Biopsy confirms prostate cancer in 12 out of 12 cores

Posted by deku @deku, Nov 7 8:20pm

Hi, all. It appears my initial post ("Journey begins - age 51, PSA 72") was not premature after all. Based on my biopsy results, I am officially diagnosed with prostate cancer (prostatic acinar adenocarcinoma). I missed a call from my urologist to discuss my test results and interpretations, but I have the full pathology report. In case anyone is interested, I'll outline below. I don't have any specific questions, I'm just sharing at this point and feeling generally numb about the whole thing.

12 out of 12 cores (systematic biopsy) show prostatic adenocarcinoma; my six grade groupings are 2 at 8 (4+4), 2 at 7 (4+3), and 2 at 7 (3+4). Percentage of pattern 4 is 71-80%, with approximately 81% of the total combined core samples (137mm out of 169mm) identified as cancer. Intraductal carcinoma could not be determined, with at least one of the samples showing an IDC component that "cannot be excluded". Additional words listed were "invasive carcinoma", "cribriform pattern favored", and "cribriform glands present".

Without having discussed with my doctor yet (aside from Dr. Google), I'm guessing this is not exactly ideal. I already have an abdominal CT scheduled for tomorrow, and an urgent order in for a full body bone scan which I hope to get scheduled ASAP. I plan to ask my doctor about other scans as well. Based on these results and other symptoms, I fully expect that it has already metastasized, so it's a matter of determining where and how much.

Ironically, I feel calmer and less anxious now than I did before seeing the pathology report. I feel more concerned about how this will affect my family than how it will affect me. But regardless, we will share the journey and figure out next steps together.

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

@billfarm

Dr Eugene Keon’s team is phenominal

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I have read his name a few times here. Thx!

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@billfarm

Sorry got spellchecked. Dr Eugene Kwon. My friend had surgery with dr Igor frank and did well also.

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Dr. Keon was a famous Canadian heart surgeon, so the spell-check error isn't surprising. Unfortunately, wrong field, and he passed away in 2019 in any case.

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@northoftheborder

Dr. Keon was a famous Canadian heart surgeon, so the spell-check error isn't surprising. Unfortunately, wrong field, and he passed away in 2019 in any case.

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Old guy here not tech savvy enough to keep iPhone from correcting me even when I don t need corrected.

