Pathology interpretation help!

@surftohealth88 at the moment I have indeterminate EPE but nothing about it was mentioned in the biopsy. If my decipher comes back high that may change my approach to treatment options and PET. In my case all of the information thus far seems to pull in opposite directions or has kept me in the grey zone for the last 18 months. Like based on the volume of cancer I should be "unfavorable intermediate" but based on the biology of the cancer I'm "favorable intermediate".

@cath57 and my team at OHSU in Portland Oregon has classified me as "favorable intermediate" so I guess they are highlighting the biology of the cancer rather than the volume in their staging. Its all sort of confusing.

@ezupcic
That is true some places don’t like to consider 3+3 anything cancerous so it doesn’t really count. The thing is though, so many 3+3’s is an issue. As I mentioned before A doctor at one of the conferences said if they are 3+3 but they’re more than Six than it may be time to be treated.

When they do a biopsy, they only biopsy about one percent of the prostate. Many people that have had biopsies have found the cancer has been worse in areas that didn’t show up in the MRI. We talk about it in this forum regularly.

@ezupcic
If the tiny "pipe" that collects tissue does not pass through the exact area where EPE is than it will not be seen on that sample.

My husband's MRI did not see it, PSMA did not see it, TRUS did not see it , biopsy did not see it but it was there when the whole gland was out and examined.

Since your MRI caught it (I do not know what intermediate means for EPE, I thought it is there or not there ) , I would stay on a side of caution. Of course, we are all different and you might decide that it means nothing which is also OK. With this cancer NOTHING is for sure "there" or for sure "not there" ... EVER 😵‍💫

@surftohealth88 in my last MRI the language about EPE was "threatening". Then a reread changed it to "indeterminate" which I guess means they can't tell for sure based on the imaging. Next up for me is the decipher and then meetings with the Surgeon and the RO. In Prostate cancer there always seems to be a "but" to every test result. You are favorable intermediate but........The PSA is a good test but........RP can take out the cancer but........RT can also successfully treat the cancer but.......

Yes try to get a Decipher and AI Artera. Also did you get at PSMA Pet scan? That would be good to get also. Do as much research on your own as you can. Look on-line and or Youtube. I learned a lot from these to doctors.
https://www.youtube.com/@TheProstateClinicTPC

Best wishes

@tactive if you have any tutorials about Gleason 7 "favorable v unfavorable" I would be interested in learning from them. Thanks.

@ezupcic Sure, try these out.

Also purchase the book Dr. Patrick Walsh's Guide to Surviving Prostate Cancer. It helped me a lot also.

Try not to make any fast decisions until you are comfortable and know all the risk and advantages. Also do you have Cribiform or perineal invasion? It is import to

@ezupcic Unfavorable Intermediate would be if 50% or more was type 4; yours is only 10%. Decipher should be covered since it is used for AS vs treatment decisions. Just say you want to see these results before a decision. Most insurance will not cover PSMA PET for 3+4. If you have Medicare (not Advantage) it should be covered. The pathology report did not indicate any aggressive features. At 3+4 you can have surgery or radiation (SBRT, IMRT, LDR, or HDR) so lots of treatment options. If ADT suggested get ArteraAI test to determine if you will benefit.
Your two 3+4 cores are on opposite sides of the prostate. This and all of the Gleason 6 make you a poor candidate for focal therapy. Except for Medicare, most insurance will not cover focal treatment.
You can get a second opinion of the pathology, but will this be useful? Do you believe the 10% of 4 in the 3+4s should be downgraded to 3 for AS and with all the 3+3 cores is AS advisable? Not likely another pathologist will find that 40% was misclassified as 3 when it should have been 4 for an upgrade to 4+3.

Seems like there is more pathology that you could share such as the stage, IDC or EPE? These data points provide key information as to favourable or unfavourable. Your numbers are similar to mine; 7/15 cores positive, several are 3+4, and a few 3+3, no IDC or EPE. I have <5% cribriform which puts me on the cusp of unfavourable. Here in Canada, they don’t give PET Scans un less you are a minimum of Unfavourable risk. Overall cancer in cores <10%. I was given two choices; SBRT x 5 sessions, no ADT, or RP surgery. I have landed on my decision for RARP. However, everyone chooses treatment based on how they wish to mitigate quality of life post treatment. As Jeff noted, SBRT would do the job and likely without ADT. For me, I have gone back and forth many times between radiation and surgery. After you meet both the RO and surgeon, you can take your time deciding on treatment. And, if you find that you have unanswered questions from either the RO or Surgeon, ask for another consultation. I did, and was happy to have all my questions thoroughly answered. And to help resolve my anxiousness about waiting 6 months for the surgery and worrying that the cancer might progress outside the prostate, the surgeon has offered and ordered CT scan and Bone Scan to have evidence to show me the certainty around no need for concern waiting for treatment. Having more tests will help me, as I have feel stress and anxiousness is much lower and I feel confident now. Furthermore, I left that follow-up meeting feeling as though I had developed a good rapport with my surgeon, which helps settle my anxiousness about the pending treatment. Best of luck going forward.