% or 4.5% of core) that was 4. So that puts you as intermediate favorable 3+4 with a low percentage of 4. Since all cancer is on one side you are probably a good candidate for focal therapy such as Nanoknife, Tulsa Pro, Cyro, etc. if you do not want to do active surveillance. Any of the focal therapy will leave you with better quality of life than either RP or RT. Not sure these were mentioned; they do have higher recurrence rates.

It does look like the percentages came from a monogram that estimated chances based on PSA, number of cores, Gleason, age, etc. rather than any finding. Note that they all add up to 100%. So it is saying that with no other information (no PSMA PET, etc. to confirm) that there is only a 3% chance of being more than a EPE. The actual EPE tissue in the biopsy showed no cancer.

@jim18
The total being 100% is a very interesting observation I had not even realized
That all was under a column labeled "Partin Table"
Lymph 1%
Seminal Vesicle 2%
EPE 23%
Organ Confined 74%
This is first I've heard about cancer all on 1 side helping to determine treatment options. Not sure of any additional tests I should ask for or just wait for the Prolaris results.