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Deku - OK you have prostate cancer . the up side is your 51 and hopefully in decent shape . Start now getting ready for treatments . This is not a death sentence BUT , you have to meet this head on and start learning . Create a binder , EVERY document, Dr visit notes, images , PSA test , Blood panel tests , narratives about your case go into this mobile binder ! This will be helpful for you and other doctors . Here in Canada you will be surprised how one hospital does not talk to another Image department hospital . So you will have your mobile profile there . Over the last 5-8 years so many advances in Cancers like this ! You will likely die of something else than protate cancer at 85+ years of age - to be VERY frank . It appears with the high PSA the PC has travelled a wee bit . Why did you not get yearly physicals ? Or did you ? Have you been monitoring the PSA rise or ? From what I see in the Biopsy ( which can be misleading ) you have some extra-capular extensions to this PC likely the seminal vesicles , maybe the close by Lymph nodes - but im not certain . Here what you need to do . Get in the best shape of your life for potential surgery , know that yoru age is on your side for healing and recovery , make sure ALL yoru friends and family know you have this challenge in front of you and encourage them to get PSA check now and every 12 months ! ( dont hide it re - people with breast cancer tell the world usually , hence more dollars and attention to this cancer) , consider with yoru Dr a PSMA-Pet scan , contrast MRI , Bone scan, Ultra sound of abdomen , an Dany other diagnostics that the Dr's think would be good . One advantage of surgery is you can get the Pathology details . Also , make sure you ask hospital to freeze your Prostate for further testing , as Gene therapy and other cures/helpful treatments are comming every month it seems now . Remain VERY positive - this helps with healing . Make sure EVERYONE KNOWS , and how to get a PSA test and track the yearly results - it may save someones life , this is nothing to be ashamed of - thats what got the PSA up to 72 likely in the first place . This is now a life project for you , great it as such . Do you have any urological symptoms ? Any other health issues ? Speak right away with a Urologist ( URO ) and a Radiation Oncologist( RO) as soon as possible . We are here for you - so many great minds here and medical experience . Be proactive to the Max ! About me - I was diagnosed early at 58. Very fit . PSA was 4.2 . Steep family history , hence going to GP and URO for 5 years yearly prior to diagnosis . Im 61 now . Had surgery , 3 years ago , Pathology report saw no tissues infected with PC other than Prostate ( But micro pieces/cells can escape prostate at any time. Lesson was small in size , but near wall of Prostate and 2mm extrusion of cap of prostate that Dr's feel just happened , as no tissues were infected close by outside of prostate , but still a major concern of mine. No invasion of seminal vesecls, predominately , 3+4= 7 Gleason . My 3 type was 60% of session my 4 type was 40% of session. No type 5 present . Type 3 is usually not treated these days . A type 3 cell will not turn into a type 4 cell and so on, my Urologist told me . This is a key feature of PC surgery is you get the prize, the Prostate after surgery to get all the material facts - remember to get them to preserve it for future DNA and other testing( usually routine these days , but check your region) . After surgery my PSA did not bottom out at 0.008 . It was like 0.07 for the longest time , so two years ago I spoke with my RO . RO said we could do Salvage radiation . I was at 0.14 PSA at the time . He said no need to wait for 0.2 or 0.3 he said . So at 0.14 , I got External Bean Radiation Therapy ( EBRT) , also known as salvage radiation. This knocked PSA back eventually . I went from 0.14 , and after about 10 months PSA started to decrease . Last PSA test was 0.041 from what was o.14 prior to radiation. Dr's were quite sure any "good or bad cells still remain in pelvic region" . Anyway I gather they were right as PSA came down , after about 8-10 months . Radiation and operation has about the equivalent PSA Efficacy for 'normal' PC . Different recovery curves though- with surgery taking longer . Start reading up on both primary treatment types . We are here for you . You are not alone . Please keep us informed of yoru progress . I am not a dr ( rather an airline pilot) so my medical knowledge is very minimal , but I can tell you of my experience . Its also best you join a Prostate support group that meets monthly or whatever . You can learn a lot , plus the guys are very nice to bond with . God Bless Sir ! James on Vancouver Island .

