Biopsy vs Surgery Results

The Gleason Method relates to an eyeball estimate of RISK of metastasis. ARTERRA uses AI to compare hopefully a good sample of tissue... (IMHO: ...per a 3T-multiparametric dye enhanced MRI, ideally read not by general radiologist but rather one who is steeped in GU rad-pathology. A subsequent CT-MRI fusion perineal targeted biopsy would be preferred. It has fewer infections and can visualize the anterior of the prostate though an infrequent disease site.

Mentioned earlier in a post: Post & Pre-surgical prostate gland only samples were concordant 60-75%, (15-25% worse if corrected (worse minus better) but still it is an estimate of RISK of metastasis. The studies incidentally were summarized from far earlier data sets. Their publication dates occurred probably a decade later than the raw data.

In the interim PSMA PET CT scan 'ruling in' or 'ruling out' of 'mets' (...for the most part) have become almost universally applied in follow-up to increasing classical Gleason RISK of metastasis in gland contained findings. DECIPHER genomic tests, ARTERRA,
AI review of biopsy, even AI review of MRIs [deepviewimaging.com] can help in the decision process. Other intraglandular features & considerations remain such as tumor burden: amount and size, cribriform types of '4' Gleason, intraductal, extension into seminal vessels, etcetera. These all are factors that can now be taken into consideration by an 'at arm's length' GU medical oncologist. Let us realize that employees of corporations of even the best institutions tow the line and are often in the rear guard, i.e. , looking in dollar incentivized rear view therapeutic mirrors. The specter of micro-mets in low burden disease can be addressed with annual
mpMRIs and quarterly PSA tests. Spot radiotherapy would be an option in that unlikely outcome.

@thmssllvn thanks for the info. My uro said a pet scan wasn’t necessary and I’m looking to set up a second opinion and hopefully new pathology review.
I would think any testing to help confirm containment would be wise especially if looking at surgery but what do I know.

@ireland1964
You have a Gleason 3+4 and a T1c. A PET scan really isn’t useful in that low level PC. That’s why they discouraged it. Very unlikely you’re gonna have anything found and insurance may not want to pay for it.

@jeffmarc Recent Prolaris results put me unfavorable inter along with good % chance surgery will show upgrade. My biggest concern is finding out it wasn’t contained After surgery which means I would have elected radiation instead

@ireland1964
The Prolaris Result didn’t put you Too high on the chart, About 1/3 up from the minimum.

I would definitely want to hear from the doctor, what they thought Of the result.

I might want to have a decipher test for comparison.

You do realize that the only way to really know what Is going on is to have a prostatectomy. Radiation can be used after that if it comes back. If you have radiation to start with you never know what you really had.

Maybe the Prolaris result will get you a PET scan.

@jc76 I know the worlds not perfect but it really all comes down to testing to help guide our treatment decisions.
I just received notice my Prolaris came back at 4.1 and unfavorable interm risk. Will have to get clarification on how I went from 3+4 stage T1c Group 2 biopsy and originally given the option for active surveillance, to this report saying surgery or radiation is the only option.
Makes me think surgery is probably best option given the fact there’s a decent chance the cancer is actually worse

Data from this paper from the UK in 2019 showed that initial grade and pathological grade matched 59% of the time, was downgraded just 16% of the time, and was upgraded just 25% of the time —> “Pathological upgrading in prostate cancer treated with surgery in the United Kingdom: trends and risk factors from the British Association of Urological Surgeons Radical Prostatectomy Registry”

This is the reason there are so many biomarker tests that are available to check if the diagnosis is the same/better/worse than PSA & Gleason are indicating.

@ireland1964
Is the Prolaris test you mentioned the same class of test as Decipher? If so they are a lot more accurate in risk (per my R/Os) assessment as I believe is genetic testing. It looks like your test results were the opposite of mine.

I am not sure of your age but it seems to a lot of MCC what age you are at makes a lot of difference in treatments plan planning.

I did not have surgery so do not have direct experience with that so I should not comment on something I don't have direct experience with. I I have read the post of those who have had surgery and quite a lot of different side affects and outcomes.

Have you considered a second opinion? It is best, just like you are planning, to get your answers best from your medical doctors. They have all your medical and mental health history and far greater knowledge and experience of your specific cancer to help you.

Just know very high chances of having a successful treatment regardless of radiation with/without hormone treatments or surgery option. There so many new treatment options that have even come up since I came on MCC 3.5 years ago.

Good luck!!!!