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Pathology interpretation help!

Posted by ezupcic @ezupcic, Oct 19 3:46pm

hi. I just received my Pathology results from my Fusion biopsy. Any help interpreting the results, suggestions, advice going forward would be much appreciated.

Final Pathologic Diagnosis
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A. Prostate, RLB, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 1 of 1 core(s) (2.8 mm greatest contiguous focus, 30% of tissue)

B. Prostate, RMB, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 1 of 1 core(s) (0.6 mm greatest contiguous focus, 5% of tissue)

C. Prostate, RLM, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 1 of 1 core(s) (4.2 mm greatest contiguous focus, 45% of tissue)

D. Prostate, RMM, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 1 of 1 core(s) (0.5 mm greatest contiguous focus, 5% of tissue)

E. Prostate, RLA, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 4 = 7 (Grade group 2, 10% pattern 4)
- Carcinoma involves 1 of 1 core(s) (4 mm greatest contiguous focus, 40% of tissue)

F. Prostate, RMA, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 1 of 1 core(s) (0.7 mm greatest contiguous focus, 5% of tissue)

G. Prostate, LLB, biopsy:
- Benign prostate tissue

H. Prostate, LMB, biopsy:
- Benign prostate tissue

I. Prostate, LLM, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 1 of 1 core(s) (2.8 mm greatest contiguous focus, 20% of tissue)

J. Prostate, LMM, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 1 of 1 core(s) (2.5 mm greatest contiguous focus, 20% of tissue)

K. Prostate, LMA, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 1 of 1 core(s) (2.5 mm greatest contiguous focus, 20% of tissue)

L. Prostate, LLA, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 4 = 7 (Grade group 2, 10% pattern 4)
- Carcinoma involves 1 of 1 core(s) (3 mm greatest contiguous focus, 45% of tissue)

M. Prostate, ROI 1, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 2 of 2 core(s) (3.5 mm greatest contiguous focus, 40% of tissue)

N. Prostate, ROI 2, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 4 = 7 (Grade group 2, 10% pattern 4)
- Carcinoma involves 2 of 2 core(s) (7.5 mm greatest contiguous focus, 60% of tissue)

O. Prostate, ROI 3, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 1 of 2 core(s) (2 mm greatest contiguous focus, 10% of tissue)

P. Prostate, ROI 4, biopsy:
- Prostatic adenocarcinoma, Gleason score 3 + 3 = 6 (Grade group 1)
- Carcinoma involves 2 of 2 core(s) (7.8 mm greatest contiguous focus, 85% of tissue)

Best block for ancillary testing: Block N1

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for copyman
copyman | @copyman | Oct 19 9:47pm

If insurance will pay for it I would get the PET scan, specifically a PSMA PET/CT scan. This will cover all the bases along with a Decipher test.

REPLY
Profile picture for ezupcic
ezupcic | @ezupcic | Oct 19 10:39pm
In reply to @topf "All the cores except 2 are positive. Even if you only have two 3+4 cores with..." + (show)
Profile picture for topf @topf

All the cores except 2 are positive. Even if you only have two 3+4 cores with relatively little pattern 4, the extent of the 3+3 cores means you should probably get treatment.
The good news is that is does not look very aggressive. You should get that confirmed with a Decipher test.
You should have plenty of treatment options and would likely be a goid candidate for some RT only to the prostate and without ADT. You could also look into whole gland Tulsa.

Jump to this post

@topf do you think this is a "favorable intermediate" or "unfavorable intermediate Grade Group 2? I'm just trying to understand the difference and how it might impact decision making.

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sorensend58 | @sorensend58 | Oct 20 8:12am

This group is great to find out a lot of things about PC.
My 2 cents is to definetley get a PSMA/PET scan. Then get an ARTERAAI done, that is a prognostic tool that uses your pathology slides along with other information to provide information for you.

If you've spent anytime with ChatGPT I've found using CHAT is I just copy the information into CHATGPT, ask it to tell me what it means. I would look at creating a prompt that you initially load your test results in and then ask tell me what this means.
The next question is tell me what my options are,
The next prompt would be what questions should I ask my surgeon, what questions should I ask my radiologist, after I got those questions.
I then asked what can I expect for responses and what follow up questions should I be have.
I had those with me in both my meetings, and then put the answers into CHAT again.

The AI tool (CHATGPT) is NOT a substitute, nor did I use it as one for my relationship with my Doctors. It did however provide a sounding board, provided a way to deep dive (call that the rabbit hole of PC) into options, information, data points to help make my decision. Tomorrow I'll have SpaceOAR and markers put in and November 2nd I'll start SBRT.

Good luck and stay Positive!!!

REPLY
1 reply
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cath57 | @cath57 | Oct 20 8:32am

I find the Pathology surprising. Small Foci and low grade cancer, but Medium to high percentage of involvement and so many of them. Is it possible to get a second opinion on the pathology?

I would also definitely vote for a PSMA-PET Scan for evaluating the extension at the edges.

All the best to you!