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@vancouverislandhiker

Deku - OK you have prostate cancer . the up side is your 51 and hopefully in decent shape . Start now getting ready for treatments . This is not a death sentence BUT , you have to meet this head on and start learning . Create a binder , EVERY document, Dr visit notes, images , PSA test , Blood panel tests , narratives about your case go into this mobile binder ! This will be helpful for you and other doctors . Here in Canada you will be surprised how one hospital does not talk to another Image department hospital . So you will have your mobile profile there . Over the last 5-8 years so many advances in Cancers like this ! You will likely die of something else than protate cancer at 85+ years of age - to be VERY frank . It appears with the high PSA the PC has travelled a wee bit . Why did you not get yearly physicals ? Or did you ? Have you been monitoring the PSA rise or ? From what I see in the Biopsy ( which can be misleading ) you have some extra-capular extensions to this PC likely the seminal vesicles , maybe the close by Lymph nodes - but im not certain . Here what you need to do . Get in the best shape of your life for potential surgery , know that yoru age is on your side for healing and recovery , make sure ALL yoru friends and family know you have this challenge in front of you and encourage them to get PSA check now and every 12 months ! ( dont hide it re - people with breast cancer tell the world usually , hence more dollars and attention to this cancer) , consider with yoru Dr a PSMA-Pet scan , contrast MRI , Bone scan, Ultra sound of abdomen , an Dany other diagnostics that the Dr's think would be good . One advantage of surgery is you can get the Pathology details . Also , make sure you ask hospital to freeze your Prostate for further testing , as Gene therapy and other cures/helpful treatments are comming every month it seems now . Remain VERY positive - this helps with healing . Make sure EVERYONE KNOWS , and how to get a PSA test and track the yearly results - it may save someones life , this is nothing to be ashamed of - thats what got the PSA up to 72 likely in the first place . This is now a life project for you , great it as such . Do you have any urological symptoms ? Any other health issues ? Speak right away with a Urologist ( URO ) and a Radiation Oncologist( RO) as soon as possible . We are here for you - so many great minds here and medical experience . Be proactive to the Max ! About me - I was diagnosed early at 58. Very fit . PSA was 4.2 . Steep family history , hence going to GP and URO for 5 years yearly prior to diagnosis . Im 61 now . Had surgery , 3 years ago , Pathology report saw no tissues infected with PC other than Prostate ( But micro pieces/cells can escape prostate at any time. Lesson was small in size , but near wall of Prostate and 2mm extrusion of cap of prostate that Dr's feel just happened , as no tissues were infected close by outside of prostate , but still a major concern of mine. No invasion of seminal vesecls, predominately , 3+4= 7 Gleason . My 3 type was 60% of session my 4 type was 40% of session. No type 5 present . Type 3 is usually not treated these days . A type 3 cell will not turn into a type 4 cell and so on, my Urologist told me . This is a key feature of PC surgery is you get the prize, the Prostate after surgery to get all the material facts - remember to get them to preserve it for future DNA and other testing( usually routine these days , but check your region) . After surgery my PSA did not bottom out at 0.008 . It was like 0.07 for the longest time , so two years ago I spoke with my RO . RO said we could do Salvage radiation . I was at 0.14 PSA at the time . He said no need to wait for 0.2 or 0.3 he said . So at 0.14 , I got External Bean Radiation Therapy ( EBRT) , also known as salvage radiation. This knocked PSA back eventually . I went from 0.14 , and after about 10 months PSA started to decrease . Last PSA test was 0.041 from what was o.14 prior to radiation. Dr's were quite sure any "good or bad cells still remain in pelvic region" . Anyway I gather they were right as PSA came down , after about 8-10 months . Radiation and operation has about the equivalent PSA Efficacy for 'normal' PC . Different recovery curves though- with surgery taking longer . Start reading up on both primary treatment types . We are here for you . You are not alone . Please keep us informed of yoru progress . I am not a dr ( rather an airline pilot) so my medical knowledge is very minimal , but I can tell you of my experience . Its also best you join a Prostate support group that meets monthly or whatever . You can learn a lot , plus the guys are very nice to bond with . God Bless Sir ! James on Vancouver Island .

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It's good advice to start a file.

As for communication among different care providers, it depends on where you are. Many Ontario hospitals use Epic (MyChart), so that most of our information is in one place, and patients can see it too (that's how I know my uPSA results in a couple of hours). Family doctors here aren't on MyChart, but they can see it if you grant access, and there's also some provincial system where they can see all test results if they go looking (I don't know much about that one).

But still, like @vancouverislandhiker said, in the end you're your own project manager for cancer treatment, and you'll find yourself doing a lot of coordination. One thing that helps is that whenever I get a test, I have them write in my oncologist and/or family doctor to receive a copy (if they didn't order it) — I'm not sure if that would work elsewhere, but Ontario has a standard form for routine tests no matter where they're performed.

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@billfarm

Old guy here not tech savvy enough to keep iPhone from correcting me even when I don t need corrected.

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I've been a tech consultant since the 1990s, and spell check still trips me up sometimes, too.

