Pathology interpretation help!

@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

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.

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.

@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.

@johnnyz and nothing in my biopsy report mentioned cribriform or IDC but EPE is still "indeterminate".

@jim18 I'm not planning to get a second opinion on the pathology. I am just trying to educate myself and decide on best treatment. So decipher is next. Do you think in my case another pathologist could easily upgrade me to 4+3? How might that change treatment options? appreciate your response.

@ezupcic I assumed that you had an MRI to support the fusion biopsy. The MRI would have indicated IDC and or possible EPE. I believe that a digital rectal exam would also possibly provide some evidence of EPE as the doctor could feel the texture and shell of the prostate. But I am not an expert by any means, and I don’t want to make it sound simplified. I too am intermediate favourable, just shy of unfavourable. I have robotics surgery scheduled for early 2027 which I am trying to get moved up.

@johnnyz hi. I did have an MRI and a fusion biopsy and the language about EPE was “indeterminate” on MRI. There was no mention of IDC or Cribriform. I’m hoping to do the decipher test to help refine my decision about treatment. At the moment leaning toward SBRT but not sure.

@ezupcic What is your age? At this point, it seems that you need to hear what the fusion biopsy follow up from the doctor/specialist is. I was told from both the RT /SBRT or RP surgeon advised me that either method is good / curable in my situation. I had 6/7 positive cores that were 3+4, one was 3+3, like the year before when my biopsy 12 cores were all 3+3. So after my MRI this year, I was told that i needed a fusion biopsy to determine if there is any progression. At that time, the urologist said that if any progression is seen on the fusion biopsy. They would push for treatment.
Wow, did that statement have me feeling decision time is now. Because of my age; 68, and in relatively good physical health, and my intent on preparing myself physically several months in advance, I feel as though I can manage the post surgery impacts. My robotics surgeon said to me that yes radiation and/or surgery are both good options, But - “getting the cancerous organ out is the golden rule”. My two brothers had radiation 2 years ago and they seem fine and satisfied with their results. But they really did not have an option due to one being 100 lbs overweight and one with extra weight and other health complications. So they both had RT. In my case, the extra accuracy and enhanced 4K vision the robotics surgeons have access to, helps me to have more confidence in minimizing the outcomes. And my wife and family all seem to support surgery over radiation. This does not mean that surgery is best for you though, as anyone in these groups will say, everyone is different with a multitude of factors to consider.
Thanks to Jim’s comment about what qualifies one for PSMA tests, as my doctors keep saying No to me for that test when I ask. It’s because I am slightly still in the favourable category… I did not realize that having Gleason of 4+3 prompts coverage by insurance.
When do you have your pathology follow up to hear your urologist’s interpretation and recommendations for next steps?

@ezupcic What is your age? At this point, it seems that you need to hear what the fusion biopsy follow up from the doctor/specialist is. I was told from both the RT /SBRT or RP surgeon advised me that either method is good / curable in my situation. I had 6/7 positive cores that were 3+4, one was 3+3, like the year before when my biopsy 12 cores were all 3+3. So after my MRI this year, I was told that i needed a fusion biopsy to determine if there is any progression. At that time, the urologist said that if any progression is seen on the fusion biopsy. They would push for treatment.
Wow, did that statement have me feeling decision time is now. Because of my age; 68, and in relatively good physical health, and my intent on preparing myself physically several months in advance, I feel as though I can manage the post surgery impacts. My robotics surgeon said to me that yes radiation and/or surgery are both good options, But - “getting the cancerous organ out is the golden rule”. My two brothers had radiation 2 years ago and they seem fine and satisfied with their results. But they really did not have an option due to one being 100 lbs overweight and one with extra weight and other health complications. So they both had RT. In my case, the extra accuracy and enhanced 4K vision the robotics surgeons have access to, helps me to have more confidence in minimizing the outcomes. And my wife and family all seem to support surgery over radiation. This does not mean that surgery is best for you though, as anyone in these groups will say, everyone is different with a multitude of factors to consider.
Thanks to Jim’s comment about what qualifies one for PSMA tests, as my doctors keep saying No to me for that test when I ask. It’s because I am slightly still in the favourable category… I did not realize that having Gleason of 4+3 prompts coverage by insurance.
When do you have your pathology follow up to hear your urologist’s interpretation and recommendations for next steps?