REPLY
2 replies
Profile picture for ezupcic
ezupcic | @ezupcic | Oct 20 9:01am
In reply to @cath57 "I find the Pathology surprising. Small Foci and low grade cancer, but Medium to high percentage..." + (show)
Profile picture for cath57 @cath57

I find the Pathology surprising. Small Foci and low grade cancer, but Medium to high percentage of involvement and so many of them. Is it possible to get a second opinion on the pathology?

I would also definitely vote for a PSMA-PET Scan for evaluating the extension at the edges.

All the best to you!

Jump to this post

@cath57 I have a decipher test next. But yes the volume of cancer would put me in the unfavorable intermediate category but the biology of the cancer seems to be more favorable. I hope the treatment options become more clearer.

REPLY
Profile picture for ezupcic
ezupcic | @ezupcic | Oct 20 9:10am
In reply to @sorensend58 "This group is great to find out a lot of things about PC. My 2 cents..." + (show)
Profile picture for sorensend58 @sorensend58

This group is great to find out a lot of things about PC.
My 2 cents is to definetley get a PSMA/PET scan. Then get an ARTERAAI done, that is a prognostic tool that uses your pathology slides along with other information to provide information for you.

If you've spent anytime with ChatGPT I've found using CHAT is I just copy the information into CHATGPT, ask it to tell me what it means. I would look at creating a prompt that you initially load your test results in and then ask tell me what this means.
The next question is tell me what my options are,
The next prompt would be what questions should I ask my surgeon, what questions should I ask my radiologist, after I got those questions.
I then asked what can I expect for responses and what follow up questions should I be have.
I had those with me in both my meetings, and then put the answers into CHAT again.

The AI tool (CHATGPT) is NOT a substitute, nor did I use it as one for my relationship with my Doctors. It did however provide a sounding board, provided a way to deep dive (call that the rabbit hole of PC) into options, information, data points to help make my decision. Tomorrow I'll have SpaceOAR and markers put in and November 2nd I'll start SBRT.

Good luck and stay Positive!!!

Jump to this post

@sorensend58 good luck with your treatment.....

REPLY
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largojoe | @largojoe | Oct 20 9:40am

The first thing you should do is Google the Pathologist to see if he's a specialty or general pathologist. Second send your specimens to someone who specializes in prostate cancer. Like Johnathan Epstein at John Hopkins, MD Anderson or Mayo or for second read on your slides. PCRI has a good series of videos that are very informative.

REPLY
Profile picture for Jeff Marchi
Jeff Marchi | @jeffmarc | Oct 20 10:46am
In reply to @ezupcic "@jeffmarc thanks. I've scheduled meetings with the radiation oncologists and surgeons. I'll also do a Decipher..." + (show)
Profile picture for ezupcic @ezupcic

@jeffmarc thanks. I've scheduled meetings with the radiation oncologists and surgeons. I'll also do a Decipher test. Where do you stand on a PET scan at this point? It has not been suggested to me at this point although on my last MRI EPE was "indeterminate".

Jump to this post

@ezupcic
Because you are only a 3+4 they may not want to do a PET scan. The thing is, you have so many cores That are suspect I would definitely want to have a pet scan.

Ask your doctor about it and emphasize the fact that 14 cores were found with 3+4 or 3+3.

REPLY
1 reply
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surftohealth88 | @surftohealth88 | Oct 20 12:15pm
In reply to @ezupcic "@jeffmarc thanks. I've scheduled meetings with the radiation oncologists and surgeons. I'll also do a Decipher..." + (show)
Profile picture for ezupcic @ezupcic

@jeffmarc thanks. I've scheduled meetings with the radiation oncologists and surgeons. I'll also do a Decipher test. Where do you stand on a PET scan at this point? It has not been suggested to me at this point although on my last MRI EPE was "indeterminate".

Jump to this post

@ezupcic
If your Decipher comes high I personally would insist on PSMA . MRI and biopsy do not see it all and especially if you have EPE detected by one scan already. I do not think that there is such thing as "too much information" especially when cancer is involved : (((.

Wishing you the best of luck 🍀.

REPLY
1 reply
Profile picture for ezupcic
ezupcic | @ezupcic | Oct 20 12:38pm
In reply to @jeffmarc "@ezupcic Because you are only a 3+4 they may not want to do a PET scan...." + (show)
Profile picture for Jeff Marchi @jeffmarc

@ezupcic
Because you are only a 3+4 they may not want to do a PET scan. The thing is, you have so many cores That are suspect I would definitely want to have a pet scan.

Ask your doctor about it and emphasize the fact that 14 cores were found with 3+4 or 3+3.

Jump to this post

@jeffmarc I'm assuming OHSU is staging me as "favorable intermediate GG2" because 96% of the cancer is 3+3 and the rest low volume pattern 4, even though there is a lot of cancer volume bilaterally. The indeterminate EPE is a concern but there is nothing else in my MRI history or even PSA history that would suggest more distant spread. Of course if decipher comes back high, that will change some things.

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