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@deku

Thanks for your support. I'm just trying to keep it together by focusing on the clinical aspects and cold facts and not on what this might mean for me as a person and for my family. Part of me is terrified, but I'm trying my best to suppress that for now until we know more facts and have a plan and a path forward. As many have pointed out, a PSMA-PET scan would be helpful (I plan to speak with my care team today about whether that is an option for me), and in the meantime I know I am possibly getting ahead of myself in assuming it has spread - which we can't know for certain yet.

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@deku You will make good decisions, I'm sure. I am concerned, though, when you say, "I'm just trying to keep it together by focusing on the clinical aspects and cold facts and not on what this might mean for me as a person and for my family."

It's my belief that if you have a steady sexual partner and/or are in a long-term relationship (e.g., married), you should involve them every step of the way, meaning going to doctor visits, discussing treatment options, etc. As my wife said, "It's my penis, too."

This cancer, and its treatment will definitely "mean [something] for you as a person and for your family." Best to get working on that sooner than later, IMO. The support that family (and friends) provide, if only as a sounding board for processing everything, is invaluable, and WILL result in better outcomes for you.

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@trusam1

@deku You will make good decisions, I'm sure. I am concerned, though, when you say, "I'm just trying to keep it together by focusing on the clinical aspects and cold facts and not on what this might mean for me as a person and for my family."

It's my belief that if you have a steady sexual partner and/or are in a long-term relationship (e.g., married), you should involve them every step of the way, meaning going to doctor visits, discussing treatment options, etc. As my wife said, "It's my penis, too."

This cancer, and its treatment will definitely "mean [something] for you as a person and for your family." Best to get working on that sooner than later, IMO. The support that family (and friends) provide, if only as a sounding board for processing everything, is invaluable, and WILL result in better outcomes for you.

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I'm a firm believer in involving family, maybe not so much with my sons, although I talk to them about it. I sure do share with my wife, would be so hard for me without her support. Over these past 20 months, I've had a couple emotional breakdowns. I'll never forget reading for the first time test results at the beginning. It's hard not to let it consume me. Just one time, I wish I could wake up some morning and forget I have cancer and the effects the treatment has on me. Not every day is a downer, I find joy in the little things more now and lots of days, meds be damned, I have a good time. My wife's support for me means everything to me and I share my journey, which is hers as well. And it goes without saying, this site has given so much support as well. Best to all.

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@stevecando54

I'm a firm believer in involving family, maybe not so much with my sons, although I talk to them about it. I sure do share with my wife, would be so hard for me without her support. Over these past 20 months, I've had a couple emotional breakdowns. I'll never forget reading for the first time test results at the beginning. It's hard not to let it consume me. Just one time, I wish I could wake up some morning and forget I have cancer and the effects the treatment has on me. Not every day is a downer, I find joy in the little things more now and lots of days, meds be damned, I have a good time. My wife's support for me means everything to me and I share my journey, which is hers as well. And it goes without saying, this site has given so much support as well. Best to all.

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It's interesting how there are so many different emotional journeys with cancer.

It was a huge shock to me hearing 3 years ago that they'd found a likely tumour on my spine on the MRI, but also a relief, because I was already in a hospital bed with my legs failing fast, so at least we had a probable cause.

Since then, I've been getting stronger every month: I was wheeled in flat on a gurney for the debulking surgery and the first post-op radiation on my spine (they had to call in all the staff to lift me over like a sack of potatoes), wheeled myself in a wheelchair for the radiation to my prostate six months later, was able to use a walker in another few months, etc., until I can do maybe 80–90% of my previous physical activity now (and still continually improving,).

That's been challenging, but it's also been a blessing. The fact that my health keeps improving (albeit from a very low starting point) helps prevent me from feeling too discouraged about all the side-effects from the radiation and meds.

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Thanks to all for your advice, encouragement, and sharing personal experiences. I have support from my family and I am continuing to work through my various feelings in my own time. Many unknowns still, nothing new to report, but working toward a firmer diagnosis and a clearer idea of what is indicated for my case going forward. In the meantime, I'll plan to stay offline until I know something more definitive. Thanks again.

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